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| 題 名 | 糖化血色素對於篩檢葡萄糖耐量異常高血糖其敏感性與特異性之分析=The Sensitivity and Specificity of HbA1c to Screen Glucose Intolerance and Diabetes |
|---|---|
| 作 者 | 花雀惠; 李弘元; 林怡如; 洪玉鳳; 周自賢; 簡毓芬; | 書刊名 | Journal of Biomedical & Laboratory Sciences |
| 卷 期 | 18:1-4 2006[民95] |
| 頁 次 | 頁1-6 |
| 分類號 | 415.668 |
| 關鍵詞 | 糖尿病; 葡萄糖耐量異常; 糖化血色素; 空腹血漿葡萄糖濃度; 口服葡萄糖耐量試驗二小時後血漿葡萄糖濃度; Diabetes; Impaired glucose tolerance; HbA1c; Fasting plasma glucose; 2-H postload glucose; |
| 語 文 | 中文(Chinese) |
| 中文摘要 | 根據美國糖尿病學會及世界衛生組織的最新建議，診斷糖尿病的黃金標準為空腹血漿葡萄糖濃度 ≥ 126 mg/dl，或口服葡萄糖耐量試驗二小時後血漿葡萄糖濃度≥ 200 mg/dl。進行口服葡萄糖耐量 試驗相當費時及耗事，因此不適用於大量篩檢。許多流行病學研究調查表示，單靠空腹血糖濃度 的測試，對於葡萄糖耐量異常糖尿病的診斷，其敏感度仍顯不足。因此本研究目的是評估空腹血 糖正常的病人，利用HbA1c及ROC曲線(receiver operating curve)的檢測來診斷其是否有葡萄糖 耐量異常糖尿病的效益。本實驗共收集500位屬於糖尿病高危險群的成人，每位皆檢測其空腹血 糖、HbA1c，並進行口服葡萄糖耐量試驗。結果顯示：有316位空腹血糖在正常範圍下(< 100 mg/dl)，其葡萄糖耐量試驗結果正常(n = 237)與異常(口服葡萄糖耐量試驗二小時後血漿葡萄糖濃 度介於140 mg/dl 至200 mg/dl之間者，n = 79)兩組間，HbA1c平均值分別為5.3±0.5%和5.5± 0.7%，雖有統計上顯著差異(p < 0.01)，但差值是落於可容許的實驗誤差範圍內。而與口服葡萄糖 耐量試驗二小時後血漿葡萄糖濃度≥ 140 mg/dl的結果相關性最好的HbA1c臨界值是5.8%，其敏 感度與特異性分別可達61%與81%，而ROC曲線下面積則為0.72。若改以5.4%做為HbA1c的臨 界值，則可將敏感度稍提高至75%，但特異性卻下降為49%。本研究結論是：對於診斷葡萄糖耐 量異常或糖尿病而言，HbA1c無論在敏感度或是特異性，都無法有效提供較空腹血糖更多有利的 參考數據。此外，對於糖尿病高危險群個體而言，即使空腹血糖小於100 mg/dl，還是建議要加 測口服葡萄糖耐量試驗二小時後血漿葡萄糖濃度試驗，以找出其中潛藏的高比例葡萄糖耐量異常 患者。 |
| 英文摘要 | According to the criteria by the American Diabetes Association and the World Health Organization, the definition to diagnose diabetes is fasting plasma glucose (FPG) levels ≥ 126 mg/dl, or 2-h postload glucose (2hPG) levels ≥ 200 mg/dl during an oral glucose tolerance test (OGTT). To perform an OGTT is inconvenient and time-consuming. Therefore, it is not suitable for a large-scale screening program. However, to screen diabetes of impaired glucose tolerance by simply FPG testing is insensitive, as shown by several epidemiological reports. For this reason, we conducted this study to evaluate the role of HbA1c and receiver operating curve (ROC) in diagnosing diabetes of impaired glucose tolerance for patients with a normal FPG situation. A total of 500 adult subjects with high risks of diabetes were included and undergone the measurement of FPG, HbA1c and OGTT. A total of 316 subjects had a normal FPG level (< 100 mg/dl). For these subjects, although HbA1c levels were significantly higher in subjects with 2hPG levels ranged between 140 and 200 mg/dl (n=79; mean HbA1c, 5.5±0.7%) than those with a normal OGTT result (n=237; mean HbA1c, 5.3±0.5%, p < 0.01), the differences were within the acceptable variations that could occur among different runs of examinations. The optimal cut-off value of HbA1c to be correlated with 2hPG levels of ≥ 140 mg/dl was 5.8%, with a sensitivity of 61% and a specificity of 81% (area under ROC curve = 0.72). Using a cut-off value of 5.4% would improve the sensitivity to 75%, in the cost of a lowered specificity of 49%. In conclusion, HbA1c did not provide additional power than FPG alone to diagnose impaired glucose tolerance or diabetes from the viewpoint of either sensitivity or specificity. Furthermore, for subjects with high risks of diabetes, screening with OGTT is suggested to identify the relatively high proportion of patients with cryptic impaired glucose tolerance or diabetes, even if their FPG levels are apparently less than 100 mg/dl. |
本系統中英文摘要資訊取自各篇刊載內容。