糖化血红蛋白筛查青春期前儿童血糖异常的效果研究

娄珂; 董彬; 邓睿; 周斯亮; 李星秀; 马军

doi:10.16835/j.cnki.1000-9817.2021.10.024

糖化血红蛋白筛查青春期前儿童血糖异常的效果研究

doi: 10.16835/j.cnki.1000-9817.2021.10.024

北京大学公共卫生学院，北京 100191

基金项目:

国家自然科学基金 81903344

北京市优秀人才培养资助项目，引进人才计划与启动项目 BMU2017YJ002

详细信息

作者简介:
娄珂(1996-)，女，河南新乡人，在读硕士，主要研究方向为儿童青少年心血管健康

通讯作者:
董彬，E-mail：bindong@bjmu.edu.cn

中图分类号: R446 R179 R725.8
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- 被引次数: 0
出版历程
- 收稿日期: 2021-04-26
- 修回日期: 2021-08-15
- 网络出版日期: 2021-10-25
- 刊出日期: 2021-10-25

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

the Institute of Child and Adolescent Health, Peking University, Beijing(100191), China

摘要

摘要: 目的探讨糖化血红蛋白(HbA1c)筛查青春期前儿童血糖异常的效果，为儿童血糖异常筛查指标的选择提供科学依据。方法 2017年整群抽取厦门市未进入Tanner Ⅱ期的1 208名7~10岁学生为研究对象，抽取空腹静脉血检测HbA1c和空腹血糖(FPG)。采用美国糖尿病协会标准将研究对象分为正常组、HbA1c异常组、FPG异常组和联合指标异常组(HbA1c或FPG异常)，使用偏相关分析HbA1c与FPG的相关性，使用约登系数法计算FPG为5.6 mmol/L时HbA1c的界值点，使用受试者工作特征曲线(ROC)判断HbA1c的筛查效果。结果以HbA1c，FPG及联合指标为筛查指标，儿童血糖异常检出率分别为2.2%, 4.0%和5.8%。HbA1c和FPG的偏相关系数为0.15(P < 0.01)，女生组、非超重组偏相关系数较高(r值分别为0.22，0.16)。FPG为5.6 mmol/L时，对应的HbA1c界值点为5.15%。以联合指标为参照标准，FPG和HbA1c的ROC曲线下面积(95%CI)分别为0.84(0.79~0.90)和0.69(0.63~0.74)。结论青春期前儿童HbA1c和FPG的相关性较低，HbA1c筛查血糖异常的效果与FPG相比存在差异。建议同时使用HbA1c和FPG筛查青春期前儿童血糖异常。
- 血红蛋白A, 糖基化 /
- 血糖 /
- 患病率 /
- ROC曲线 /
- 儿童
Abstract: Objective To explore the performances of HbA1c when identifying elevated blood glucose among pre-pubertal children, and to provide scientific basis for early screening biomarkers of abnormal blood glucose in children. Methods A total of 1 208 prepubertal children aged 7 to 10 years old in Xiamen were sampled with the cluster sampling method. Fasting venous blood was drawn to measure the level of HbA1c and FPG. According to American Diabetes Association (ADA) criteria, participants were divided into normal group, HbA1c abnormal group, FPG abnormal group and combined abnormal group. Partial correlation analysis was used to analyze the correlation between HbA1c and FPG. The cutoffs of HbA1c were calculated when FPG was 5.6 mmol/L. Receiver operating curve (ROC) was used to judge the performances of HbA1c while screening abnormal blood glucose. Results With HbA1c, FPG and the combined indicators as the screening criteria, the prevalence of high blood glucose were 2.2%, 4.0%, and 5.8%, respectively. The partial correlation coefficient of FPG and HbA1c was 0.15(P < 0.01), and the correlation coefficient in girls(r=0.22) and non-overweight group(r=0.16) were higher. The cutoff of HbA1c was 5.15% if FPG was 5.6 mmol/L. Taking the combined indicator as the reference standard, the AUC of FPG was 0.84 (95%CI=0.79-0.90) and the AUC of HbA1c was 0.69(95%CI=0.63-0.74). Conclusion There is a low correlation between HbA1c and FPG in pre-pubertal children. The performance of HbA1c is different from FPG when used as the indicator to screen children with abnormal blood glucose. It is recommended to use the combined indicator of HbA1c and FPG to screen abnormal blood glucose in prepubertal children.
- Hemoglobin A, glycosylated /
- Blood glucose /
- Prevalence /
- ROC curve /
- Child

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表 1 不同组别青春期前儿童FPG及HbA1c指标分布比较

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

组别	人数	FPG			HbA1c			联合指标异常组
组别	人数	检出人数	χ²值	P值	检出人数	χ²值	P值	检出人数	χ²值	P值
性别
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)
地区^*
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
乡村	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： ()内数字为检出率/%；*表示人数有缺失。

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表 2 不同组别FPG为5.6 mmol/L对应的HbA1c界值点

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

组别	选项	人数	界值/%	约登系数/%	灵敏度	特异度	AUC
性别	男	609	5.15	0.16	0.79	0.37	0.58
	女	599	5.25	0.29	0.68	0.60	0.64
实足年龄/岁	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
合计		1 208	5.15	0.16	0.77	0.39	0.58
注： AUC为ROC曲线下面积。

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