文章摘要
张笑,张梅,李纯,黄正京,于梦婷,王丽敏.我国不同海拔水平下糖化血红蛋白与血糖指标的关联研究[J].中华流行病学杂志,2023,44(3):401-407
我国不同海拔水平下糖化血红蛋白与血糖指标的关联研究
Associations between glycated hemoglobin and glucose indicators in adults in areas at different altitude in China
收稿日期:2022-08-14  出版日期:2023-03-14
DOI:10.3760/cma.j.cn112338-20220814-00710
中文关键词: 糖化血红蛋白  血糖指标  海拔水平  糖尿病诊断
英文关键词: Glycated hemoglobin  Glucose indicator  Altitude  Diabetes diagnosis
基金项目:国家重点研发计划(2018YFC1311702)
作者单位E-mail
张笑 中国疾病预防控制中心慢性非传染性疾病预防控制中心慢病危险因素监测室, 北京 100050  
张梅 中国疾病预防控制中心慢性非传染性疾病预防控制中心慢病危险因素监测室, 北京 100050  
李纯 中国疾病预防控制中心慢性非传染性疾病预防控制中心慢病危险因素监测室, 北京 100050  
黄正京 中国疾病预防控制中心慢性非传染性疾病预防控制中心慢病危险因素监测室, 北京 100050  
于梦婷 中国疾病预防控制中心慢性非传染性疾病预防控制中心慢病危险因素监测室, 北京 100050  
王丽敏 中国疾病预防控制中心慢性非传染性疾病预防控制中心慢病危险因素监测室, 北京 100050 wanglimin@ncncd.chinacdc.cn 
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中文摘要:
      目的 探讨我国不同海拔水平下糖化血红蛋白(HbA1c)与FPG和服糖后2 h血糖(OGTT-2 h)的关联。方法 研究人群来自2018-2019年中国慢性病及危险因素监测中未曾经被医疗机构诊断为糖尿病的对象,按居住地所在县/区海拔分为<2 000、2 000~、≥3 000 m三组。考虑群内相关性后,分别在HbA1c处于正常范围(<5.7%)和超出正常范围(≥5.7%)时用多因素线性回归分析HbA1c与FPG和OGTT-2 h的关联,并进一步用限制性立方样条拟合HbA1c与血糖指标的关系曲线。最后用受试者工作特征曲线评价HbA1c对糖尿病的诊断能力。结果 最终纳入157 277人。随着海拔升高,FPG和OGTT-2 h逐渐降低,而HbA1c无明显变化。当HbA1c<5.7%时,HbA1c与FPG和OGTT-2 h的关联较弱且在不同海拔地区间差异不大。而当HbA1c≥5.7%时,HbA1c每上升一个标准差,海拔<2 000 m地区FPG和OGTT-2 h分别升高15.45%(95%CI:14.71%~16.18%)和24.54%(95%CI:23.18%~25.91%),海拔2 000~m地区FPG和OGTT-2 h分别升高13.08%(95%CI:10.46%~15.76%)和21.72%(95%CI:16.39%~27.31%),海拔≥3 000 m地区FPG和OGTT-2 h分别升高11.41%(95%CI:9.32%~13.53%)和20.03%(95%CI:15.38%~24.86%)。限制性立方样条进一步表明HbA1c与FPG和OGTT-2 h关联的形状在HbA1c<5.7%时较为平坦,而在HbA1c≥5.7%时呈线性增长。海拔<2 000和≥3 000 m地区HbA1c诊断糖尿病的曲线下面积分别为0.808(95%CI:0.803~0.812)和0.728(95%CI:0.660~0.796)(P=0.022),对应的最佳切点分别为5.7%(灵敏度:65.4%,特异度:83.0%)和6.0%(灵敏度:48.3%,特异度:93.7%)。结论 当HbA1c≥5.7%时,HbA1c与FPG和OGTT-2 h的关联强度随海拔升高而降低。在海拔≥3 000 m地区,HbA1c可能不适合作为糖尿病的诊断标准。
英文摘要:
      Objective To explore the associations of glycated hemoglobin (HbA1c) with FPG and oral glucose tolerance test 2-hour (OGTT-2 h) in areas at different altitude in China.Methods Subjects who participated in 2018-2019 China Chronic Disease and Risk Factor Surveillance and had no prior type 2 diabetes diagnosis were included. Subsequently, they were categorized into three groups based on altitude of living area (<2 000, 2 000- and ≥ 3 000 m). With adjustment for intracluster correlation, multivariable linear regression analysis was performed to evaluate the associations of HbA1c with FPG and OGTT-2 h in the context of HbA1c was normal (<5.7%) or abnormal (≥ 5.7%). Furthermore, the shape of relationships between HbA1c and glucose indicators was examined using restricted cubic spline. Finally, receiver operating characteristic curve was used to evaluate the diagnostic performance of HbA1c for diabetes. Results A total of 157 277 subjects were included in the analysis. While FPG and OGTT-2 h levels gradually decreased with increase of altitude, HbA1c level was similar among the three groups. When HbA1c was <5.7%, its association with FPG and OGTT-2 h was weak and no obvious difference was observed among the three groups. When HbA1c was ≥ 5.7%, the FPG and OGTT-2 h increased by 15.45% (95%CI:14.71%- 16.18%) and 24.54% (95%CI:23.18%-25.91%) respectively per one standard deviation increase in HbA1c in group in area at altitude <2 000 m. However, the FPG and OGTT-2 h increased by 13.08% (95%CI:10.46%-15.76%) and 21.72% (95%CI:16.39%-27.31%), respectively, in group in area at altitude 2 000- m, and increased by 11.41% (95%CI:9.32%-13.53%) and 20.03% (95%CI:15.38%- 24.86%), respectively, in group of altitude ≥ 3 000 m. The restricted cubic spline indicated that the curve showing the association of HbA1c with FPG and OGTT-2 h was flat when HbA1c was <5.7%, but showed a positive linear relationship when HbA1c was ≥ 5.7%. The area under curve for detecting diabetes was 0.808 (95%CI:0.803-0.812) in group of altitude <2 000 m and 0.728 (95%CI:0.660-0.796, P=0.022) in group of altitude ≥ 3 000 m. The relevant optimal cutoff value of HbA1c was 5.7%, with a sensitivity of 65.4% and a specificity of 83.0%, and 6.0%, with a sensitivity of 48.3% and a specificity of 93.7%, respectively. Conclusions When HbA1c was ≥ 5.7%, the association between HbA1c and glucose indicators became weaker as the increase of altitude. In the area at altitude ≥ 3 000 m, it may not be appropriate to use HbA1c in the diagnosis of diabetes.
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