早餐后2h血糖筛查糖尿病的切点及其应用
Cut-off point of 2-hours postprandial glucose and its application in screening diabetes
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摘要:目的 探讨早餐后2h血糖(2hPG)在糖尿病筛查中合适的切点及其在糖尿病筛查中的应用.方法 选择四川泸天化集团公司6 387名职工的糖尿病流行病学调查数据, 以WHO诊断标准作为金标准, 采用诊断试验评价方法及标准工作曲线(ROC)进行分析.结果 与检测空腹血糖(FPG)比较, 检测早餐后2hPG具有更好的灵敏度和特异度; FPG和早餐后2hPG的ROC曲线下面积, 男性分别为0.79, 0.962, 女性分别为0.77, 0.957, 两者间差异有统计学意义(P=0.000);当早餐后2hPG取6.65 mmol/L时, 具有最大的灵敏度和特异度, 其中男性为97.2和84.4, 在女性为93.5和89.1;一致性率(Youden’s index)男性为0.83, 女性为0.82;当早餐后2hPG取 > 6.65 mmol/L时, 所筛查出的糖耐量减低(IGT)人数几乎是FPG > 5.6 mmol/L筛查出的2倍.结论 早餐后2hPG比FPG在筛查早期糖尿病人时有更好的灵敏度和特异度, 当切点取6.65时能更好的筛查出IGT人群, 建议将早餐后2hPG作为糖尿病筛查的指标.Abstract:Objective To discuses the cut-off point of 2-hours postprandial glucose and its application on screening fo rundiagnosed population.Methods The epidemiolog y data of people in chemical industrial of Luzhou, Sichuan was reanalyzed by using diagnostic test appraise method and the receiver characteristic(ROC)curve with WHOcriteria as gold standard.Results Comparing with FPG, 2-hours postprandial glucose had high sensitivity and specificity; The area of ROCcurve was 0.79 with FPGand 0.962 with 2-h postprandial glucose in male and 0.77 with FPGand 0.957 with 2-h postprandial glucose in female, the difference had statistic significant; When cut-off point of 2-h postprandial glucose was at 6.65 mmol/L, the max imal sensitivity was 97.2% and specificity was 84.4% in male, 93.5% and 89.1% in female.The Youden's index was 0.83 and 0.82 formale and female; The numberof IGTwas nearly 2 times when using 2-h postprandial glucose≥6.65 mmol/L than using FPG≥516 mmol/L.Conclusion 2-h postprandial glucose has highersensitivity and specificity than FPGwhen screening diabetes; When cut-off pointis 6.65 mmol/L, using 2-h postprandial glucose can screeningout more IGTthan FPG.Itis suggested that 2-h postprandial glucose can be an efficientindex when screening diabetes.
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