[1]刘乐,于会宁,郭晓坤,等.OGTT 0.5 h血糖切点值在诊断糖尿病及糖尿病前期中的临床意义[J].国际内分泌代谢杂志,2015,(04):217-221.[doi:10.3760/cma.j.issn.1673-4157.2015.04.001]
　Liu Le*,Yu Huining,Guo Xiaokun,et al.Clinical value of 0.5 h-plasma glucose and its cutoff value during OGTT in diagnosing diabetes mellitus and prediabetes[J].International Journal of Endocrinology and Metabolism,2015,(04):217-221.[doi:10.3760/cma.j.issn.1673-4157.2015.04.001]
点击复制

OGTT 0.5 h血糖切点值在诊断糖尿病及糖尿病前期中的临床意义()
分享到：

《国际内分泌代谢杂志》[ISSN:1673-4157/CN:12-1383/R]

卷:
期数:
2015年04
页码:
217-221
栏目:
论著
出版日期:
2015-07-20

文章信息/Info

Title:
Clinical value of 0.5 h-plasma glucose and its cutoff value during OGTT in diagnosing diabetes mellitus and prediabetes
作者:
刘乐; 于会宁; 郭晓坤; 张红梅; 黄姣红; 冯凭
300211　天津医科大学第二医院干部保健科（刘乐，于会宁，郭晓坤，张红梅，黄姣红）；300052　天津医科大学总医院代谢病科（冯凭）
Author(s):
Liu Le*; Yu Huining; Guo Xiaokun; Zhang Hongmei; Huang Jiaohong; Feng Ping.
*The Cadre Sanitarian Division，The Second Hospital Affiliated of Tianjin Medical University，Tianjin 300211，China Corresponding author：Feng Ping，Email：xingxing626@sina.com
关键词:
糖尿病; 口服葡萄糖耐量试验; 0.5 h高血糖 ; 胰岛素分泌早时相; 胰岛素抵抗
Keywords:
Diabetes mellitus; Oral glucose tolerance test; 0.5-Hour hyperglycemia; Early-phase insulin secretion; Insulin resistance
DOI:
10.3760/cma.j.issn.1673-4157.2015.04.001
摘要:
目的　确定口服葡萄糖耐量试验（OGTT）负荷后0.5 h血糖（0.5 hPG）诊断糖尿病和糖尿病前期（preDM）的切点值及0.5 hPG与?茁细胞功能、胰岛素敏感性的关系。方法　4 351名受试者行OGTT，以2008年美国糖尿病协会（ADA）糖代谢异常诊断标准为参考标准，应用受试者工作特征（ROC）曲线分析0.5 hPG诊断糖尿病和preDM的切点值。将受试人群先按照2008年ADA糖代谢异常诊断标准分为正常糖耐量组（NGT组）、preDM组、糖尿病组，再按研究得出的切点值将NGT组中0.5 hPG＜诊断preDM切点值者作为N-NGT组，0.5 hPG≥诊断preDM切点值者则为H-NGT组；将preDM组中0.5 hPG＜诊断糖尿病切点值者作为N-preDM组，0.5 hPG≥诊断糖尿病切点值者则为H-preDM组。比较5组的血糖、胰岛素水平、胰岛素敏感性、早时相及总时相胰岛素分泌功能等指标，并进行0.5 hPG与上述指标的相关性分析。结果　以2008年ADA糖尿病诊断标准为参考标准，由ROC得出诊断糖尿病最佳的0.5 hPG切点值为10.79 mmol/L，灵敏性为80.6%，特异性为86.1%，曲线下面积0.92±0.00；以2008年ADA关于preDM的诊断标准为参考标准，得出诊断preDM最佳的0.5 hPG切点值为8.69 mmol/L，灵敏性为74.7%，特异性为70.9%，曲线下面积0.79±0.01。随着糖代谢异常的进展，5组的早时相胰岛素分泌指数、30 min处置指数（DI30）及总时相胰岛素分泌指数、120 min处置指数（DI120）、稳态模型评估-胰岛?茁细胞分泌指数（HOMA-?茁）逐渐下降（F =412.25~2 113.02， P均＜0.01），而稳态模型评估-胰岛素抵抗指数（HOMA-IR）逐渐升高（F =151.78，P＜0.01）。0.5 hPG与HOMA-?茁（r =-0.69）、胰岛素生成指数（r =-0.71）、Matsuda胰岛素敏感指数（r =-0.21）、早时相胰岛素分泌指数（r =-0.48）、总时相胰岛素分泌指数（r =-0.54）、DI30（r =-0.62）、DI120（r =-0.70）呈负相关（P均＜0.01），与HOMA-IR呈正相关（r =0.34，P＜0.01）。结论　0.5 hPG≥10.79 mmol/L可诊为糖尿病，8.69 mmol/L≤ 0.5 hPG＜10.79 mmol/L可诊为preDM。0.5 hPG在一定程度上可反映胰岛素敏感性及胰岛?茁细胞功能，随着0.5 hPG的升高，胰岛素敏感性逐渐下降，早时相胰岛素分泌缺陷亦逐渐加重，这种相关性独立于胰岛素敏感性。
Abstract:
Objective　To assess the cutoff values of plasma glucose at 0.5 hour（0.5 hPG）during an oral glucose tolerance test（OGTT） for diagnosing diabetes（DM） and prediabetes （preDM） and the correlation between 0.5 hPG and ?茁 cell function as well as insulin sensitivity. Methods　A total of 4 351 subjects were recruited to have an OGTT. Using 2008-American Diabetes Association（ADA） diagnostic criteria of DM and preDM as assumed standard. The cutoff values were analyzed by receiver operating characteristic（ROC）curve. According to 2008 -ADA diagnostic criteria，all the subjects were divided into normal tolerance test group（NGT group），preDM group and DM group. In NGT group，the individual with 0.5 hPG＜cutoff value for diagnosing preDM were divided into N-NGT group，and the individual with 0.5 hPG≥cutoff value for diagnosing preDM were divided into H-NGT group. In preDM group，the individual with 0.5 hPG＜cutoff value for diagnosing DM were divided into N-preDM group，the individual with 0.5 hPG≥cutoff value for diagnosing DM were divided into H-preDM group. Plasma glucose，insulin，insulin sensitivity，early-phase insulin secretion and total insulin secretion were compared among five groups. The correlations between 0.5 hPG and ?茁 cell function，insulin sensitivity were analyzed. Results　According to ROC results，using 2008-ADA diagnostic criteria of DM as reference，the optimal cutoff value of 0.5 hPG in diagnosing DM was 10.79 mmol/L；the sensitivity was 80.6%，the specificity was 86.1% and area under curve（AUC） was 0.92±0.00. Using 2008-ADA diagnostic criteria of preDM as reference，the optimal cutoff value of 0.5 hPG in diagnosing preDM was 8.69 mmol/L；the sensitivity was 74.7%，the specificity was 70.9% and AUC was 0.79±0.01. Along with the progress of glucose intolerance，the early-phase insulin secretion ability，30 min disposal index（DI30） and total insulin secretion ability，120 min disposal index（DI120） and homeostasis model assessment-islet ?茁 cell secretion（HOMA-?茁）decreased gradually （F =412.25-2 113.02， all P＜0.01），whereas homeostasis model assessment-insulin resistance（HOMA-IR）increased gradually （F =151.78，P＜0.01）. There was a negative correlation between 0.5 hPG and HOMA-?茁（r =-0.69），insulingenic index（r =-0.71），Matsuda insulin sensitivity index（r =-0.21），early-phase insulin secretion index（r =-0.48），total-phase insulin secretion index（r =-0.54），DI30（r =-0.62）and DI120（r =-0.70，all P＜0.01）. There was a positive correlation between 0.5 hPG and HOMA-IR（r =0.34， P＜0.01）. Conclusions　Patient with 0.5 hPG≥10.79 mmol/L can be diagnosed as DM，whereas patient with 0.5 hPG≥8.69 mmol/L but ＜10.79 mmol/L can be diagnosed as preDM. 0.5 hPG reflects insulin sensitivity and islet ?茁 cell function to some extent. Along with the increase of 0.5 hPG，the abnormal insulin sensitivity and the early phase insulin secretion get worse and this correlation is independent of insulin sensitivity.

参考文献/References:

[1]　Xu Y，Wang L，He J，et al.Prevalence and control of diabetes in Chinese adults[J].JAMA，2013，310（9）：948-959. 　
[2]　American Diabetes Association.Standards of medical care in diabetes-2008[J].Diabetes Care，2008，31（Suppl 1）：S12-S54. 　
[3]　Levy JC，Matthews DR，Hermans MP．Correct homeostasis model assessment（HOMA）evaluation uses the computer program[J]．Diabetes Care，1998，21（12）：2191-2192. 　
[4]　刘乐，冯凭.OGTT 1小时切点血糖在筛查糖尿病及糖调节受损中的临床意义[J].中国糖尿病杂志，2010，3：204-206. 　
[5]　Zhou W，Gu Y，Li H，et al.Assessing 1-h plasma glucose and shape of the glucose curve during oral glucose tolerance test[J].Eur J Endocrinol，2006，155（1）：191-197. 　
[6]　Zhou W，Li H，Gu Y，et al.The ROC analysis for different time points during oral glucose tolerance test[J].Diabetes Res Clin Pract，2006，72（1）：88-92. 　
[7]　Lin L，Chen G，Zou X，et al.Diabetes，pre-diabetes and associated risks on Minnesota code-indicated major electrocardiogram abnormality among Chinese：a cross-sectional diabetic study in Fujian province，southeast China[J].Obes Rev，2009，10（4）：420-430. 　
[8]　Chen G，Zou X，Yao J，et al.The correlation between the oral glucose tolerance test 30-minutes plasma glucose and risk factors for diabetes and cardiovascular diseases：a cross-sectional epidemiological study of diabetes in Fujian Province in the South-East of China[J].J Endocrinol Invest，2011，34（5）：e115-e120. 　
[9]　Stancáková A，Javorsky M，Kuulasmaa T，et al.Changes in insulin sensitivity and insulin release in relation to glycemia and glucose tolerance in 6，414 Finnish men[J].Diabetes，2009，58（5）：1212-1221.
[10]　Matsuda M，DeFronzo RA.Insulin sensitivity indices obtained from oral glucose tolerance testing：comparison with the euglycemic insulin clamp[J].Diabetes Care，1999，22（9）：1462-1470.
[11]　Snehalatha C，Ramachandran A，Sivasankari S，et al.Insulin secretion and action show differences in impaired fasting glucose and in impaired glucose tolerance in Asian Indians[J].Diabetes Metab Res Rev，2003，19（4）：329-332.
[12]　Retnakaran R，Shen S，Hanley AJ，et al.Hyperbolic relationship between insulin secretion and sensitivity on oral glucose tolerance test[J].Obesity（Sliver Spring），2008，16（8）：1901-1907.
[13]　Hanley AJ，Retnakaran R，Qi Y，et al.Association of hematological parameters with insulin resistance and beta-cell dysfunction in nondiabetic subjects[J].J Clin Endocrinol Metab，2009，94（10）：3824-2832.
[14]　Utzschneider KM，Prigeon RL，Faulenbach MV，et al.Oral disposition index predicts the development of future diabetes above and beyond fasting and 2-h glucose levels[J].Diabetes Care，2009，32（2）：335-341.
[15]　周文敬，金京姬，李素香，等.正常糖耐量胰岛?茁细胞功能及胰岛素敏感性的观察[J].现代预防医学，2008，35（5）：836-839.
[16]　Bacha F，Lee S，Gungor N，et al.From pre-diabetes to type 2 diabetes in obese youth：pathophysiological characteristics along the spectrum of glucose dysregulation[J].Diabetes Care，2010，33 （10）：2225-2231.
[17]　张明亮，朱云霞，尹德超，等.应用高葡萄糖钳夹技术评估高糖喂养小鼠胰岛细胞功能[J].中华糖尿病杂志，2011，3（6）：478-481.

相似文献/References:

[1]郑少雄.罗格列酮和心血管风险——近期文献解读[J].国际内分泌代谢杂志,2007,(04):231.
[2]凌厉,朱本章.胰岛素类似物安全性研究进展[J].国际内分泌代谢杂志,2007,(04):234.
[3]李颖,刘东方.餐后1小时血糖升高的意义及干预[J].国际内分泌代谢杂志,2007,(04):235.
[4]崔巍,施秉银.内质网应激介导β细胞生存/死亡的研究进展[J].国际内分泌代谢杂志,2007,(04):256.
[5]杨叶虹,胡仁明.SELDI-TOF-MS技术及其在糖尿病研究中的应用[J].国际内分泌代谢杂志,2007,(04):261.
[6]高妍.针对华人糖尿病特点优化降糖方案[J].国际内分泌代谢杂志,2007,(04):269.
[7]杨志霞,郭莹辉,杨永生,等.胰岛素泵和多次皮下注射治疗糖尿病的比较[J].国际内分泌代谢杂志,2007,(04):273.
[8]周建英,马向华.胃旁路术减肥同时改善糖代谢的机制[J].国际内分泌代谢杂志,2007,(04):285.
[9]李翠柳,朱大龙.破译肠道代谢信息,驱动治疗革新[J].国际内分泌代谢杂志,2014,(06):383.[doi:10.3760/cma.j.issn.1673-4157.2014.06.006]
　Li Cuiliu*,Zhu Dalong..Deciphering metabolic messages from the gut drives therapeutic innovation[J].International Journal of Endocrinology and Metabolism,2014,(04):383.[doi:10.3760/cma.j.issn.1673-4157.2014.06.006]
[10]袁捷 姜云生 杜彦丽 王肃.1型糖尿病对小鼠早孕时期子宫肌层结构和细胞增殖的影响[J].国际内分泌代谢杂志,2015,(01):6.[doi:10.3760/cma.j.issn.1673-4157.2015.01.002]
　Yuan JieJiang YunshengDu YanliWang Su.Effects of type 1 diabetes on the muscularis structure and cell proliferation of uterine in mice during early pregnancy[J].International Journal of Endocrinology and Metabolism,2015,(04):6.[doi:10.3760/cma.j.issn.1673-4157.2015.01.002]

备注/Memo

备注/Memo:
通信作者：冯凭，Email：xingxing626@sina.com
更新日期/Last Update: 2015-07-20