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目的构建受试者工作特征(ROC)曲线模型,评价空腹毛细血管血糖(FCBG)、空腹血浆血糖(FPG)、糖负荷2 h血浆血糖(2HPG)、糖化血红蛋白(HbA1c)和2型糖尿病(T2DM)危险评分表(DRS)筛查无症状糖尿病患者的效果。方法使用2006年青岛糖尿病预防计划中“未被医生告知患有糖尿病”的4 070名受试者的横断面调查资料,所有受试者均测FCBG、FPG、2HPG、HbA1c,填写DRS,并行口服糖耐量实验(OGTT),以确诊无症状T2DM。比较上述5种方法筛查无症状T2DM的灵敏度、特异度及ROC曲线下的面积(AUROC)。结果 FCBG筛查无症状T2DM的灵敏度、特异度和AUROC为64.08%、69.81%和0.712;FPG为60.10%、100.00%和0.896;2HPG为67.12%、100.00%和0.898;HbA1c为40.21%、81.96%和0.673;DRS为61.50%、63.72%和0.679。FPG和2HPG的AUROC与其他3个筛查指标的AUROC差别有统计学意义;FPG与2HPG的AUROC差别无统计学意义;FCBG、HbA1c与DRS的AUROC两两比较差别无统计学意义。结论 FCBG和DRS可作为筛查无症状T2DM简单有效的一线方法;HbA1c暂不适合于社区T2DM的筛查;适当降低FPG与2HPG筛查切点可提高灵敏度,减少漏诊率。
Objective To construct a curve model of ROC curve to evaluate the effects of fasting capillary blood glucose (FCBG), fasting plasma glucose (FPG), glycemic hemoglobin (HbA1c) and type 2 diabetes mellitus (T2DM) ) Scoring of Hazard Score (DRS) for screening asymptomatic diabetic patients. Methods According to the cross-sectional survey data of 4 070 subjects who were not told to have diabetes by doctor in Qingdao Diabetes Prevention Plan in 2006, all subjects tested FCBG, FPG, 2HPG and HbA1c, and filled in DRS, Parallel oral glucose tolerance test (OGTT) to confirm asymptomatic T2DM. The sensitivity, specificity, and area under the ROC curve (AUROC) of screening the asymptomatic T2DM for these five methods were compared. Results The sensitivity, specificity and AUROC of FCBG screening for asymptomatic T2DM were 64.08%, 69.81% and 0.712, FPG was 60.10%, 100.00% and 0.896 respectively; 2HPG was 67.12%, 100.00% and 0.898; HbA1c was 40.21% and 81.96% And 0.673 respectively; DRS was 61.50%, 63.72% and 0.679. AUROC of FPG and 2HPG was significantly different from AUROC of the other three screening indexes; AUROC of FPG and 2HPG had no significant difference; AUROC of FCBG, HbA1c and DRS had no significant difference between two groups. Conclusions FCBG and DRS can be used as a simple and effective first-line method to screen asymptomatic T2DM. HbA1c is not suitable for community-based T2DM screening. Appropriate reduction of FPG and 2HPG screening points can improve the sensitivity and reduce the rate of misdiagnosis.