Cutoff Value of HbA1c for Predicting Diabetes and Prediabetes in a Chinese High Risk Population Aged Over 45

糖化血红蛋白在中国45岁以上糖尿病高危人群糖尿病及糖尿病前期诊断的界点

Ruyi Zhang ； Jiao Wang ； Jin-Hua Luo ； Xiao-Yan Yang ； Rui Yang ； Dehong Cai ； Hua Zhang

《Asia Pacific Journal of Clinical Nutrition》 24卷3期 (2015/09) Pp. 360-366

https://doi.org/10.6133/apjcn.2015.24.3.14

摘要

目的：探讨糖化血红蛋白（HbA1c）在中国中老年糖尿病高危人群中是否存在诊断糖尿病及糖尿病前期的界点。方法：随机抽取广州市5个社区619名45岁或以上的中老年人填写芬兰糖尿病风险积分表（FINDRSC），积分9分定义为糖尿病高危人群。随后对筛查出的糖尿病高危人群（共208例）进行生化指标的检测，同时使用口服葡萄糖耐量试验（OGTT）及HbA1c诊断糖尿病及糖尿病前期，使用受试者工作特征（ROC）曲线下面积判断HbA1c或HbA1c联合空腹血浆血糖（FPG）在诊断糖尿病及糖尿病前期的诊断效能。结果：在这组糖尿病高危人群中，HbA1c诊断糖尿病及糖尿病前期的界值分别为5.8%及5.4%，其ROC曲线下面积分别为0.85（95% CI：0.80-0.90）及0.62（95% CI：0.54-0.70）；而HbA1c联合FPG诊断糖尿病及糖尿病前期的ROC曲线下面积均比前者大，且在诊断糖尿病中具有更高的灵敏度，而在诊断糖尿病前期中具有更高的特异度及阳性预测值。但是单用HbA1c或联合FPG诊断糖尿病的ROC曲线下面积之间差异无统计学意义（p=0.173）。结论：FINDRSC是筛查糖尿病高危人群的有效量表。在中国45岁或以上的中老年糖尿病高危人群中HbA1c诊断糖尿病及糖尿病前期的界值分别为5.8%及5.6%，但是其特异度及敏感度相对较低，因此需要联合FPG增加其预测疾病的可靠性。

關鍵字

诊断界值 ； 糖化血红蛋白 ； 糖尿病 ； 糖尿病前期 ； 风险

並列摘要

Objective: To evaluate the cutoff value of HbA1c for predicting diabetes and prediabetes in a Chinese high risk population aged over 45. Methods: A total of 619 people aged over 45 without diabetes were randomly recruited to complete the Finnish Diabetes Risk Score (FINDRISC) questionnaire. 208 high-risk individuals (defined by Diabetes Risk Score ≥9) had OGTT and HbA1c determined at the same time. Results: In a Chinese population aged over 45, the best cutoff values of HbA1c for detecting diabetes and prediabetes were 5.8% and 5.4% respectively. The area under the receiver operating characteristic (AUROC) curve of HbA1c for detecting diabetes was 0.85 (95% CI: 0.80-0.90) and prediabetes was 0.62 (95% CI: 0.54-0.70). The combined use of HbA1c and fasting blood glucose (FPG) had a larger AUROC than HbA1c alone (0.88, 95%CI: 0.83-0.92 in detecting diabetes vs 0.75, 95% CI: 0.67-0.82 in prediabetes), and had a higher sensitivity in predicting diabetes and higher specificity and positive predictive value (PPV) in predicting prediabetes. However, the AUROC between HbA1c alone and combined use in predicting diabetes was not significantly different (p=0.173). Conclusions: FINDRISC is a feasible tool to screen people who are at high risk of diabetes. The cutoff values of HbA1c to diagnose diabetes and prediabetes in a Chinese high risk population aged over 45 were 5.8% and 5.4%, respectively. The sensitivity and specificity of HbA1c for detecting diabetes and prediabetes were relatively low, so that the combined use of HbA1c and FPG may be more effective in prediction.

並列關鍵字

cutoff ； HbA1c ； diabetes ； prediabetes ； risk