1 Service Endocrinologie, Diabétologie, Centre Hospitalier Universitaire-Dijon, France.
2 Service de Réadaptation Cardiaque, Clinique Les Rosiers, France.
Eur J Prev Cardiol. 2018 Mar;25(5):464-471. doi: 10.1177/2047487317754011. Epub 2018 Jan 26.
Introduction Diabetes and pre-diabetes are highly prevalent in patients with a history of acute coronary syndrome. This is why screening for glucose metabolism disorders is recommended in patients following an acute coronary syndrome. The aim of our study was to determine whether glycated haemoglobin alone compared with the oral glucose tolerance test could allow effective screening for glucose metabolism disorders in acute coronary syndrome patients undergoing cardiac rehabilitation. Patients and methods Among 347 patients with a recent history of acute coronary syndrome enrolled in our cardiac rehabilitation centre, 267 patients without previously known diabetes were recruited for this prospective study with performance of both oral glucose tolerance test and glycated haemoglobin measurement. The patients were divided into three groups: newly diagnosed diabetes mellitus, pre-diabetes and normoglycaemia according to the oral glucose tolerance test and glycated haemoglobin results. The results obtained with glycated haemoglobin were compared with those obtained with the oral glucose tolerance test, considered as the reference. Results For the diagnosis of diabetes, glycated haemoglobin had a sensitivity of 72% and a specificity of 100%. Positive and negative predictive values were high at 100% and 96%, respectively. However, for the diagnosis of pre-diabetes the sensitivity of glycated haemoglobin was low at 64% as were the specificity (53%) and the positive predictive values (37%). Glycated haemoglobin overdiagnosed pre-diabetes (52% vs 30%, p < 0.0001). For the diagnosis of normoglycaemia, the sensitivity of glycated haemoglobin was also low (48%). Conclusion According to our study, glycated haemoglobin has low sensitivity and specificity for the detection of pre-diabetes in patients with coronary disease enrolled in cardiac rehabilitation, and glycated haemoglobin over-diagnoses pre-diabetes in comparison with the oral glucose tolerance test.
简介
糖尿病和糖尿病前期在急性冠状动脉综合征患者中患病率很高。这就是为什么建议对急性冠状动脉综合征患者进行葡萄糖代谢紊乱筛查。我们的研究目的是确定糖化血红蛋白是否可以单独与口服葡萄糖耐量试验相比，在接受心脏康复的急性冠状动脉综合征患者中有效地筛查葡萄糖代谢紊乱。
患者和方法
在我们的心脏康复中心登记的最近有急性冠状动脉综合征病史的 347 名患者中，招募了 267 名没有已知糖尿病的患者进行这项前瞻性研究，同时进行口服葡萄糖耐量试验和糖化血红蛋白测量。根据口服葡萄糖耐量试验和糖化血红蛋白结果，患者被分为三组：新诊断的糖尿病、糖尿病前期和血糖正常。将糖化血红蛋白的结果与口服葡萄糖耐量试验的结果进行比较，后者被视为参考。
结果
糖化血红蛋白对糖尿病的诊断具有 72%的敏感性和 100%的特异性。阳性和阴性预测值分别为 100%和 96%，非常高。然而，对于糖尿病前期的诊断，糖化血红蛋白的敏感性较低（64%），特异性（53%）和阳性预测值（37%）也较低。糖化血红蛋白过度诊断了糖尿病前期（52%比 30%，p < 0.0001）。对于血糖正常的诊断，糖化血红蛋白的敏感性也较低（48%）。
结论
根据我们的研究，糖化血红蛋白对接受心脏康复的冠心病患者中糖尿病前期的检测具有较低的敏感性和特异性，并且与口服葡萄糖耐量试验相比，糖化血红蛋白过度诊断了糖尿病前期。
