探讨西宁地区HbA1c筛查和诊断糖尿病的最佳切点

发布时间：2018-06-18 05:05

本文选题：糖化血红蛋白 + 筛查诊断　；参考：《青海大学》2017年硕士论文

【摘要】：目的探讨西宁地区筛查和诊断糖尿病时应采用的糖化血红蛋白(HbA1c)的最佳切点值,为青海地区研究HbA1c诊断DM提供数据资料,为我国学者完善高原地区相关资料提供参考。方法选取2015年1月至2016年10月期间,青海省西宁市范围内就诊于青海大学附属医院内分泌科的糖尿病高危人群,严格依据入选标准和排除标准,确定研究对象,共699例,其中男性439例,女性260例。所有研究对象均在青海大学附属医院行口服葡萄糖耐量试验(OGTT)及检测HbA1c,血样统一送交该院检验科完成检验。结果(1)本研究699例研究对象中,男性439例(占62.8%),女性260例(占37.2%)。以1999年糖代谢分类标准,其中DM组共369例(占52.8%),IGR组共148例(占21.2%),NGT组共182例(占26.0%)。(2)以OGTT为诊断DM的“金标准”,绘制FPG、OGTT、HbA1c三种检测方法的受试者工作特征曲线(ROC曲线),可得出采用OGTT2hPG诊断DM优于HbA1c,而应用HbA1c诊断DM则优于FPG:三者相比,OGTT2hPG曲线下面积为:0.999(95%CI 0.998~1.000);HbA1c的曲线下面积为:0.972(95%CI 0.962~0.983);FPG的曲线下面积:0.959(95%CI 0.945~0.973)。(3)通过绘制ROC曲线找到HbA1c诊断DM的最佳切点值为6.45%,此切点对应的敏感度为87.3%,特异度为98.5%,阳性预测值为98.5%,阴性预测值为87.4%;用于糖尿病前期(即IGR)的早期筛查所采用的HbA1c最佳切点值为5.65%,其敏感度为58.8%,特异度为75.3%,阳性预测值和阴性预测值分别为65.9%和69.2%。结论(1)应用HbA1c诊断DM优于FPG。(2)HbA1c在西宁地区糖尿病高危人群中筛查糖尿病前期(IGR)和诊断糖尿病(DM)的最佳切点值分别为5.65%和6.45%。(3)应用HbA1c"g6.45%作为糖尿病诊断标准的敏感度高于应用FPG"g7.0mmol/L作为诊断标准的敏感度,但比OGTT2h"g11.1mmol/L作为诊断标准的敏感度低。
[Abstract]:Objective to explore the optimal value of HbA1c for screening and diagnosis of diabetes mellitus in Xining, and to provide data for the study of HbA1c in Qinghai, and to provide reference for Chinese scholars to perfect the relevant data in plateau area. Methods from January 2015 to October 2016, a total of 699 patients with diabetes mellitus were selected from the Department of Endocrinology of Qinghai University affiliated Hospital in Xining, Qinghai Province, according to the selection criteria and exclusion criteria. There were 439 males and 260 females. All subjects were given oral glucose tolerance test (OGTT) and HbA1c in the affiliated hospital of Qinghai University. The blood samples were sent to the laboratory of Qinghai University to complete the test. Results 1) of the 699 subjects in this study, 439 (62.8%) were males and 260 (37.2%) females. According to the classification criteria of glucose metabolism in 1999, there were 369 cases (52.8%) in DM group (148 cases in IGR group) (182 cases (26.0%) in NGT group). OGTT was taken as the "gold standard" for the diagnosis of DM. By drawing the operating characteristic curve and ROC curve of subjects using OGTT2hPG and HbA1c, it can be concluded that using OGTT2hPG is superior to HbA1cand using HbA1c to diagnose DM is superior to FPG: the area under the OGTT2hPG curve is 1: 0.9999 95CI 0.9981.000 HbA1c. The area under the curve is: 0.972995 CI 0.9620.983FPG Below line area: 0.959995 CI 0.945 0.973t. 3) by drawing the ROC curve, the best point of HbA1c for the diagnosis of DM is 6.45. The sensitivity of this point is 87.3, the specificity is 98.5, the positive predictive value is 98.5, and the negative predictive value is 87.4. It is used in the early stage of diabetes mellitus (IGR). The optimum point of HbA1c was 5.65, the sensitivity was 58.8, the specificity was 75.3, the positive predictive value and negative predictive value were 65.9% and 69.2%, respectively. Conclusion HbA1c is better than FPG.2HbA1c in screening prediabetic IGR and diagnosing DM in Xining area. The sensitivity of HbA1c "g6.45% is higher than that of HbA1c" g6.45%. Using FPG "g 7.0 mmol / L" as diagnostic criteria, But it was less sensitive than OGTT 2h "g 11.1 mmol / L as diagnostic criteria."
【学位授予单位】：青海大学
【学位级别】：硕士
【学位授予年份】：2017
【分类号】：R587.1

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