本文選題：糖化血紅蛋白 + 篩查診斷�。� 參考：《青海大學》2017年碩士論文

【摘要】：目的探討西寧地區(qū)篩查和診斷糖尿病時應采用的糖化血紅蛋白(HbA1c)的最佳切點值,為青海地區(qū)研究HbA1c診斷DM提供數(shù)據(jù)資料,為我國學者完善高原地區(qū)相關資料提供參考。方法選取2015年1月至2016年10月期間,青海省西寧市范圍內就診于青海大學附屬醫(yī)院內分泌科的糖尿病高危人群,嚴格依據(jù)入選標準和排除標準,確定研究對象,共699例,其中男性439例,女性260例。所有研究對象均在青海大學附屬醫(yī)院行口服葡萄糖耐量試驗(OGTT)及檢測HbA1c,血樣統(tǒng)一送交該院檢驗科完成檢驗。結果(1)本研究699例研究對象中,男性439例(占62.8%),女性260例(占37.2%)。以1999年糖代謝分類標準,其中DM組共369例(占52.8%),IGR組共148例(占21.2%),NGT組共182例(占26.0%)。(2)以OGTT為診斷DM的“金標準”,繪制FPG、OGTT、HbA1c三種檢測方法的受試者工作特征曲線(ROC曲線),可得出采用OGTT2hPG診斷DM優(yōu)于HbA1c,而應用HbA1c診斷DM則優(yōu)于FPG:三者相比,OGTT2hPG曲線下面積為:0.999(95%CI 0.998~1.000);HbA1c的曲線下面積為:0.972(95%CI 0.962~0.983);FPG的曲線下面積:0.959(95%CI 0.945~0.973)。(3)通過繪制ROC曲線找到HbA1c診斷DM的最佳切點值為6.45%,此切點對應的敏感度為87.3%,特異度為98.5%,陽性預測值為98.5%,陰性預測值為87.4%;用于糖尿病前期(即IGR)的早期篩查所采用的HbA1c最佳切點值為5.65%,其敏感度為58.8%,特異度為75.3%,陽性預測值和陰性預測值分別為65.9%和69.2%。結論(1)應用HbA1c診斷DM優(yōu)于FPG。(2)HbA1c在西寧地區(qū)糖尿病高危人群中篩查糖尿病前期(IGR)和診斷糖尿病(DM)的最佳切點值分別為5.65%和6.45%。(3)應用HbA1c"g6.45%作為糖尿病診斷標準的敏感度高于應用FPG"g7.0mmol/L作為診斷標準的敏感度,但比OGTT2h"g11.1mmol/L作為診斷標準的敏感度低。
[Abstract]:Objective to explore the optimal value of HbA1c for screening and diagnosis of diabetes mellitus in Xining, and to provide data for the study of HbA1c in Qinghai, and to provide reference for Chinese scholars to perfect the relevant data in plateau area. Methods from January 2015 to October 2016, a total of 699 patients with diabetes mellitus were selected from the Department of Endocrinology of Qinghai University affiliated Hospital in Xining, Qinghai Province, according to the selection criteria and exclusion criteria. There were 439 males and 260 females. All subjects were given oral glucose tolerance test (OGTT) and HbA1c in the affiliated hospital of Qinghai University. The blood samples were sent to the laboratory of Qinghai University to complete the test. Results 1) of the 699 subjects in this study, 439 (62.8%) were males and 260 (37.2%) females. According to the classification criteria of glucose metabolism in 1999, there were 369 cases (52.8%) in DM group (148 cases in IGR group) (182 cases (26.0%) in NGT group). OGTT was taken as the "gold standard" for the diagnosis of DM. By drawing the operating characteristic curve and ROC curve of subjects using OGTT2hPG and HbA1c, it can be concluded that using OGTT2hPG is superior to HbA1cand using HbA1c to diagnose DM is superior to FPG: the area under the OGTT2hPG curve is 1: 0.9999 95CI 0.9981.000 HbA1c. The area under the curve is: 0.972995 CI 0.9620.983FPG Below line area: 0.959995 CI 0.945 0.973t. 3) by drawing the ROC curve, the best point of HbA1c for the diagnosis of DM is 6.45. The sensitivity of this point is 87.3, the specificity is 98.5, the positive predictive value is 98.5, and the negative predictive value is 87.4. It is used in the early stage of diabetes mellitus (IGR). The optimum point of HbA1c was 5.65, the sensitivity was 58.8, the specificity was 75.3, the positive predictive value and negative predictive value were 65.9% and 69.2%, respectively. Conclusion HbA1c is better than FPG.2HbA1c in screening prediabetic IGR and diagnosing DM in Xining area. The sensitivity of HbA1c "g6.45% is higher than that of HbA1c" g6.45%. Using FPG "g 7.0 mmol / L" as diagnostic criteria, But it was less sensitive than OGTT 2h "g 11.1 mmol / L as diagnostic criteria."
【學位授予單位】：青海大學
【學位級別】：碩士
【學位授予年份】：2017
【分類號】：R587.1

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