补充使用糖化血红蛋白（HbA1c）作为高血糖标准来检测代谢综合征。
Supplementary use of HbA1c as hyperglycemic criterion to detect metabolic syndrome.
作者信息
Siu Parco M, Yuen Queenie S
机构信息
Department of Health Technology and Informatics, Faculty of Health and Social Sciences, The Hong Kong Polytechnic University, Hung Hom, Hong Kong China.
出版信息
Diabetol Metab Syndr. 2014 Nov 6;6(1):119. doi: 10.1186/1758-5996-6-119. eCollection 2014.
BACKGROUND
Metabolic syndrome (MetS) refers to a cluster of cardiovascular risk factors including hyperglycemia, dyslipidemia, abdominal obesity and hypertension. An effective detection of MetS not only reflects the prediction risk of diabetes mellitus and cardiovascular diseases but also helps to plan for management strategy which could reduce the healthcare burden of the society. This study aimed to compare the use of hemoglobin A1c (HbA1c) to fasting plasma glucose (FPG) as the hyperglycemic component in MetS diagnosis.
METHODS
Waist circumference, blood pressure, blood triglyceride, high-density lipoprotein (HDL)-cholesterol, FPG, and HbA1c were examined in 120 Hong Kong Chinese adults with MetS and 120 without MetS. After reviewing the subject basal characteristics, 11 of them were found with undiagnosed diabetes (FPG ≧7.0 mmol/L) and were excluded for further analysis.
RESULTS
The most prevalent MetS components among the included subjects were elevated systolic blood pressure and central obesity. Significant correlation relationships existed between FPG and HbA1c in both subject pools diagnosed with and without MetS (p < 0.001). The diagnostic rate of MetS using HbA1c was compared to FPG by the receiver operating characteristics (ROC) analysis which suggested an area under curve of 0.807 (95% CI: 0.727 to 0.887). The agreement was 90.7% in MetS-positive group with increased FPG as one of the criterion co-existed with elevated HbA1c. If including HbA1c as an additional criterion to FPG in the MetS diagnosis, 30 more participants in MetS-negative group would be MetS-positive leading to an increase in detection rate. Furthermore, 47 subjects (38 from MetS-positive group and 9 from MetS-negative group) were found having HbA1c ≧6.5%, who would have been diagnosed with diabetes based on the diagnostic criteria implemented by the Expert Group in 2009.
CONCLUSION
These findings suggest that HbA1c enhances the detection of hyperglycemia for the diagnosis of MetS.
背景
代谢综合征（MetS）是指一组心血管危险因素，包括高血糖、血脂异常、腹型肥胖和高血压。有效检测MetS不仅反映糖尿病和心血管疾病的预测风险，还有助于制定管理策略，从而减轻社会的医疗负担。本研究旨在比较糖化血红蛋白（HbA1c）与空腹血糖（FPG）作为MetS诊断中高血糖成分的应用情况。
方法
对120名患有MetS的中国香港成年人和120名未患MetS的成年人进行腰围、血压、血甘油三酯、高密度脂蛋白（HDL）胆固醇、FPG和HbA1c检查。在审查受试者的基础特征后，发现其中11人患有未确诊的糖尿病（FPG≧7.0 mmol/L），并将其排除以进行进一步分析。
结果
纳入研究的受试者中最常见的MetS成分是收缩压升高和中心性肥胖。在诊断为MetS和未诊断为MetS的两组受试者中，FPG与HbA1c之间均存在显著的相关性（p＜0.001）。通过受试者工作特征（ROC）分析比较了使用HbA1c与FPG诊断MetS的情况，结果显示曲线下面积为0.807（95%CI：0.727至0.887）。在MetS阳性组中，以FPG升高作为标准之一且同时伴有HbA1c升高时，一致性为90.7%。如果在MetS诊断中把HbA1c作为FPG的附加标准，MetS阴性组中将有30多名参与者变为MetS阳性，导致检出率增加。此外，发现47名受试者（38名来自MetS阳性组，9名来自MetS阴性组）的HbA1c≧6.5%，根据2009年专家组实施的诊断标准，这些人原本会被诊断为糖尿病。
结论
这些发现表明，HbA1c可提高用于MetS诊断的高血糖检测率。
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