糖化血清白蛋白用于诊断糖尿病及糖调节异常的价值研究

Study of Glycated Albumin Cut-off Point in Diabetes Mellitus and Impaired Glucose Regulation

中文关键词:  糖尿病 糖调节异常 糖化血清白蛋白 切点 诊断

英文关键词:Diabetes mellitus Impaired glucose regulation (IGR) Glycated albumin (GA) Cut-off point Diagnosis

中文摘要:

      目的 探讨糖化血清白蛋白（GA）作为诊断糖尿病（DM）及糖调节异常（IGR）的可能切点值，并分析GA对于诊断DM及IGR的应用价值。方法 392例为明确DM诊断而就诊者和DM高危人群接受筛查者，年龄20～84岁，行口服葡萄糖耐量试验（OGTT），并测定糖化血红蛋白（HbA1c）和GA，以受试者工作特征曲线(ROC)评价GA诊断DM和IGR的敏感性和特异性。结果 ①按WHO1999年DM诊断标准判断，392例就诊者中DM 131例， IGR 126例，糖耐量正常（NGT）135例，3组 GA水平呈递增趋势(P <0.05)。②Spearman 相关分析显示 GA与 HbA1c（r=0.942 1，P <0.05）、空腹血糖(FPG，r=0.856 6，P <0.05）、餐后2 h血糖（2-hPG，r=0.813 7， P <0.05）呈正相关。③DM组GA/HbA1c为2.58±0.37， IGR组为2.44±0.37，NGT组为2.17±0.25，三者比较差异有统计学意义。④GA诊断DM的最佳切点值为16.6%，曲线下面积（AUC）为0.888（95%CI：0.855～0.920），敏感性为71.8%，特异性为87.4%，诊断价值中等。GA诊断IGR的AUC较小（0.510），诊断价值较低。结论 GA可作为单一方法诊断DM，其最佳切点值为16.6％，敏感性和特异性分别为71.8%和87.4%。GA可能不适合用于单独诊断IGR。

英文摘要:

      【Abstract】 Objective To investigate the cut-off point of glycated albumin (GA) in the detection of diabetes mellitus (DM) and impaired glucose regulation (IGR). Methods This study was conducted in 20-84 years-old adults who had risk factors of diabetes but no previously diagnosed diabetes. There were finally 392 individuals included and received the measurement of GA and HbA1c. Receiver operating characteristic curve (ROC) was plotted to determine the performance of GA. Results ①Based on the diabetes diagnosis criteria of WHO (1999), the subjects were divided into DM group (n=131), IGR group (n126), and normal glucose tolerance (NGT) group (n=135). The GA level in the three groups tended to increase (P<0.05).②Spearman correlation analysis demonstrated that GA was positively correlated with glycated haemoglobin A 1c (HbA1c) r=0.942 1, P<0.05), fasting plasma glucose (FPG) (r=0.856 6, P <0.05) and 2 h post-load plasma glucose (2-hPG) (r=0.813 7, P <0.05). ③The mean levels of serum GA/HbA1c were 2.58±0.37, 2.44±0.37 and 2.17±0.25 for DM, IGR and NGT respectively. ④The optimal cut-off points for detecting diabetes were 16.6 % in GA 〔area under the carve (AUC) =0.888〕， producing the sensitivity of 71.8% and the specificity of 87.4%. Conclusion GA as a single screening test shows adequate to detect newly diagnosed DM, and the optimal GA cut-off point was 16.6% in this study.