糖化血红蛋白A₁c用于诊断50岁以上中国人群糖尿病：一项基于社区的横断面研究。

Glycated haemoglobin A₁c for diagnosing diabetes in Chinese subjects over 50 years old: a community-based cross-sectional study.

作者信息

Lin Shuo, Hu Li, Li Xiaofeng, Chen Yanming, Xu Haixia, He Shengqing, Ren Zhuozhuo, Tang Xixiang, Qiu Yawei, Xu Jing, Mu Panwei, Zeng Longyi

机构信息

Department of Endocrinology, The 3rd Affiliated Hospital of Sun Yat-sen University, Guangzhou, China.

出版信息

Clin Endocrinol (Oxf). 2014 May;80(5):656-61. doi: 10.1111/cen.12202. Epub 2013 Apr 9.

DOI:10.1111/cen.12202

PMID:23488681

Abstract

OBJECTIVE

Little is known about using glycated haemoglobin A₁c (HbA₁c) to diagnose diabetes in Chinese subjects over 50 years old. This study aims to evaluate HbA₁c in diagnosing diabetes and identify the optimal threshold to be used in Chinese community subjects aged over 50 years.

METHODS

A community-based cross-sectional survey was conducted from October 2010 to January 2011 in Shipai community of Guangzhou, Guangdong, China. A total of 1494 subjects (72·8%) aged over 50 years were investigated. Fasting plasma glucose (FPG₁st ) and HbA₁c were assayed in each participant. Diabetic candidates with FPG₁st ≥ 5·6 mmol/l or HbA₁c ≥ 39 mmol/mol (5·7%) were informed to undergo a 75-g oral glucose tolerance test (OGTT). Diagnosis of diabetes was made by 1999 World Health Organization criteria. Sensitivity and specificity of HbA1 c for diagnosing diabetes were calculated by receiver operating characteristics (ROC) curve.

RESULTS

Among 1494 subjects, 161 subjects (10·8%) with previously diagnosed diabetes and 21 with missing data were excluded. Among the remaining 1312 subjects (87·8%), 861 subjects (65·6%) with either FPG1st ≥ 5·6 mmol/l or HbA₁c ≥ 39 mmol/mol (5·7%) were invited to perform OGTT. Finally, 453 subjects (52·6%) performed OGTT (FPG₂nd and 2-h plasma glucose were measured) and 54 subjects (11·9%) were identified as being diabetes. The area under ROC curve was 0·916 (0·887-0·940) for HbA₁c and 0·972 (0·953-0·985) for FPG₂nd in diagnosing diabetes (P = 0·045). An HbA₁c threshold of 48 mmol/mol (6·5%) yielded the highest combination of sensitivity (75·9%) and specificity (95·5%) for diagnosing diabetes.

CONCLUSION

An HbA1 c threshold of 48 mmol/mol (6·5%) was highly specific and had a good sensitivity for diagnosing diabetes among Chinese subjects aged over 50 years with FPG ≥ 5·6 mmol/l or HbA₁c ≥ 39 mmol/mol (5·7%). This threshold may be suitable for diagnosing diabetes in Chinese subjects over 50 years old.

摘要

目的

对于使用糖化血红蛋白A₁c（HbA₁c）诊断50岁以上中国人群糖尿病的情况，我们了解甚少。本研究旨在评估HbA₁c在糖尿病诊断中的价值，并确定适用于50岁以上中国社区人群的最佳诊断阈值。

方法

2010年10月至2011年1月，在中国广东省广州市石牌社区进行了一项基于社区的横断面调查。共调查了1494名50岁以上的受试者（占72.8%）。对每位参与者测定空腹血糖（FPG₁st）和HbA₁c。FPG₁st≥5.6 mmol/l或HbA₁c≥39 mmol/mol（5.7%）的糖尿病疑似患者被通知进行75g口服葡萄糖耐量试验（OGTT）。根据1999年世界卫生组织标准诊断糖尿病。通过受试者工作特征（ROC）曲线计算HbA₁c诊断糖尿病的敏感性和特异性。

结果

在1494名受试者中，排除161名（10.8%）先前诊断为糖尿病的受试者和21名数据缺失的受试者。在其余1312名受试者（87.8%）中，861名（65.6%）FPG₁st≥5.6 mmol/l或HbA₁c≥39 mmol/mol（5.7%）的受试者被邀请进行OGTT。最终，453名受试者（52.6%）进行了OGTT（测定了FPG₂nd和2小时血糖），54名受试者（11.9%）被确诊为糖尿病。HbA₁c诊断糖尿病的ROC曲线下面积为0.916（0.887 - 0.940），FPG₂nd诊断糖尿病的ROC曲线下面积为0.972（0.953 - 0.985）（P = 0.045）。HbA₁c阈值为48 mmol/mol（6.5%）时，诊断糖尿病的敏感性（75.9%）和特异性（95.5%）组合最佳。