摘要
目的应用梯形积分法分析口服糖耐量实验(OGTT)中各点血糖即空腹血糖(FPG)和负荷后血糖对糖化血红蛋白(Hb A1c)的相对贡献。方法连续收集2010年1月1日至2012年12月31日哈尔滨医科大学附属第二医院内分泌科门诊和住院处就诊病例,符合入选标准的2853例(16~85岁)的临床数据进入研究,均采集血液检测Hb A1c和进行OGTT而未给予临床干预。选择标准:OGTT均是在无合并酮症的状态下进行,数据收集不考虑是否有糖尿病病史、糖尿病分型、是否应用降糖药和胰岛素治疗以及合并的基础疾病。排除妊娠病例。建立四点血糖模型应用梯形积分法评估OGTT各点血糖对Hb A1c的相对贡献。结果FPG的相对贡献随着Hb A1c的增高逐渐增高:在Hb A1c最小五分位时为15.9%,最大五分位时为44.0%(P<0.001);负荷后血糖的相对贡献随着Hb A1c的增高逐渐降低:负荷后1 h血糖的相对贡献从Hb A1c最小五分位时为25.0%到最大五分位时为14.2%(P<0.001)逐渐降低。在FPG和负荷后2 h血糖均增高的亚组中,当Hb A1c≥8.6%时FPG的相对贡献超过负荷后2 h血糖的相对贡献。结论随着Hb A1c水平的增高,FPG对Hb A1c的相对贡献逐渐增高,而负荷后血糖对Hb A1c的相对贡献逐渐降低,临床中可依据Hb A1c水平制定不同的降糖方案。
Objective The study assessed the relative contributions of plasma glucose in oral glucose tolerance test(OGTT),fasting plasma glucose(FPG)and post-load glucose to Haemoglobin A1c(HbA1c)with trapezoidal integration method.Methods This study is based on the data random selected from patients without clinical intervention enrolled in the endocrinology department and admission office in the Second Affiliated Hospital of Harbin Medical University from January 1st of 2010 to December 31st of 2012.2853 patients aged 16-85 year were selected,who performed OGTT and HbA1c on the same day.Their data of HbA1c and OGTT were collected.The OGTT and HbA1c were performed simultaneously unless the conditions of acidosis,without considering past history of diabetes and oral hypoglycemic drugs or insulin treatment,or other basic combined diseases.People in pregnancy were ruled out.We adopted four-point plasma glucose model and analyze the relationship between HbA1c and plasma glucose in OGTT based on trapezoidal integration method.Results The relative contribution of FPG increased gradually with increasing levels of HbA1c:15.9%in the lowest vs.44.0%in the highest quintile(P<0.001).And the relative contribution of postprandial glucose decreased progressively with increasing levels of HbA1c:the relative contribution of 1-hour post-load glucose decreased progressively from the lowest(25.0%)to the highest quintile of HbA1c(14.2%,P<0.001).When HbA1c≥8.6%,the relative contribution of FPG exceeded that of 2-hour post-load glucose(2 hPG)in the group of diabetes with 2 hPG and FPG all rising.Conclusion These findings suggest that the relative contribution of FPG increased gradually with increasing levels of HbA1c,however,the contribution of post-load glucose decreased progressively.According to the different HbA1c levels and we put forward different schemes to control plasma glucose.
作者
李晓君
鲍春丹
王威
洪旭
LI Xiao-jun;BAO Chun-dan;WANG Wei(Department of Endocrinology,Beijing Friendship Hospital Affiliated to Capital Medical University,Beijing 100050,China;Department of Epidemiology,School of Public Health,Harbin Medical University,Harbin Heilongjiang 150086,China;Department of Endocrinology,the Second Affiliated Hospital of Harbin Medical University,Harbin Heilongjiang 150086,China)
出处
《临床和实验医学杂志》
2022年第6期656-660,共5页
Journal of Clinical and Experimental Medicine
基金
北京市自然科学基金项目(编号:17082053)。
关键词
血糖
糖化血红蛋白
相对贡献
口服糖耐量实验
Plasma glucose
Haemoglobin A1c
Relative contribution
Oral glucose tolerance test
