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目的:探讨糖化血红蛋白(Hb A1c)评估诊断糖调节受损(IGR)的适用性与局限性。方法:回顾性分析2012年2月至2013年7月东莞市中医院同期检测Hb A1c和口服葡萄糖耐量试验(OGTT)的663例样本资料。结果:663例中IGR 502例,其中IFG 134例(20.2%)、IGT 122例(8.4%)、IFG+IGT 246例(37.1%)、NGT 161例(24.3%)。283例FPG<5.6 mmol/L患者中122例为IGT;296例2h-PG<7.8mmol/L中134例为IFG。Hb A1c诊断IFG的最佳切点为5.39%,敏感性为0.567,特异性为0.596,AUCROC为0.569;Hb A1c诊断IGT的最佳切点为5.39%,敏感性为0.574,特异性为0.596,AUCROC为0.576;Hb A1c诊断IFG+IGT的最佳切点为5.39%,敏感性为0.703,特异性为0.596,AUCROC为0.674;Hb A1c诊断整体IGR的最佳切点为5.38%,敏感性为0.635,特异性为0.696,AUCROC为0.622。只测FPG,使用FPG≥5.60 mmol/L为切点时,其中有24.3%(122例)诊断为IGT的糖调节受损(IGR)会被遗漏;只测FPG,使用FPG≥6.10 mmol/L为切点时,在368例IGT、IFG+IGT数据中,有55.4%(204例)的属于IGT和IFG+IGT的IGR会被遗漏;只使用Hb A1c≥5.39%为切点时,有36.8%(185例)的IGR会被遗漏;使用Hb A1c≥5.39%和FPG≥5.60 mmol/L为切点时,有10.8%(54例)的IGR会被遗漏;但其假阳性率也增高至40.3%。使用Hb A1c≥5.39%和FPG≥6.10 mmol/L为切点时,有24.9%(125例)的IGR会被遗漏。结论:Hb A1c不适用于对IFG和IGT的诊断和筛查;而适用于对IFG+IGT的筛查,不适用于对IFG+IGT的诊断。FPG和Hb A1c的联合应用能大幅度提高有助于对IGR的筛查效果。
Objective: To investigate the applicability and limitations of glycosylated hemoglobin (Hb A1c) in the diagnosis of impaired glucose regulation (IGR). Methods: The data of 663 samples of Hb A1c and oral glucose tolerance test (OGTT) in Dongguan Hospital of Chinese Medicine from February 2012 to July 2013 were analyzed retrospectively. Results: There were 502 cases of IGR in 663 cases, including IFG in 134 cases (20.2%), IGT in 122 cases (8.4%), IFG + IGT in 246 cases (37.1%) and NGT in 161 cases (24.3%). 122 out of 283 patients with FPG <5.6 mmol / L were IGT; 134 of 296 patients with 2h-PG <7.8 mmol / L were IFG. The best cut-point of Hb A1c diagnosis of IFG was 5.39%, the sensitivity was 0.567, the specificity was 0.596, and the AUCROC was 0.569. The optimal cut-off point of Hb A1c in diagnosing IGT was 5.39%, the sensitivity was 0.574, the specificity was 0.596, AUCROC was 0.576. The best cut-point of Hb A1c in diagnosing IFG + IGT was 5.39%, the sensitivity was 0.703, the specificity was 0.596, and the AUCROC was 0.674. The best cut-point of Hb A1c in diagnosing IGR was 5.38% 0.635, specificity 0.696, AUCROC 0.622. When only FPG was detected, 24.3% (122 cases) of IGT diagnosed with IGT were missed when using FPG≥5.60 mmol / L; only FPG was measured and FPG≥6.10 mmol / L In the 368 cases of IGT, IFG + IGT data, 55.4% (204 cases) of IGRs belonging to IGT and IFG + IGT were missed; when Hb A1c≥5.39% was used as the cut point, 36.8 % (185 cases) of IGR were missed. When Hb A1c≥5.39% and FPG≥5.60 mmol / L were used as cut points, 10.8% (54 cases) of IGR were missed; however, the false positive rate was also increased to 40.3%. With Hb A1c ≥ 5.39% and FPG ≥ 6.10 mmol / L as the cut-off point, 24.9% (125 cases) of IGR were missed. Conclusion: Hb A1c is not suitable for the diagnosis and screening of IFG and IGT. However, the screening of IFG + IGT is not suitable for the diagnosis of IFG + IGT. The combination of FPG and Hb A1c can dramatically improve the screening of IGR.