摘要
目的探索HbA1c在高原不同血红蛋白水平人群糖尿病和糖尿病前期诊断价值的差异。方法纳入来自西藏高原(平均海拔≥3 000 m)、无糖尿病既往史的健康体检者904人,按血红蛋白分为正常血红蛋白组(460人)、高血红蛋白组(332人)和高原红细胞增多症(HAPC)组(112人),均行75 g口服葡萄糖耐量试验(OGTT),检测空腹血糖、餐后2 h血糖(2 hPG)、HbA1c、血常规和生化相关指标。测定血压、身高、体重。以1999年WHO诊断糖代谢异常的标准为金标准,绘制受试者工作特征曲线(ROC),计算高原不同血红蛋白人群HbA1c诊断糖尿病和糖尿病前期的最佳切点、曲线下面积(AUC)、特异性、灵敏性。结果正常血红蛋白组、高血红蛋白组和HAPC组HbA1c诊断糖尿病的最佳切点分别为6.1%、6.5%、7.1%,AUC分别为0.96、0.91、0.74,特异性分别为0.94、0.90、0.82,灵敏性分别为0.87、0.82、0.57。HbA1c诊断糖尿病前期的最佳切点分别为5.8%、5.9%、6.2%,AUC分别为0.73、0.72、0.61,特异性分别为0.77、0.68、0.57,灵敏性分别为0.59、0.68、0.67。结论HbA1c诊断高原糖尿病和糖尿病前期的切点随血红蛋白水平升高而升高,HbA1c并不适用于HAPC人群糖代谢异常的诊断。
Objective To explore the discrepancy of HbA1c for diagnosis of diabetes mellitus and pre-diabetes in highland dwellers with different hemoglobin (Hb) level. Methods A total of 904 health volunteers living in Tibet altitude(average altitude is above 3 000 m) were recruited. Subjects were divided into three groups according to the Hb level: normal Hb group (n=460), high Hb group (n=332) and high altitude polycythemia (HAPC) group (n=112). Oral glucose tolerance tests (OGTT) with 75 g glucose was performed. Fasting blood glucose(FBG), 2-hour post-prandial blood glucose(2 hPG), HbA1c, blood routine and biochemical indexes were tested. Blood pressure, height and weight were measured.Based on criteria for diagnosis of abonormal glucose metabolism by WHO in 1999, receiver operating characteristic curves (ROC) were drawn to determine the optimal HbA1c diagnostic cut-off point, areas under the curves(AUC), specificity, sensitivity of diabetes and pre-diabetes status respectively in highland dwellers with different Hb levels. Results Among normal Hb group, high Hb group and HAPC group, the best threshold of HbA1c for detecting diabetes was 6.1%, 6.5% and 7.1% respectively, the AUC for detecting diabetes was 0.96, 0.91 and 0.74 respectively, the specificity for detecting diabetes was 0.94, 0.90 and 0.82 respectively, the sensitivity for detecting diabetes was 0.87, 0.82 and 0.57 respectively. The best threshold of HbA1c for detecting pre-diabetes was 5.8%, 5.9% and 6.2% respectively, the AUC for detecting pre-diabetes was 0.73, 0.72 and 0.61 respectively, the specificity for detecting pre-diabetes was 0.77, 0.68 and 0.57 respectively, the sensitivity for detecting pre-diabetes was 0.59, 0.68 and 0.67 respectively. Conclusion The cut-off point of HbA1c detecting diabetes elevates with the increase of Hb level. HbA1c may not be suitable for diagnosing diabetes or pre-diabetes in HAPC population.
作者
孙曾梅
王溯源
何华
孙舒瑶
叶燕
姚璿羽
龙文春
张惠勤
张成慧
李明霞
唐冬梅
邬云红
Sun Zengmei;Wang Suyuan;He Hua;Sun Shuyao;Ye Yan;Yao Xuanyu;Long Wenchun;Zhang Huiqin;Zhang Chenghui;Li Mingxia;Tang Dongmei;Wu Yunhong(Department of Endocrinology ,Hospital of Chengdu Office of People's Government of Tibetan Autonomous Region, Chengdu 610041, China)
出处
《国际内分泌代谢杂志》
2019年第2期73-76,共4页
International Journal of Endocrinology and Metabolism
基金
西藏自治区自然科学基金(2016ZR-QY-12).
