HbA1c诊断2型糖尿病特性观察及在空腹血糖正常人群中的分布特征研究

doi:10.3969/j.issn.1673-8640.2014.02.010

检验医学 ›› 2014, Vol. 29 ›› Issue (2): 130-134.DOI: 10.3969/j.issn.1673-8640.2014.02.010

HbA_1c诊断2型糖尿病特性观察及在空腹血糖正常人群中的分布特征研究

李跃松, 荀雪影, 武红玉, 浦洪波, 陈永伟, 包建东

江苏省原子医学研究所附属江原医院检验科, 江苏无锡 214063

收稿日期:2013-01-07 出版日期:2014-02-20 发布日期:2014-02-20
作者简介:李跃松, 男, 1971年生, 学士, 副主任技师, 主要从事临床生化检验工作。

Observation on the characteristic of HbA_1c for diagnosing type 2 diabetes mellitus and research on the distribution characteristic in population with normal fasting plasma glucose

LI Yuesong, XUN Xueying, WU Hongyu, PU Hongbo, CHEN Yongwei, BAO Jiandong.

Department Clinical Laboratory, Jiangyuan Hospital Affiliated to Jiangsu Institute of Nuclear Medicine, Jiangsu Wuxi 214063, China

Received:2013-01-07 Online:2014-02-20 Published:2014-02-20

摘要/Abstract

摘要： 目的观察糖化血红蛋白(HbA_1c)诊断2型糖尿病(T2DM)的特点及其在空腹血糖(FPG)正常者中的分布情况。方法同时测定729例FPG正常者尿酸(UA)、甘油三酯(TG)、总胆固醇(TC)、高密度脂蛋白胆固醇(HDL-C)和低密度脂蛋白胆固醇(LDL-C);用免疫抑制比浊法测定247例接受口服葡萄糖耐量试验(OGTT)者(包括T2DM 164例、糖耐量受损41例、空腹血糖受损18例、糖耐量正常者24例)的HbA_1c, 以OGTT和临床诊断结果作为标准, 绘制HbA_1c和FPG的受试者工作特征(ROC)曲线, 确定HbA_1c诊断T2DM的切点, 通过对比分析观察不同性别及同性别不同年龄组中HbA_1c的分布情况。结果免疫抑制比浊法测定HbA_1c诊断T2DM的切点为6.36%, 诊断灵敏度为86.50%、特异性为90.60%、阳性预测值为94.63%、阴性预测值为76.50%、曲线下面积为0.944[95%可信区间(CI):0.917～0.971], FPG>7.0 mmol/L时诊断糖尿病的灵敏度为85.90%、特异性为93.80%、曲线下的面积为0.957[95% CI:0.932～0.981]。FPG正常者中女性HbA_1c、HDL-C水平明显高于男性(P=0.000), 男性血红蛋白(Hb)、FPG、UA、TG水平高于女性(P值分别为0.000、0.020、0.000、0.000)。随着年龄的增加, 男、女性HbA_1c、FPG、TC和LDL-C均有增高的趋势;特别是在60岁以后, 女性HbA_1c升高更高明显;但HDL-C在男性中有上升的趋势, 在女性中有下降的趋势。结论免疫抑制比浊法测定HbA_1c诊断T2DM的切点为6.36%, 随着年龄的增加要定期测定HbA_1c, 以达到预防糖尿病的目的。

关键词: 糖化血红蛋白, 2型糖尿病, 免疫抑制比浊法, 诊断

Abstract: Objective To observe the characteristic of glycosylated hemoglobin A_1c (HbA_1c) for diagnosing type 2 diabetes mellitus (T2DM) and its distribution characteristic inpopulation with normal fasting plasma glucose(FPG). Methods A total of 729 subjects with normal FPG were enrolled, and uric acid(UA), triglyceride(TG), total cholesterol(TC), high-density lipoprotein cholesterol(HDL-C) and low-density lipoprotein cholesterol (LDL-C) were determined. Oral glucose tolerance test(OGTT) was administered to 247 patients, including 164 cases with T2DM, 41 cases with impaired glucose tolerance, 18 cases with impaired fasting glucose and 24cases with normal glucose tolerance. HbA_1c was determined by turbidimetric inhibition immunoassay, and the receiver operating characteristic(ROC) curve was used to determine the cut-off point of HbA_1c and FPG for diagnosing T2DM according to the results of OGTT and clinical diagnosis. The distribution characteristics of HbA_1c with different sex and with different age in same sex were analyzed and observed comparatively.Results The cut-off point of HbA_1c for the diagnosis of T2DM was 6.36% with a sensitivity and specificity of 86.50% and 90.60% respectively, the positive predictive value and negative predictive value were 94.63% and 76.50% respectively, and the area under ROC curve was 0.944 [95% confidence interval (CI):0.917-0.971]. The area under ROC curve of FPG was 0.957 (95% CI:0.932-0.981), the sensitivity and specificitywere 85.90% and 93.80% when FPG>7.0 mmol/L for the diagnosis of T2DM. The HbA_1c and HDL-C in females with normal FPG were significantly higher than those in males with normal FPG (P=0.000).Hemoglobin (Hb), FPG, UA and TG in males were higher than those in females (P=0.000, 0.020, 0.000 and 0.000).HbA_1c, FPG, TC and LDL-C were positively correlated with age. After 60 years old, HbA_1c in females increased significantly, there was increasing trend of HDL-C in males, and there was decreasing tread of HDL-C in females. Conclusions The cut-off point of HbA_1c for diagnosing T2DM is 6.36% by turbidimetric inhibition immunoassay. In order to avoid diabetes mellitus, elder people should monitor HbA_1c termly.

Key words: Glycosylated hemoglobin A_1c, Type 2 diabetes mellitus, Turbidimetric inhibition immunoassay, Diagnosis

中图分类号:

R446.1

李跃松, 荀雪影, 武红玉, 浦洪波, 陈永伟, 包建东. HbA_1c诊断2型糖尿病特性观察及在空腹血糖正常人群中的分布特征研究[J]. 检验医学, 2014, 29(2): 130-134.

LI Yuesong, XUN Xueying, WU Hongyu, PU Hongbo, CHEN Yongwei, BAO Jiandong.. Observation on the characteristic of HbA_1c for diagnosing type 2 diabetes mellitus and research on the distribution characteristic in population with normal fasting plasma glucose[J]. , 2014, 29(2): 130-134.

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HbA_1c诊断2型糖尿病特性观察及在空腹血糖正常人群中的分布特征研究

Observation on the characteristic of HbA_1c for diagnosing type 2 diabetes mellitus and research on the distribution characteristic in population with normal fasting plasma glucose

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HbA1c诊断2型糖尿病特性观察及在空腹血糖正常人群中的分布特征研究

Observation on the characteristic of HbA1c for diagnosing type 2 diabetes mellitus and research on the distribution characteristic in population with normal fasting plasma glucose

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Observation on the characteristic of HbA_1c for diagnosing type 2 diabetes mellitus and research on the distribution characteristic in population with normal fasting plasma glucose