Hartman Mor-Li, Goodson J Max, Barake Roula, Alsmadi Osama, Al-Mutawa Sabiha, Ariga Jitendra, Soparkar Pramod, Behbehani Jawad, Behbehani Kazem, Welty Francine
Department of Applied Oral Sciences, The Forsyth Institute, Cambridge, MA, USA.
Department of Nutrition, The Dasman Diabetes Institute, Dasman, Kuwait.
Diabetes Metab Syndr Obes. 2014 Dec 17;8:9-15. doi: 10.2147/DMSO.S72744. eCollection 2015.
Metabolic syndrome in childhood predicts the development of cardiovascular disease and type 2 diabetes (T2D) in adulthood. Testing for features of metabolic syndrome, such as fasting plasma glucose concentration, requires blood sampling which can be difficult in children. Here we evaluated salivary glucose concentration as a surrogate measurement for plasma glucose concentration in 11-year-old US children.
Children from Portland, Maine, and Cambridge, Massachusetts, with a mean age of 10.6±0.2 years provided 6-hour fasting samples of both blood and whole saliva. Salivary glucose levels were measured with a high-sensitivity assay (sensitivity =0.002 mg/dL). Plasma glucose levels were determined by a commercial clinical laboratory. Blood pressure, salivary flow rate, height, and weight were also measured.
Of the 65 children enrolled, there were two underweight children (3.1%), 30 normal-weight children (46.2%), 12 overweight children (18.4%), and 21 obese children (32.3%). The mean overall glucose concentrations were 0.11±0.02 mg/dL in saliva and 86.3±0.8 mg/dL in plasma, and these did not differ significantly by body-weight groups. By regression analysis, the plasma concentration equaled 13.5 times the saliva concentration, with a threshold level of 84.8 mg/dL. Salivary glucose values less than threshold plasma concentration were essentially zero. Diagnostic analysis indicated a positive predictive value of 50%, a negative predictive value of 90%, and a sensitivity and specificity both of approximately 75%. The salivary glucose concentration did not vary with saliva flow rate.
Taking into account the threshold response characteristics of the salivary glucose concentration response, these results suggest that testing salivary glucose levels may be useful as a screening assay for high fasting plasma glucose levels. The low false positive value is important to assure a low fraction of missed diagnoses.
儿童期代谢综合征可预测成年后心血管疾病和2型糖尿病（T2D）的发生。检测代谢综合征的特征，如空腹血糖浓度，需要采集血样，而这对儿童来说可能具有挑战性。在此，我们评估了唾液葡萄糖浓度作为美国11岁儿童血浆葡萄糖浓度的替代测量指标。
来自缅因州波特兰市和马萨诸塞州剑桥市的儿童，平均年龄为10.6±0.2岁，提供了禁食6小时后的血样和全唾液样本。采用高灵敏度检测方法（灵敏度=0.002mg/dL）测量唾液葡萄糖水平。血浆葡萄糖水平由商业临床实验室测定。同时测量血压、唾液流速、身高和体重。
在纳入的65名儿童中，有2名体重过轻儿童（3.1%），30名正常体重儿童（46.2%），12名超重儿童（18.4%）和21名肥胖儿童（32.3%）。唾液中平均总葡萄糖浓度为0.11±0.02mg/dL，血浆中为86.3±0.8mg/dL，不同体重组之间无显著差异。通过回归分析，血浆浓度等于唾液浓度的13.5倍，阈值水平为84.8mg/dL。低于阈值血浆浓度的唾液葡萄糖值基本为零。诊断分析显示，阳性预测值为50%，阴性预测值为90%，灵敏度和特异性均约为75%。唾液葡萄糖浓度不随唾液流速变化。
考虑到唾液葡萄糖浓度反应的阈值响应特征，这些结果表明检测唾液葡萄糖水平可能作为空腹血浆葡萄糖水平升高的筛查方法。低假阳性值对于确保低漏诊率很重要。
