【摘要】 目的探讨2型糖尿病(T2DM)及其高危人群筛查适宜而有效的方法。方法选择首钢四个社区的16 056例T2DM普查人群,同时测定空腹血糖(FPG)、口服葡萄糖耐量试验(OGTT)后2 h血糖值(2 h PG)及糖化血红蛋白(Hb A1c),筛查T2DM患者及高危人群。结果 (1)以WHO(1999年)糖尿病诊断标准FPG≥7.0 mmol/L,2 h PG≥11.1 mmol/L,筛出T2DM患者2 011例(12.52%),T2DM高危人群4 334例(26.99%)。(2)按2010年ADA的糖尿病诊断标准筛查T2DM患者:单检测Hb A1c≥6.5%灵敏度为53.41%,漏诊46.59%;单检测FPG≥7.0 mmol/L灵敏度为49.98%,漏诊率50.02%。糖尿病高危人群:Hb A1c≥6.0%或FPG≥6.0 mmol/L灵敏度为69.4%。(3)应用受试者工作特征(ROC)曲线进行统计分析,与OGTT诊断糖尿病相关的FPG最佳切点为6.1 mmol/L,灵敏度和特异度分别为75.5%和90.3%;Hb A1c最佳切点为6.2%,灵敏度和特异度分别为71.4%和84.5%。与OGTT诊断T2DM及高危人群相关的FPG最佳切点为5.7 mmol/L,灵敏度和特异度分别为62%和87.2%,Hb A1c最佳切点为6.0 mmol/L,灵敏度和特异度分别为57.3%和77.4%。(4)若采用联合筛查T2DM以FPG≥6.1 mmol/L或Hb A1c≥6.2%作为标准,灵敏度可达到85.3%,同时有较好的特异度78.9%;以FPG≥5.6 mmol/L或Hb A1c≥6.1%联合筛查T2DM及高危人群作为标准,灵敏度74.4%,特异度71.5%。结论 Hb A1c与FPG联合测定是一种筛查诊断T2DM及糖尿病高危人群方便而有效的方法,建议对5.6 mmol/L≤FPG≤7 mmol/L或Hb A1c≥6.1%的人群应行OGTT,以降低糖尿病的漏诊率。更多还原

【Abstract】 Objective To explore the suitable ways screening of type 2 diabetes mellitus(T2DM) and DM related high-risk population. Methods The 16 056 subjects from Shougang community were studied. The oral glucose tolerance test(OGTT) was performed and the Hb A1 c, FPG and 2 h PG were examined in all subjects in the screening. Receiver operating characteristic(ROC) curve analysis was used to examine the sensitivity and specificity of FPG, Hb A1 c and 2 h PG for diagnosing T2 DM and DM related high-risk population, which was defined by the standard from WHO in 1999. Results According to the OGTT standard of screening for DM, which was FPG≥7.0 mmol/L or 2 h PG≥11.1 mmol/L, the detection rates were 12.52% for T2 DM and 26.99% for DM related high-risk population. With Hb A1c≥6.5% for the screen of DM, the rate of missed diagnosis was 46.59%. With FPG≥7.0 mmol/L, the rate of missed diagnosis was 50.02%. Based on the ROC curve, the optimal cut-points of FPG related to the OGTT-diagnostic criteria for DM was 6.1 mmol/L which was associated with a sensitivity and specificity of 75.5% and 90.3% respectively. The optimal cut-points of Hb A1 c related to T2 DM diagnosis by OGTT was 6.2%, which was associated with a sensitivity and specificity of 71.4% and 84.5% respectively. The optimal cut-points of 2 h PG related to T2 DM diagnosis by OGTT was 11.1%, which was associated with a sensitivity and specificity of 87.7% and 100% respectively. The optimal cut-points of FPG related to the OGTT-diagnostic criteria for T2 DM and DM related high-risk population was 5.7 mmol/L which was associated with a sensitivity and specificity of 62% and 87.2% respectively. The optimal cut-points of Hb A1 c related to T2 DM and DM related high-risk population diagnosis by OGTT was 6.0%, which was associated with a sensitivity and specificity of 57.3% and 77.4% respectively. The optimal cut-points of 2 h PG related to T2 DM and DM related high-risk population diagnosis by OGTT was 7.8%, which was associated with a sensitivity and specificity of 86.7% and 100% respectively. The screening model using FPG≥6.1 mmol/L or Hb A1c≥6.2% had sensitivities 85.3% for detecting T2 DM and using FPG≥5.6 mmol/L or Hb A1 c ≥ 6.1% had sensitivities 74.4% for detecting T2 DM and DM related high-risk population. Conclusions The simultaneous measurement of FPG and Hb A1 c might be a more sensitive and specific screening tool for identifying high-risk individuals for T2 DM at an early stage.更多还原