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1、2小时糖耐量试验的临床意义FinnishAcademyResearchFellow芬兰赫尔辛基大学及国立公共卫生研究院北大糖尿病论坛2007年5月12日，北京乔青MD,Ph.D糖尿病诊断试验:历史回顾糖尿病症状尿糖空腹血糖糖耐量(1913年)JacobsenA.BiochemZ51:443,1913NormalGlucoseHomeostasisDaytimeProfile(N=12,health;Mean+95%CI)OwensD,ZinmanB&BolliG:Lancet358,739,2001MealTimes80400Insulin(mU/L)08.
2、0013.0016.0019.00hGlucose(mmol/L)8426什么是糖耐量异常?1.高于均值+2标准差可诊断糖尿病:根据年轻(20-30岁)健康人群资料,纯统计！不考虑临床，预后及年龄(50年代)2h全血血糖>=120mg/dl(100g糖耐量)诊断糖尿病(血浆血糖比全血高14-16%!)发病率高诊断标准混乱(血样，服糖量，时间)直到70年代MosenthalH.O.andBarryE(AnnInternMed33:1175,1950)什么是糖耐量异常?1.均值+2标准差2.血糖双峰分布,小血管病变(眼病，肾病等):糖尿病高发人群,如PimaIn
3、dians(1971),Mexican-Americans,Micronesians,PolynesiansBimodaldistributionofglucose andprevalenceofretinopathyandproteinuriainPimaIndiansKnowlerWCetc.DiabetesMetabRev6:1-27,1990Copyright©1994BMJPublishingGroupLtd.McCane,DRetal.BMJ1994;308:1323-85yearcumulativeincidence(top)andpreval
4、ence(bottom)ofretinopathyinrelationtotenthsof2hPG,FPG,andHBa1c现用诊断标准NDDG1979:FPG>=7.8mmol/land75gOGTTat½,1,1½,2hoursWHO1980:adoptedtheNDDGcriteria,2hglucose>=11.1mmol/lafter75gloadas“金标准”WHO1985:slightlymodifiedtheWHO1980criteriaADA1997:FPG7.8mmol/lto7.0mmol/l，NotuseOGTTWHO1999:ado
5、ptedtheFPG7.0mmol/l,retainedthe2hOGTTWHO/IDF2006:nochangesexceptforsometerms什么是糖耐量异常?1.均值+2标准差2.血糖双峰分布,小血管病变3.大血管病变:心脑血管及外周血管病变Dysglycemia>>NormoglycemiainAcuteandStableCVDiseaseConsecutivepts:2107in-pts;2854out-ptelectiveCVconsultsinEurope(71%men;meanage66)OGTT/oldDMin1587(75%)acu
6、te&1857(66%)electiveptsbeforedischargeorwithin2mo.EuroHeartSurveyBartnikMetal;EurHtJ2004;1880NGTIFGIGTKnownDMNewDM29%35%22%22%31%30%15%10%3%3%020406080100%AcuteElectiveTheDECODEStudy(http://www.ktl.fi/decode/index.html)DiabetesEpidemiology:CollaborativeanalysisOfDiagnosticcriteriai
7、nEurope2-hourplasmaglucose(mmol/l)<7.87.8–11.0³11.1Total<6.16.1–6.921,9682,0202,56289331620624,8463,119³7.02763784891,143Fastingplasmaglucose(mmol/l)Total24,2643,8331,01129,108AdaptedfromDECODEStudyGroup.BrMedJ1998;317:371–375Classificationofindividuals-theDECODEStudyDiscrepancyofF
8、PGand2hPGcriteriaintheDECO
