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目的 分析糖化血红蛋白(HbA1c)在糖耐量正常(NGT)人群中的分布特点及相关因素.方法 选择首钢4个社区糖尿病普查人群的资料,所有参加者进行人体学测量和75 9葡萄糖耐量试验(OGTT),同时检测HbA1c、空腹血糖(FPG)、OGTT后2h血糖值(2hPG)及血生化.将9 711名符合入选标准的NGT人群的结果纳入分析,比较HbA1c在不同性别及年龄组间[青年组(16～44岁)、中年组(45 ～ 59岁)、老年组(60～79岁)及老老年组(≥80岁)]的差异;根据HbA1c水平分为≤5.6％、5.7％～6.4％和≥6.5％三组,比较其临床特点;采用logistic回归方法分析与HbA1c的相关因素.结果 ①HbA1c在NGT人群呈正态分布,平均(5.69±0.44)％,95％CI为4.83％～6.55％;男性(5.68±0.44)％低于女性(5.70±0.44)％(P＜0.05),尤其在老年组差异显著(P＜0.01).②HbA1c随着年龄的增加逐渐升高,青年组与中年组的HbA1c(％)(5.56±0.41vs.5.68±0.44)、FPG(mmol/L)(5.14±0.39vs.5.20±0.40)及2hPG(mmol/L)(5.85±1.08 vs.6.01±1.06)的比较均有统计学意义(P＜0.01);老年组与老老年组的HbA1c(％) (5.75±0.44 vs.5.86±0.60)、FPG (mmol/L)(5.26±0.39vs.5.26±0.39)及2hPG(mmol/L)(6.19±1.04 vs.5.95±1.16)比较均无统计学意义;青年组、中年组的HbA1c、FPG与老年组和老老年组比较均有统计学意义(P＜0.01),而青年组、中年组的2 hPG与老老年组差异无统计学意义.③HbA1 c≤5.6％与HbA1 c5.7％～ 6.4％和≥6.5％组之间在年龄、体质指数(BMI)、腰臀比、收缩压、血胆固醇(TC)、三酰甘油(TG)、低密度脂蛋白胆固醇(LDL-C)水平、FPG和2 hPG均有统计学意义(P＜0.01或0.05);而HbA1 c5.7％～ 6.4％与≥6.5％组之间比较差异均无统计学意义.④logistic回归分析显示HbA1c与性别、年龄、BMI、腰臀比、收缩压、TC、FPG呈正相关,与舒张压、HDL-C呈负相关;其OR值分别为1.377、1.018、1.033、22.867、1.011、1.3、4.049、0.973、0.835.结论 NGT人群的HbA1c随年龄的增长而升高,并与FPG呈正相关;处于高危HbA1c范围的非糖尿病人群应加强对FPG、2 hPG和心血管危险因素的监测.

Objective To analyze the result of glycated hemoglobin (HbA1c) measurement and related factors in persons with normal glucose tolerance (NGT).Methods A 75 g glucose tolerance test (OGTT) was conducted in all participants from diabetes screening population of Shougang four communities.HbA1c,fasting plasma glucose (FPG),2 hour plasma glucose (2 hPG) after OGTT and blood biochemical tests were conducted.Anthropometric measurements were performed to all the subjects.A total of 9 711 individuals with normal FPG and 2 hPG were included for data analysis.All the subjects were divided into three groups by levels of HbA1c,and the clinical characteristics of the three groups were compared.Logistic regression was used to analyze the correlation of HbA1c to related factors.Results ① HbA1c was normally distributed in NGT populations.The range of HbA1c was 4.9％-6.5％ (5.69±0.44)％.There wassignificant difference in HbA1c between men (5.68 ± 0.44)％ and women (5.70 ± 0.44)％ (P＜0.05).Especially,there was significant difference (P＜0.01) between the older group (60 to 79 years old) and the other grooups.②HbA1c increased with age.There was significant differences among the young group (16 to 44 years old),middle-aged group (45-59 years),the elderly groups and very elderly group (≥80 years) in HbA1c,FPG and 2 hPG (P＜0.01),whereas there was no significant difference between the elderly groups and the very elderly group.③There were statistically significant differences between HbA1c≤5.6％ group and HbA1c 5.7％-6.4％ group,HbA1c≥6.5％ group in body mass index (BMI),waist-hip ratio (WHR),systolic blood pressure (SBP),serum total cholesterol (TC),triglyceride (TG),low density lipoprotein cholesterol (LDL-C) levels,FPG and 2 hPG (P＜001 or P＜005),whereas there was no significant difference between HbA1c 5.7％-6.4％ group and ≥the 6.5％ group.④ Logistic regression analysis showed that HbA1c was positively correlated with gender,age,BMI,WHR,SBP,TC,FPG,and was negatively correlated with DBP,HDL-C (OR:1.377,1.018,1.033,22.867,1.011,1.3,4.049,0.973,0.835,respectively).Conclusion HbA1c is positively correlated with age and FPG in the population with normal glucose tolerance.The non-diabetic population with high risk HbA1c should undergo monitoring for FPG,2 hPG and related cardiovascular risk factors.