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目的:评估空腹血糖(FBG)和糖化血清白蛋白(GA)在筛查糖尿病(DM)中的应用价值。方法:选取2013年4月至2014年4月本院健康体检者869例,测定空腹血糖及糖化血清白蛋白。FBG≥6.1且<7.0 mmol/L或GA>18.5%行口服葡萄糖耐量试验(OGTT)进行确诊。结果:FBG与诊断为DM相关的截断点为6.2 mmol/L,敏感性为97.1%,特异性为96.0%,曲线下面积(AUC)0.988(95%CI 0.980~0.996),阳性似然比24.55,阴性似然比0.03;GA与诊断为DM相关的截断点为14.55%,敏感性和特异性分别为82.8%和90.2%,曲线下面积为0.923(95%CI 0.870~0.975),阳性似然比8.43,阴性似然比0.19。当筛查DM时,AUC的结果为FBG=6.2(0.988)>GA=14.55(0.923),提示FBG的筛查准确度较高。FBG≥6.2且GA大于14.55%同时符合为阳性,得出灵敏度为96.7%,比单纯采用FBG≥7.0 mmol/L筛查糖尿病提高筛查效率35.4%,而特异度无明显差异。结论:空腹血糖联合糖化血清白蛋白筛查糖尿病有较高的灵敏度、特异性。
Objective: To evaluate the value of fasting blood glucose (FBG) and glycated serum albumin (GA) in the screening of diabetes mellitus (DM). Methods: From April 2013 to April 2014, 869 healthy subjects in our hospital were selected for determination of fasting plasma glucose and serum albumin. The oral glucose tolerance test (OGTT) was used to confirm the diagnosis of FBG≥6.1 and <7.0 mmol / L or GA> 18.5%. RESULTS: The cut-off point for FBG was 6.2 mmol / L with a sensitivity of 97.1% and a specificity of 96.0%. The area under the curve (AUC) was 0.988 (95% CI 0.980-0.996) with a positive likelihood ratio of 24.55 , And the negative likelihood ratio was 0.03. The cut-off point of GA correlated with DM was 14.55%, the sensitivity and specificity were 82.8% and 90.2% respectively. The area under the curve was 0.923 (95% CI 0.870-0.975) Than 8.43, the negative likelihood ratio of 0.19. When screening for DM, the results of AUC were FBG = 6.2 (0.988)> GA = 14.55 (0.923), suggesting that the screening accuracy of FBG was high. FBG≥6.2 and GA> 14.55%, both of them were positive. The sensitivity was 96.7%, which was 35.4% higher than screening screening diabetes with FBG≥7.0 mmol / L, but the specificity was not significantly different. Conclusion: Fasting blood glucose combined with glycosylated serum albumin screening for diabetes has a higher sensitivity and specificity.