Sung K C, Rhee E J
Department of Internal Medicine, Kangbuk Samsung Hospital, Sungkyunkwan University School of Medicine, Seoul, Korea.
Diabet Med. 2007 Aug;24(8):848-54. doi: 10.1111/j.1464-5491.2007.02146.x.
With increasing prevalence of diabetes mellitus and metabolic syndrome (MS), the importance of early detection of insulin resistance is emphasized. However, a simple and practical method of measurement is not readily available. Therefore, we examined the sensitivity and specificity of HbA(1c) for predicting impaired fasting glucose (IFG) and MS and its association with cardiovascular risk factors, particularly in the normal range of HbA(1c) levels in non-diabetic Korean subjects.
In 40,155 participants (median age 40 years) participating in a medical check-up programme, analysis of the distribution of HbA(1c) and its association with various cardiovascular risk factors was performed. In 22,465 selected participants, an analysis was conducted of the ability of HbA(1c) to predict MS and IFG. Anthropometric measurements were made in all subjects and fasting glucose, lipid profiles and HbA(1c) were measured. The presence of MS was defined according to the definitions of the Adult Treatment Panel III (ATP III) guideline and the new International Diabetes Federation (IDF) guideline. Patients with diabetes were excluded from the study.
The incidence of MS was 12.2% according to ATP III criteria and 7.6% according to IDF criteria. When subjects were grouped by quartile of HbA(1c), cardiovascular risk factors significantly increased as the HbA(1c) increased. An HbA(1c) of 5.45% predicted the presence of MS (ATP III: sensitivity/specificity 57.4/64.3%, area under the curve 64.8%; IDF: sensitivity 60.2/63.4%, area under the curve 66.1%) and fasting blood glucose > or = 5.6 mmol/l (sensitivity/specificity 53.7/70%, area under the curve 66.1%). When the analyses were done separately by gender, female subjects showed higher cut-off of HbA(1c) for the prediction of MS (5.55% for both ATP III and IDF criteria).
HbA(1c) increased as cardiovascular risk factors increased and HbA(1c) of 5.45% predicted the presence of MS. HbA(1c) might be a predictive measure of IFG and MS, and also cardiovascular risk factors in the Korean population.
随着糖尿病和代谢综合征（MS）患病率的不断上升，胰岛素抵抗早期检测的重要性日益凸显。然而，目前尚缺乏一种简单实用的测量方法。因此，我们研究了糖化血红蛋白（HbA₁c）预测空腹血糖受损（IFG）和MS的敏感性和特异性及其与心血管危险因素的关系，特别是在非糖尿病韩国受试者HbA₁c水平的正常范围内。
在40155名参与体检项目的参与者（中位年龄40岁）中，分析了HbA₁c的分布及其与各种心血管危险因素的关系。在22465名选定的参与者中，分析了HbA₁c预测MS和IFG的能力。对所有受试者进行人体测量，并测量空腹血糖、血脂谱和HbA₁c。根据成人治疗小组第三次报告（ATP III）指南和新的国际糖尿病联盟（IDF）指南的定义确定MS的存在。糖尿病患者被排除在研究之外。
根据ATP III标准，MS的发生率为12.2%，根据IDF标准为7.6%。当受试者按HbA₁c四分位数分组时，心血管危险因素随着HbA₁c的升高而显著增加。HbA₁c为5.45%时可预测MS的存在（ATP III：敏感性/特异性为57.4/64.3%，曲线下面积为64.8%；IDF：敏感性为60.2/63.4%，曲线下面积为66.1%）以及空腹血糖≥5.6 mmol/l（敏感性/特异性为53.7/70%，曲线下面积为66.1%）。当按性别分别进行分析时，女性受试者预测MS的HbA₁c临界值较高（ATP III和IDF标准均为5.55%）。
随着心血管危险因素的增加，HbA₁c升高，HbA₁c为5.45%可预测MS的存在。HbA₁c可能是韩国人群中IFG和MS以及心血管危险因素的一种预测指标。
