2小时糖耐量试验的临床意义66.pptVIP

2小时糖耐量试验的临床意义 Finnish Academy Research Fellow 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) Jacobsen A. Biochem Z 51:443, 1913 Normal Glucose Homeostasis Daytime Profile (N=12, health; Mean + 95%CI) Owens D ,Zinman B Bolli G : Lancet 358,739,2001 Meal Times 80 40 0 Insulin (mU/L) 08.00 13.00 16.00 19.00 h Glucose (mmol/L) 8 4 2 6 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 Mosenthal H.O. and Barry E (Ann Intern Med 33: 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Pima Indians (1971), Mexican-Americans, Micronesians, Polynesians Bimodal distribution of glucoseand prevalence of retinopathy and proteinuria in Pima Indians Knowler WC etc. Diabetes Metab Rev 6: 1-27, 1990 Copyright ©1994 BMJ Publishing Group Ltd. McCane, D R et al. BMJ 1994;308:1323-8 5 year cumulative incidence (top) and prevalence (bottom) of retinopathy in relation to tenths of 2hPG, FPG, and HBa1c 现用诊断标准 NDDG1979: FPG=7.8 mmol/l and 75g OGTT at ½, 1, 1½, 2 hours WHO 1980: adopted the NDDG criteria, 2h glucose=11.1 mmol/l after 75g load as “金标准” WHO 1985: slightly modified the WHO 1980 criteria ADA 1997: FPG 7.8 mmol/l to 7.0 mmol/l，Not use OGTT WHO 1999: adopted the FPG 7.0 mmol/l, retained the 2h OGTT WHO/IDF 2006: no changes except for some terms 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 Normoglycemia in Acute and Stable CV Disease Consecutive pts: 2107 in-pts; 2854 out-pt elective CV consults in Europe (71% men; mean age 66) OGTT/old DM in 1587 (75%) acute 1857 (66%) elective pts before discharge or within 2 mo. Euro Heart Survey Bartnik M et al; Eur Ht J 2004;1880 The DECODE Study (http://www.ktl.fi/decode/index.html) Diabetes Epidemiology: Collaborative analysis Of Diagnostic criteria in Europe 2-h