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目的比较并评价空腹血糖(FPG)和糖化血红蛋白(HbA_1c)在筛查DM中的应用价值。方法上海地区研究对象2298名,为明确DM诊断而就诊者和DM高危人群接受DM筛查者,男956名,女1342名,年龄52±13岁,行OGTT并测定HbA_1c;以其工作特征曲线(ROC)评价FPG和HbA_1c在筛查DM中的敏感性和特异性。结果 (1)按照1999年WHO的DM诊断标准,本研究人群糖耐量正常(NGT)、空腹血糖受损(IFG)、糖耐量受损(IGT)、IGT合并IFG和DM者分别为830、110、380、183、795例。其中DM患病率为34.6%。(2)依据ROC判断,与DM状态相关的FPG最佳临界点为6.1mmol/L,敏感性和特异性均为81.5%,曲线下面积为0.899(95%CI 0.885～0.914),阳性似然比4.18,阴性似然比0.23;与DM状态相关的HbA_1c最佳临界点为6.1%,敏感性和特异性均为81.0%,曲线下面积为0.890(95%CI 0.876～0.904),阳性似然比4.26,阴性似然比0.23;如应用FPG≥6.1mmol/L或HbA_1 c≥6.1%筛查DM,敏感性和特异性分别为96.5%和65.2%,阳性似然比2.77,阴性似然比0.05。结论 FPG和HbA_1c在筛查DM中具有相似的价值,二者均有相似的特异性和敏感性以及阳性似然比和阴性似然比。为了最大限度的筛查出DM患者,建议对于6.1mmol/L≤FPG<7.0mmol/L或HbA_1c≥6.1%的患者行OGTT检查以明确有无DM。
Objective To compare and evaluate the value of fasting blood glucose (FPG) and glycosylated hemoglobin (HbA_1c) in screening DM. Methods Totally 2298 subjects in Shanghai area were enrolled in this study. A total of 956 male and 1342 female patients aged 52 ± 13 years were enrolled in this study. DM patients undergoing DM screening were enrolled in this study. OGTT and HbA_1c were measured. (ROC) to evaluate the sensitivity and specificity of FPG and HbA 1c in screening DM. Results According to the WHO diagnostic criteria of WHO in 1999, the study population had normal glucose tolerance (NGT), impaired fasting glucose (IFG), impaired glucose tolerance (IGT), IGT with IFG and DM were 830,110 , 380,183,795 cases. The prevalence of DM was 34.6%. (2) According to ROC, the best critical point of FPG correlated with DM state was 6.1mmol / L, the sensitivity and specificity were 81.5%, the area under the curve was 0.899 (95% CI 0.885-0.914), the positive likelihood The odds ratio was 0.23; the best cut-off point of HbA_1c correlated with DM state was 6.1%, the sensitivity and specificity were both 81.0% and the area under the curve was 0.890 (95% CI 0.876-0.904) The odds ratio was 0.23; the sensitivity and specificity were 96.5% and 65.2%, respectively, and the positive likelihood ratio was 2.77 when the FPG≥6.1mmol / L or HbA_1 c≥6.1% 0.05. Conclusions FPG and HbA_1c have similar values in screening DM, both of which have similar specificity and sensitivity as well as positive likelihood ratio and negative likelihood ratio. In order to maximize the screening of patients with DM, it is recommended for patients with 6.1mmol / L≤FPG <7.0mmol / L or HbA_1c≥6.1% OGTT check to determine the presence or absence of DM.