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目的探讨老年人群中糖化血红蛋白(HbA1c)诊断糖尿病(DM)和糖调节异常(IGR)的理想切点及可行性。方法对北京万寿路社区老年人群(≥60岁)进行横断面流行病学调查,其中1 674人无糖尿病者行口服75g葡萄糖耐量试验(OGTT),测定空腹血糖、2h血糖及HbA1c。采用受试者工作特征曲线(ROC曲线)进行判断,以OGTT诊断DM及IGR时的HbA1c值计算最佳切点。并与美国糖尿病协会(ADA)的糖尿病HbA1c诊断标准比较。结果按照1999年WHO的DM诊断标准,本研究人群中糖耐量正常(NGT)894例,空腹血糖受损(IFG)53例,糖耐量低减(IGT)369例,合并IFG+IGT 87例,新诊断糖尿病(NDDM)271例。采用ROC曲线判断与OGTT诊断DM状态相关的HbA1c理想切点为5.9%,敏感性和特异性分别为80.1%和73.8%,曲线下面积0.832(95%CI 0.802-0.862);与IGR状态相关的HbA1c理想切点为5.7%,敏感性和特异性分别为64.3%,60.9%,曲线下面积0.668(95%CI 0.638-0.698)。HbA1c≥5.9%作为糖尿病诊断标准与OGTT的符合率达75%,可确诊80.1%的NDDM(217例),但包括17.3%的NGT(155例)和41.7%的IGR(212例)。按ADA HbA1c≥6.5%的标准,NDDM中的检出率只有39.1%(106例),而特异性高仅涉及0.9%的NGT(8例)及4.5%的IGR(23例)。结论 HbA1c≥5.9%时应进一步行OGTT以明确是否患有糖尿病,≥6.5%时诊断糖尿病的特异性达到97.8%。HbA1c不适用于筛查IGR人群。
Objective To investigate the ideal point and feasibility of HbA1c in the diagnosis of diabetes mellitus (DM) and impaired glucose regulation (IGR) in the elderly population. Methods A cross-sectional epidemiological investigation was conducted on elderly population (≥60 years old) in Beijing Wanshou Road community. Among them, 1674 non-diabetic patients were given 75g oral glucose tolerance test (OGTT), fasting blood glucose, 2h blood glucose and HbA1c were measured. The receiver operating characteristic curve (ROC curve) was used to determine the optimal cut-point based on the HbA1c value of OGTT in diagnosing DM and IGR. And with the American Diabetes Association (ADA) diabetes HbA1c diagnostic criteria for comparison. Results According to the WHO diagnostic criteria of WHO in 1999, 894 NGT, 53 IFG, IGT 369, 87 IFG + IGT, 271 cases of newly diagnosed diabetes mellitus (NDDM). The ROC curve was used to determine the ideal cutoff point of HbA1c associated with OGTT diagnosis of DM was 5.9%, the sensitivity and specificity were 80.1% and 73.8% respectively, and the area under the curve was 0.832 (95% CI 0.802-0.862) The ideal cut-point of HbA1c was 5.7%. The sensitivity and specificity were 64.3% and 60.9% respectively. The area under the curve was 0.668 (95% CI 0.638-0.698). HbA1c≥5.9%, as a diagnostic criteria for diabetes, was 75% consistent with OGTT, and 80.1% of NDDM was confirmed (217 cases) but included 17.3% of NGT (155 cases) and 41.7% of IGR (212 cases). According to ADA HbA1c≥6.5%, the detection rate in NDDM was only 39.1% (106 cases), while the specificity was only 0.9% NGT (8 cases) and 4.5% IGR (23 cases). Conclusions OGTT should be further performed in patients with HbA1c≥5.9% to determine if there is diabetes. The specificity of diagnosis of diabetes≥6.5% was 97.8%. HbA1c is not suitable for screening IGR populations.