胡金喜 朱小丽

[摘要] 目的 探讨糖化血红蛋白（HbA1c）联合血清尿酸（SUA）对代谢综合征（MS）的風险评估及诊断价值。 方法 收集10 597例于2012年1～12月在浙江省台州医院体检的成年人MS相关指标及实验室检测数据，以该人群1645例MS者为实验组（MS组）和8952例非MS者为对照组（非MS组），用决策树CRT法和受试者工作曲线（ROC）分析HbA1c联合SUA对MS的患病风险及诊断价值。 结果 该人群MS患病率为15.5%（男性：18.5%，女性：7.4%）。MS组与非MS组相比HbA1c和SUA均存在显著差异（均P<0.001）。男性G6组（HbA1c>6.65%且SUA>5.14 mg/dL）相对于G1组（HbA1c≤6.05%且SUA≤7.15 mg/dL）患MS的风险（OR）是17.9（95%CI：14.35～22.31），女性G5组（HbA1c>7.65%）相对于G1组（HbA1c≤6.15%且SUA≤4.85 mg/dL）患MS的风险（OR）是78.93（95%CI：41.61～149.72）。ROC曲线得到HbA1c诊断男性和女性MS的最佳cut-off值均为5.7%，SUA诊断男性和女性MS的最佳cut-off值分别为6.4 mg/dL和4.9 mg/dL。HbA1c和SUA联检可以显著提高特异性（男性：90.9%，女性：93.9%）。 结论 HbA1c和SUA可作为MS潜在的标志物，二者联合可有效评估MS患病风险，同时可以显著提高诊断MS的特异性。

[关键词] 决策树;糖化血红蛋白;血清尿酸;代谢综合征

[中图分类号] R587.1;R589          [文献标识码] A          [文章编号] 1673-9701（2020）17-0011-05

Risk assessment and diagnostic value of glycosylated hemoglobin combined with serum uric acid for metabolic syndrome

HU Jinxi1   ZHU Xiaoli2

1.Department of Oncology Surgery， Taizhou Hospital of Zhejiang Province， Taizhou   317000， China; 2.Department of Clinical Laboratory， Taizhou Hospital of Zhejiang Province， Taizhou   317000， China

[Abstract] Objective To explore the risk assessment and diagnostic value of glycosylated hemoglobin（HbA1c） combined with serum uric acid（SUA） for metabolic syndrome（MS）. Methods The MS-related indexes and laboratory test data of 10 597 adults who had checkup in Taizhou Hospital of Zhejiang Province from January to December 2012 were collected. Among the population， 1645 MS patients were taken as the experimental group（the MS group） and 8952 non-MS patients were taken as the control group（the non-MS group）. The risk and diagnostic value of HbA1c combined with SUA for MS were analyzed through the decision tree CRT method and receiver operating characteristic（ROC） curve. Results The OR of MS for the population in question was 15.5%（male： 18.5%; female： 7.4%）. There were significant differences in HbA1c and SUA between the MS group and the non-MS group（In both， P<0.001）. The OR of MS in the male G6 group（HbA1c>6.65% and SUA>5.14 mg/dl） was 17.9（95%CI： 14.35-22.31） relative to the G1 group（HbA1c≤6.05% and SUA≤7.15 mg/dL）， while the OR of MS in the female G5 group（HbA1c>7.65%） was 78.93（95%CI： 41.61-149.72） relative to the G1 group（HbA1c≤6.15% and SUA≤4.85 mg/dL）. ROC curve showed that the best cut-off value of HbA1c for diagnosis of male and female MS was 5.7%， and the best cut-off value of SUA for diagnosis of male and female MS was 6.4 mg/dL and 4.9 mg/dL respectively. HbA1c and SUA combined examination could significantly improve specificity（male： 90.9%; female： 93.9%）. Conclusion HbA1c and SUA can be used as potential markers of MS. The combination of HbA1c and SUA can effectively assess the risk of MS and significantly improve the specificity of diagnosis of MS.

[Key words] Decision tree; Glycosylated hemoglobin; Serum uric acid; Metabolic syndrome

代谢综合征（Metabolic syndrome，MS）是以高血糖、肥胖、高血压、高甘油三酯（TG）及低高密度脂蛋白胆固醇（HDL-C）为病理生理基础，以胰岛素抵抗为特征的一组临床症候群[1-2]。MS是近年来全球关注的焦点之一，患病率逐年增加，动脉粥样硬化及心脑血管事件是其主要危害[3]，因此，对MS进行早期诊断及预防具有重要意义。研究发现，糖化血红蛋白（Hemoglobin A1c，HbA1c）与MS的患病率具有重要的联系，有学者提出外周血HbA1c诊断MS的最佳cut-off值为5.65%[4]。亦有文章提出，血清尿酸（Serum uric acid，SUA）与MS的患病率呈正相关，SUA诊断男性和女性MS的最佳cut-off值分别是6.3 mg/dL和4.9 mg/dL[3]。但是，目前还没有关于HbA1c联合SUA评估MS患病风险及诊断MS的报道，因此，本研究将探讨HbA1c联合SUA对MS的风险评估及诊断价值，现报道如下。