摘要
糖化血红蛋白（Hb）A1c用于评价糖尿病患者的血糖控制水平已有几十年历史。尽管近年来HbA1c的检测方法、计量单位以及标准化日臻完善，但迄今为止的指南仍没有推荐使用HbA1c筛查与诊断糖尿病，而是通过检测空腹或糖负荷之后的血清葡萄糖来筛查与诊断糖尿病。鉴于现有诊断方法存在的缺陷，以及近年来HbA1c检测技术的进步，HbA1c用于糖尿病的筛查与诊断已成为一种趋势。在第69届美国糖尿病协会（ADA）年会上，由ADA、欧洲糖尿病研究学会（EASD）以及国际糖尿病联盟（IDF）组成的国际专家委员会指出，将HbA1c≥6．5％作为筛查与诊断糖尿病的标准具有合理性，其准确性、敏感性与特异性也较为满意，其与血糖联合使用，可进一步提高糖尿病诊断的敏感性，更有利于临床实践。但是，临床医生需要了解影响HbA1c检测结果的因素、HbA1c的标准化、HbA1c用于筛查与诊断糖尿病的循证医学证据、基于HbA1c与血糖检测的糖尿病筛查标准等诸多问题。
Hemoglobin A1 c （HbA1 c） has been used for decades to monitor the glycemic control in diabetic patients. Although HbA1 c is currently undergoing a reassessment, and major developments have been underway in recent years, HbA1 c is not recommended at present for diabetes screening or diagnosis. In diabetes screening and diagnosis, the current diagnostic guidelines use measurement of plasma glucose either fasting or after glucose load. These diagnostic methods have shortcomings warranting a potential diagnostic role for HbAlc. Recently,an international committee assembled by the American Diabetes Association （ADA）, the European Association for the Study of Diabetes and the International Diabetes Federation is recommending the HbAlc assay as the test for the diagnosis of prediabetes and diabetes. The committee proposes HbAlc of 6.5% or greater as a reasonable cut point, with the best accuracy, sensitivity and specificity. Moreover, the addition of blood glucose test to the HbAlc assay will improve the sensitivity of diagnosis. The committee＇s recommendation, which has not yet been officially endorsed by the three diabetes organizations, was first reported in the 69th Scientific Session of ADA. This review introduces the confounding factors and standardization of the HbA1 c test, the evidence supporting HbA1 c assay for diabetes screening and diagnosis and the criteria for the screening and diagnosis using HbAlc combined with blood glucose.
出处
《国际内分泌代谢杂志》
2009年第4期231-235,共5页
International Journal of Endocrinology and Metabolism
关键词
糖尿病
糖化血红蛋白
筛查
诊断
Diabetes mellitus
Glycated hemoglobin
Screening
Diagnosis
