空腹及餐后血糖与糖化血红蛋白在评估血糖控制中的相关性：系统评价与Meta分析
Correlation of fasting and postprandial plasma glucose with HbA1c in assessing glycemic control; systematic review and meta-analysis.
作者信息
Ketema Ezra Belay, Kibret Kelemu Tilahun
机构信息
Department of Biochemistry, College of Health Science, Mekelle University, Mekelle, Ethiopia.
Department of Public Health, College of Medical and Health Science, Wollega University, Nekemte, Ethiopia.
出版信息
Arch Public Health. 2015 Sep 25;73:43. doi: 10.1186/s13690-015-0088-6. eCollection 2015.
BACKGROUND
Glycemic control in diabetes mellitus is a cornerstone in reducing morbidity and mortality of the disease. Achieving glycemic control or reducing hyperglycemia significantly decreases the microvascular and macrovascular complications of diabetes. Even though measurement of glycated hemoglobin (HbA1c) remains the gold standard for assessment of glycemic control, there is no consensus whether fasting or postprandial plasma glucose (PPG) is a better predictor of glycemic control in resource-poor settings when HbA1c is not available. The aim of this systematic review and meta-analysis was to summarize evidences on the significance of fasting and postprandial plasma glucose, and their correlation with HbA1c.
METHODS
Relevant studies were identified through systematic search of online databases (e.g. EMBASE, MEDLINE/PubMed and Cochrane library) and manual search of bibliographies of the included studies. Original research papers describing the correlations or associations of fasting and postprandial plasma glucose with HbA1c were included. The MedCalc software was used for data entry and analysis. We used the random effect model to estimate the pooled correlations of fasting and postprandial plasma glucose with HbA1c. Heterogeneity assessment and robustness analysis was also performed.
RESULT
From total 126 articles identified, 14 articles were eligible for systemic review. Eleven of these eligible studies evaluated the correlations of fasting and postprandial plasma glucose to the standard HbA1c values and used in meta-analysis. Seven of these studies (63.5 %) found better or stronger correlations between PPG and HbA1c than fasting plasma glucose (FPG). In all the studies that estimated the relative contribution FPG and PPG to the overall hyperglycemia, decreases in PPG was accounted for greater decrease in HbA1c compared with decreases in FPG value. PPG also showed a better sensitivity, specificity and positive predictive value than FPG. The pooled correlation coefficient (r) between PPG and HbA1c was 0.68 (P < 0.001, 95 % CI; 0.56-0.75) slightly higher than pooled correlation coefficient of FPG (r = 0.61(P < 0.001, 95 % CI; 0.48-0.72)).
CONCLUSION
PPG has a closer association with HbA1c than FPG. Hence, PPG is better in predicting overall glycemic control in the absence of HbA1c.
背景
糖尿病的血糖控制是降低该疾病发病率和死亡率的基石。实现血糖控制或降低高血糖水平可显著减少糖尿病的微血管和大血管并发症。尽管糖化血红蛋白（HbA1c）的测定仍是评估血糖控制的金标准，但在资源匮乏地区，当无法检测HbA1c时，空腹血糖或餐后血糖（PPG）哪一个是血糖控制更好的预测指标尚无定论。本系统评价和荟萃分析的目的是总结关于空腹血糖和餐后血糖的意义及其与HbA1c相关性的证据。
方法
通过系统检索在线数据库（如EMBASE、MEDLINE/PubMed和Cochrane图书馆）以及手动检索纳入研究的参考文献来识别相关研究。纳入描述空腹血糖和餐后血糖与HbA1c相关性或关联性的原始研究论文。使用MedCalc软件进行数据录入和分析。我们采用随机效应模型来估计空腹血糖和餐后血糖与HbA1c的合并相关性。还进行了异质性评估和稳健性分析。
结果
在总共识别出的126篇文章中，有14篇符合系统评价的标准。其中11项符合条件的研究评估了空腹血糖和餐后血糖与标准HbA1c值的相关性，并用于荟萃分析。这些研究中有7项（63.5%）发现PPG与HbA1c之间的相关性优于或强于空腹血糖（FPG）。在所有估计FPG和PPG对总体高血糖相对贡献的研究中，与FPG值下降相比，PPG下降导致HbA1c下降幅度更大。PPG在敏感性、特异性和阳性预测值方面也优于FPG。PPG与HbA1c之间的合并相关系数（r）为0.68（P<0.001，95%CI：0.56 - 0.75），略高于FPG的合并相关系数（r = 0.61（P<0.001，95%CI：0.48 - 0.72））。
结论
与FPG相比，PPG与HbA1c的关联更密切。因此，在无法检测HbA1c的情况下，PPG在预测总体血糖控制方面表现更佳。
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