Diagnostic Value of Hemoglobin A1c and Fasting Plasma Glucose Levels in Coronary Artery Bypass Grafting Patients With Undiagnosed Diabetes Mellitus
Diagnostic Value of Hemoglobin A1c and Fasting Plasma Glucose Levels in Coronary Artery Bypass Grafting Patients With Undiagnosed Diabetes Mellitus
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DOI：
10.1016/j.athoracsur.2009.11.033
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发表时间：
2010-05-01
影响因子：
4.6
通讯作者：
Akinci, Esat
中科院分区：
文献类型：
--
作者：
Tekumit, Hayrettin;Cenal, Ali Riza;Akinci, Esat
背景资料。早期发现、诊断和治疗糖尿病对于预防糖尿病并发症和改善冠状动脉搭桥术患者的短期和长期预后至关重要。本研究的目的是评价单独或与空腹血糖(FPG)联合检测术前血红蛋白A1c(HbA(1c))检测择期冠状动脉手术患者糖代谢紊乱的能力。共有166名患者接受了择期孤立体外循环冠状动脉手术。于手术前一天采静脉血测定Hb、A1c和8小时空腹血糖。1个月后，对所有无糖尿病的出院患者进行口服糖耐量试验。参照耐力试验结果，分析空腹血糖、糖化血红蛋白(1c)、糖化血红蛋白(1c)和空腹血糖联合应用对糖尿病诊断的敏感性和特异性。在没有糖尿病的患者中，60%的患者通过葡萄糖耐量试验被诊断为糖尿病或糖尿病前期。与单项检测相比，空腹血糖和糖化血红蛋白(1c)联合检测具有更高的敏感性和特异性。空腹血糖、糖化血红蛋白(1c)阳性预测值为83.6%，糖化血红蛋白(1c)阳性预测值为94%，联合使用阳性预测值为97%。联合应用的敏感度和特异度分别为84.4%和94.1%。仅靠空腹血糖似乎不足以诊断大约一半的血糖异常患者。我们的结果表明，联合使用空腹血糖和糖化血红蛋白(1c)测量可能是一种有用的策略，可以在术前识别患有不明原因糖尿病的冠心病患者。(Ann Thorac Surg 2010；89：1482-8)(C)2010年，胸外科学会
Background. Early detection, diagnosis, and treatment of diabetes are of utmost importance in preventing diabetic complications and improving short- and long-term outcomes in patients undergoing coronary artery bypass grafting surgery. The aim of this study was to evaluate the ability of preoperative hemoglobin A1c (HbA(1c)) measurement, either alone or in combination with fasting plasma glucose (FPG), to detect glycometabolic disturbances among patients undergoing elective on-pump coronary surgery.Methods. A total of 166 patients who underwent elective isolated on-pump coronary surgery were included. Hemoglobin A1c and 8-hour FPG measurements were obtained by venous blood sampling on the day before the operation. After 1 month, an oral glucose tolerance test was performed in all discharged patients without known diabetes. The sensitivity and specificity for the diagnosis of diabetes were analyzed for FPG, HbA(1c), and for the combined use of HbA(1c) and FPG, in reference to the tolerance test results.Results. Sixty percent of patients without known diabetes were diagnosed as diabetes or prediabetes with glucose tolerance test. Compared with either test alone, combined use of FPG and HbA(1c) had higher sensitivity and specificity. Positive predictive values for FPG, HbA(1c), and combined use of these two factors were 83.6%, 94%, and 97%, respectively. The combined use had a sensitivity and specificity of 84.4% and 94.1%, respectively.Conclusions. Fasting plasma glucose alone does not seem sufficient for diagnosing approximately half of the patients with dysglycemia. Our results suggest that the use of FPG and HbA(1c) measurements in combination may be a useful strategy to preoperatively identify coronary patients with unknown diabetes. (Ann Thorac Surg 2010;89:1482-8) (C) 2010 by The Society of Thoracic Surgeons