摘要
目的应用受试者工作特征(ROC)曲线寻找糖代谢指标预测糖尿病视网膜病变(DR)的最佳临界值。方法通过对866例大连地区≥40岁参加2011年中华医学会"中国2型糖尿病患者肿瘤发生风险的流行病学研究"中患2型糖尿病的社区居民进行横断面研究,给予免散瞳眼底数码照相检查、测定空腹血糖(FPG)、标准馒头餐后2h血糖(2hPG)、糖化血红蛋白(HbA_1c)。采用ROC曲线评价糖代谢指标与DR的相关性,寻找糖代谢指标对DR预测的切点。结果Logistic回归分析结果说明HbA_1c、糖尿病病程和舒张压是DR发生的独立危险因素。与非DR组相比,DR组受试者糖代谢指标明显增高,差异有统计学意义。FPG、2hPG及HbA_1c水平预测DR的ROC曲线下面积分别为0.624、0.614及0.615,与0.5相比差异均有统计学意义(P<0.001)。当FPG为8.10 mmol/L、2hPG为15.35 mmol/L时及HbA1c为7.45%时,预测DR的敏感度分别为72.6%、67.7%、59.6%,特异度分别为47%、51.2%、58.2%,约登指数分别为0.196、0.189及0.178,进行平行试验,预测DR的敏感度为82.51%,特异度为35.30%;应用序列试验,预测DR的敏感度为48.43%,特异度为69.82%。结论糖代谢异常在DR的发生和发展中起着重要作用。FPG、2hPG、HbA_1c可用来筛查2型糖尿病患者患DR的高风险人群,帮助提高诊断的灵敏度或特异度。
Objective To evaluate the critical value of glucose metabolism for predicting diabetic retinopathy using receiver operating characteristic curve. Methods A total of 866 type 2 diabetes aged over 40 years in Dalian area were enrolled as the subjects, who participated in epidemiological study of tumor risk of Chinese type 2 diabetes mellitus patients. Evaluated the critical value of glucose metabolism, including the fasting plasma glucose （FPG）, postprandial 2 hours blood glucose （2hPG） and glycosylated hemoglobin （HbA1c） for predicting diabetic retinopathy using receiver operating characteristic curve. Results Logistic regression analysis exhibited that HbA1c, the course of diabetes and diastolic blood pressure were independent risk factors for DR. Compared with non-diabetic retinopathy （NDR） group, the levels of glucose metabolism were higher in diabetic retinopathy （DR） group, the difference being statistically significant （P〈0.001）. The area under the ROC curve for FPG, 2hPG, and HbAlc were 0.624, 0.614 and 0.615 respectively, compared with 0.5, the difference being statistically significant （P〈0.001）. When FPG was 8.10mmol/L, 2hPG was 15.35 mmol/L and HbAlc was 7.45%, the sensitivity was 72.6%, 67.7% and 59.6%, the specificity was 47%, 51.2% and 58.2%, the Youden index was 0.196, 0.189 and 0.178. Using the parallel test, the sensitivity was 82.51%, and the specificity was 35.30%. Using the serial test the sensitivity was 48.43%, and the specificity was 69.82%. Conclusion Disorder of glucose metabolism plays an important role in the development of diabetic retinopathy. FPG, 2hPG and HbA1c can be used to screen the high-risk group with diabetic retinopathy in type 2 diabetes and improve the sensitivity and specificity of diagnosis..
出处
《中国实用内科杂志》
CAS
CSCD
北大核心
2016年第2期141-144,共4页
Chinese Journal of Practical Internal Medicine
基金
中华医学会内分泌学分会研究经费资助(2011-8-12)
