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糖化血紅蛋白篩查青春期前兒童血糖異常的效果研究

婁珂 董彬 鄧睿 周斯亮 李星秀 馬軍

婁珂, 董彬, 鄧睿, 周斯亮, 李星秀, 馬軍. 糖化血紅蛋白篩查青春期前兒童血糖異常的效果研究[J]. 中國學校衛生, 2021, 42(10): 1544-1547. doi: 10.16835/j.cnki.1000-9817.2021.10.024
引用本文: 婁珂, 董彬, 鄧睿, 周斯亮, 李星秀, 馬軍. 糖化血紅蛋白篩查青春期前兒童血糖異常的效果研究[J]. 中國學校衛生, 2021, 42(10): 1544-1547. doi: 10.16835/j.cnki.1000-9817.2021.10.024
LOU Ke, DONG Bin, DENG Rui, ZHOU Siliang, LI Xingxiu, MA Jun. Effectiveness effects of screening elevated blood glucose of pre-pubertal children with HbA1c[J]. CHINESE JOURNAL OF SCHOOL HEALTH, 2021, 42(10): 1544-1547. doi: 10.16835/j.cnki.1000-9817.2021.10.024
Citation: LOU Ke, DONG Bin, DENG Rui, ZHOU Siliang, LI Xingxiu, MA Jun. Effectiveness effects of screening elevated blood glucose of pre-pubertal children with HbA1c[J]. CHINESE JOURNAL OF SCHOOL HEALTH, 2021, 42(10): 1544-1547. doi: 10.16835/j.cnki.1000-9817.2021.10.024

糖化血紅蛋白篩查青春期前兒童血糖異常的效果研究

doi: 10.16835/j.cnki.1000-9817.2021.10.024
基金項目: 

國家自然科學基金 81903344

北京市優秀人才培養資助項目,引進人才計劃與啟動項目 BMU2017YJ002

詳細信息
    作者簡介:

    婁珂(1996-),女,河南新鄉人,在讀碩士,主要研究方向為兒童青少年心血管健康

    通訊作者:

    董彬,E-mail:bindong@bjmu.edu.cn

  • 中圖分類號: R446 R179 R725.8

Effectiveness effects of screening elevated blood glucose of pre-pubertal children with HbA1c

  • 摘要:   目的  探討糖化血紅蛋白(HbA1c)篩查青春期前兒童血糖異常的效果,為兒童血糖異常篩查指標的選擇提供科學依據。  方法  2017年整群抽取廈門市未進入Tanner Ⅱ期的1 208名7~10歲學生為研究對象,抽取空腹靜脈血檢測HbA1c和空腹血糖(FPG)。采用美國糖尿病協會標準將研究對象分為正常組、HbA1c異常組、FPG異常組和聯合指標異常組(HbA1c或FPG異常),使用偏相關分析HbA1c與FPG的相關性,使用約登系數法計算FPG為5.6 mmol/L時HbA1c的界值點,使用受試者工作特征曲線(ROC)判斷HbA1c的篩查效果。  結果  以HbA1c,FPG及聯合指標為篩查指標,兒童血糖異常檢出率分別為2.2%, 4.0%和5.8%。HbA1c和FPG的偏相關系數為0.15(P < 0.01),女生組、非超重組偏相關系數較高(r值分別為0.22,0.16)。FPG為5.6 mmol/L時,對應的HbA1c界值點為5.15%。以聯合指標為參照標準,FPG和HbA1c的ROC曲線下面積(95%CI)分別為0.84(0.79~0.90)和0.69(0.63~0.74)。  結論  青春期前兒童HbA1c和FPG的相關性較低,HbA1c篩查血糖異常的效果與FPG相比存在差異。建議同時使用HbA1c和FPG篩查青春期前兒童血糖異常。
  • 表  1  不同組別青春期前兒童FPG及HbA1c指標分布比較

    Table  1.   Comparison of FPG and HbA1c of pre-pubertal children in different subgroups

    組別 人數 FPG HbA1c 聯合指標異常組
    檢出人數 χ2 P 檢出人數 χ2 P 檢出人數 χ2 P
    性別
    ??男 609 29(4.8) 2.00 0.16 9(1.5) 2.65 0.10 37(6.1) 0.18 0.67
    ??女 599 19(3.2) 17(2.8) 33(5.5)
    地區*
    ??城市 1 138 46(4.0) 0.01 0.94 24(2.1) 0.01 0.93 66(5.8) 0.00 0.99
    ??鄉村 52 2(3.9) 1(2.8) 3(5.8)
    肥胖程度
    ??非超重 882 35(72.9) 0.00 0.99 19(73.1) 0.00 0.99 51(72.9) 0.00 0.98
    ??超重/肥胖 326 13(27.1) 7(26.9) 19(27.1)
    ??注: ()內數字為檢出率/%;*表示人數有缺失。
    下載: 導出CSV

    表  2  不同組別FPG為5.6 mmol/L對應的HbA1c界值點

    Table  2.   The cutoffs of HbA1c when FPG was 5.6 mmol/L in different subgroups

    組別 選項 人數 界值/% 約登系數/% 靈敏度 特異度 AUC
    性別 609 5.15 0.16 0.79 0.37 0.58
    599 5.25 0.29 0.68 0.60 0.64
    實足年齡/歲 7 465 5.45 0.25 0.41 0.84 0.63
    8 544 5.15 0.22 0.83 0.39 0.61
    9~10 199 5.15 0.28 0.88 0.41 0.64
    肥胖程度 非超重 882 5.25 0.21 0.63 0.59 0.61
    超重/肥胖 326 5.15 0.12 0.77 0.35 0.56
    合計 1 208 5.15 0.16 0.77 0.39 0.58
    注: AUC為ROC曲線下面積。
    下載: 導出CSV
    客厅的yin乱A片
  • [1] FU J F, LIANG L, GONG C X, et al. Status and trends of diabetes in Chinese children: analysis of data from 14 medical centers[J]. World J Pediatr, 2013, 9(2): 127-134. doi: 10.1007/s12519-013-0414-4
    [2] DABELEA D, MAYER-DAVIS E J, SAYDAH S, et al. Prevalence of type 1 and type 2 diabetes among children and adolescents from 2001 to 2009[J]. JAMA, 2014, 311(17): 1778-1786. doi: 10.1001/jama.2014.3201
    [3] NCD Risk Factor Collaboration(NCD-RisC). Effects of diabetes definition on global surveillance of diabetes prevalence and diagnosis: a pooled analysis of 96 population-based studies with 331, 288 participants[J]. Lancet Diabetes Endocrinol, 2015, 3(8): 624-637. doi: 10.1016/S2213-8587(15)00129-1
    [4] BARRY E, ROBERTS S, OKE J, et al. Efficacy and effectiveness of screen and treat policies in prevention of type 2 diabetes: systematic review and meta-analysis of screening tests and interventions[J]. BMJ, 2017, 356: i6538. http://www.onacademic.com/detail/journal_1000040320013110_5651.html
    [5] CHEN Y, ZHANG P, WANG J, et al. Associations of progression to diabetes and regression to normal glucose tolerance with development of cardiovascular and microvascular disease among people with impaired glucose tolerance: a secondary analysis of the 30 year Da Qing Diabetes Prevention Outcome Study[J]. Diabetologia, 2021. DOI: 10.1007/s00125-021-05401-x.
    [6] 中華醫學會糖尿病學分會. 中國2型糖尿病防治指南(2020年版)[J]. 中華糖尿病雜志, 2021, 13(4): 315-409. https://www.cnki.com.cn/Article/CJFDTOTAL-ZZXJ202106003.htm

    Chinese Diabetes Society. Guidelines for the prevention and control of type 2 diabetes in China (2020 Edition)[J]. Chin J Diabet, 2021, 13(4): 315-409. https://www.cnki.com.cn/Article/CJFDTOTAL-ZZXJ202106003.htm
    [7] American Diabetes Association. 2. Classification and diagnosis of diabetes: Standards of Medical Care in Diabetes-2021[J]. Diabetes Care, 2021, 44(Suppl 1): S15-S33. http://www.ncbi.nlm.nih.gov/pubmed/30559228
    [8] COWIE C C, RUST K F, BYRD-HOLT D D, et al. Prevalence of diabetes and high risk for diabetes using A1C criteria in the U.S. population in 1988-2006[J]. Diabetes Care, 2010, 33(3): 562-568. doi: 10.2337/dc09-1524
    [9] 李丹, 史慧靜, 張越, 等. Tanner分期看圖自評法在城市青少年中的適用性研究[J]. 中國學校衛生, 2012, 33(9): 1029-1032. https://www.cnki.com.cn/Article/CJFDTOTAL-XIWS201209002.htm

    LI D, SHI H J, ZHANG Y, et al. Applicability of drawing based on self-assessment of Tanner stages among urban Chinese adolescents[J]. Chin J Sch Health, 2012, 33(9): 1029-1032. https://www.cnki.com.cn/Article/CJFDTOTAL-XIWS201209002.htm
    [10] 國家衛生和計劃生育委員會. 學齡兒童青少年超重與肥胖篩查WS/T 586—2018[S]. 北京: 中國標準出版社, 2018.

    National Health and Family Planning Commission of the People's Republic of China. Screening for overweight and obesity among school-age children and adolescents WS/T 586-2018[S]. Beijing: Standards Press of China, 2018.
    [11] ALI M K, BULLARD K M, SAYDAH S, et al. Cardiovascular and renal burdens of prediabetes in the USA: analysis of data from serial cross-sectional surveys, 1988-2014[J]. Lancet Diabetes Endocrinol, 2018, 6(5): 392-403. doi: 10.1016/S2213-8587(18)30027-5
    [12] VINER R, WHITE B, CHRISTIE D. Type 2 diabetes in adolescents: a severe phenotype posing major clinical challenges and public health burden[J]. Lancet, 2017, 389(10085): 2252-2260. doi: 10.1016/S0140-6736(17)31371-5
    [13] KAPADIA C, ZEITLER P, DRUGS, et al. Hemoglobin A1c measurement for the diagnosis of Type 2 diabetes in children[J]. Int J Pediatr Endocrinol, 2012, 2012(1): 31. doi: 10.1186/1687-9856-2012-31
    [14] BUSE J B, KAUFMAN F R, LINDER B, et al. Diabetes screening with hemoglobin A1c versus fasting plasma glucose in a multiethnic middle-school cohort[J]. Diabetes Care, 2013, 36(2): 429-435. doi: 10.2337/dc12-0295
    [15] NOWICKA P, SANTORO N H, LIU H D, et al. Utility of hemoglobin A1c for diagnosing prediabetes and diabetes in obese children and adolescents[J]. Diabetes Care, 2011, 34(6): 1306-1311. doi: 10.2337/dc10-1984
    [16] LEE J M, WU E L, TARINI B, et al. Diagnosis of diabetes using hemoglobin A1c: should recommendations in adults be extrapolated to adolescents?[J]. J Pediatr, 2011, 158(6): 947-952. doi: 10.1016/j.jpeds.2010.11.026
    [17] EHEHALT S, WIEGAND S, K?RNER A, et al. Low association between fasting and OGTT stimulated glucose levels with HbA1c in overweight children and adolescents[J]. Pediatr Diabetes, 2017, 18(8): 734-741. doi: 10.1111/pedi.12461
    [18] FENG L, NIAN S, ZHAO Y, et al. Higher HbA1c and/or glucose levels alter the association patterns between glycated hemoglobin and fasting glucose levels[J]. Diabetes Res Clin Pract, 2018, 142: 353-362. doi: 10.1016/j.diabres.2018.06.011
    [19] CHAN C L, PYLE L, NEWNES L, et al. Continuous glucose monitoring and its relationship to hemoglobin A1c and oral glucose tolerance testing in obese and prediabetic youth[J]. J Clin Endocrinol Metab, 2015, 100(3): 902-910. doi: 10.1210/jc.2014-3612
    [20] HERMAN W H. Are there clinical implications of racial differences in HbA1c?Yes, to not consider can do great harm![J]. Diabetes Care, 2016, 39(8): 1458-1461. doi: 10.2337/dc15-2686
    [21] HERMAN W H, MA Y, UWAIFO G, et al. Differences in A1c by race and ethnicity among patients with impaired glucose tolerance in the diabetes prevention program[J]. Diabetes Care, 2007, 30(10): 2453-2457. doi: 10.2337/dc06-2003
    [22] SELVIN E, STEFFES M W, BALLANTYNE C M, et al. Racial differences in glycemic markers: a cross-sectional analysis of community-based data[J]. Ann Int Med, 2011, 154(5): 303-309. doi: 10.7326/0003-4819-154-5-201103010-00004
    [23] WANG L, GAO P, ZHANG M, et al. Prevalence and ethnic pattern of diabetes and prediabetes in China in 2013[J]. JAMA, 2017, 317(24): 2515-2523. doi: 10.1001/jama.2017.7596
    [24] TRYGGESTAD J B, WILLI S M. Complications and comorbidities of T2DM in adolescents: findings from the TODAY clinical trial[J]. J Diabetes Complications, 2015, 29(2): 307-312. doi: 10.1016/j.jdiacomp.2014.10.009
    [25] 董艷麗. 糖尿病篩查中應用空腹血糖聯合糖化血紅蛋白檢測的臨床價值[J]. 中國婦幼健康研究, 2017, 28(S4): 121. https://www.cnki.com.cn/Article/CJFDTOTAL-SANE2017S4140.htm

    DONG Y L. The performance of FPG combined with HbA1c in diabetes screening[J]. Chin J Woman Child Health Res, 2017, 28(S4): 121. https://www.cnki.com.cn/Article/CJFDTOTAL-SANE2017S4140.htm
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  • 收稿日期:  2021-04-26
  • 修回日期:  2021-08-15
  • 網絡出版日期:  2021-10-25
  • 刊出日期:  2021-10-25

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