糖化血红蛋白在2型糖尿病诊断与防治中的临床意义
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国家自然科学基金(81070684);江苏省卫生厅兴卫工程重点个人项目(RC2011069);江苏省社会发展科技支撑计划项目(BE 2011802);南京医科大学第一附属医院创新团队(20113012)


The application value of glycated hemoglobin (HbA1c) for type 2 diabetes in diagnosis and prevention
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    目的:研究糖化血红蛋白(HbA1c)检测在2型糖尿病(T2DM)早期筛查中的应用-方法:2013年在江苏省淮安地区随机选择40岁及以上在该地区居住 6 个月以上的居民作为调查对象,共1 089例-采用统一的流行病学调查表收集调查对象的人口学特征-饮食生活习惯-对糖尿病认知度及患病史-对调查对象进行身体测量,内容包括:身高-体重-腰围和血压-采集所有调查对象晨尿-空腹静脉血和口服 82.5 g 葡萄糖粉后 2 h静脉血(有糖尿病病史者不服糖粉)-检测指标包括尿常规-血糖-生化全套-胰岛素-HbA1c-糖化白蛋白等-结果:调查中空腹血糖(FPG)诊断T2DM敏感性73.89%,误诊率26.11%;HbA1c诊断T2DM敏感性73.22%,误诊率26.78%; FPG与HbA1c联合起来共同诊断T2DM,则敏感性89.59%,误诊率为10.41%,FPG与HbA1c两种诊断结果的差异无统计学意义(P = 0.830),两种诊断方法的吻合度有统计学意义,吻合度一般(k = 0.374,Pk < 0.01)-采用稳态模型评估胰岛素抵抗指数(HOMA-IR),HbA1c ≥ 6.5%受试者的HOMA-IR均大于诊断标准(HOWA-IR ≥ 2.68)且HbA1c水平与HOMA-IR大小呈正相关(r = 0.375)-结论:FPG联合 HbA1c不仅可大大提高对T2DM诊断的准确性,还可以评价胰岛素抵抗情况和糖尿病的治疗效果-

    Abstract:

    Objective:To explore the application value of glycated hemoglobin (HbA1c) in type 2 diabetes early screening. Methods: A total of 1 089 inhabitants for 40 years old and above were from Huaian area of Jiangsu province. A questionnaire survey was established to collect demographic characteristics, dietary habits, the prevalence of diabetes awareness, and illness history. The measurement of body included: height, weight, waist circumference and blood pressure. Collection of morning urine, fasting venous blood and venous blood was obtained 2 hours after oral glucose powder 82.5 g (except who has a history of diabetes). Detection indexes included routine urine, blood sugar, biochemical full, insulin and glycosylated hemoglobin and glycosylated albumin. Results: FPG diagnosed T2DM sensitivity was 73.89%, while the misdiagnosis rate was 26.11%; HbA1c diagnosed T2DM sensitivity 73.22%, while the misdiagnosis rate was 26.78%; according to FPG joint HbA1c to diagnosis T2DM, the sensitivity was 89.59%, while the misdiagnosis rate was 10.41%. The diagnosis difference of FPG and HbA1c had no statistical significance (P=0.830). The diagnosis alignment was statistically significant, inosculation general (k=0.374, Pk < 0.01). Using HOMA-IR to assess insulin resistance (HOMA-IR), the result of HbA1c≥6.5% subjects were greater than the HOMA - IR diagnostic criteria (HOWA-IR≥2.68) and HbA1c level was positive correlated with HOWA-IR (r = 0.375). Conclusion: FPG joint HbA1c not only greatly improves the diagnostic accuracy of T2DM, also evaluates insulin resistance and the therapeutic effect of diabetes.

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黄 琼,刘梦兰,李 璐,张日化,陶 然,武 鸣,刘 云.糖化血红蛋白在2型糖尿病诊断与防治中的临床意义[J].南京医科大学学报(自然科学版),2014,(10):1363-1366

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  • 收稿日期:2014-03-23
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  • 在线发布日期: 2014-11-02
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