对583例孕妇行妊娠期糖尿病筛查的临床研究  

Study of screening the gestational diabetes mellitus in 583 cases

作　　者：陈正琼[1] 成娅[1] 陈波洁[1] 谢荣凯[1] 林桂兰[1] 钟序素[1] 程湘[1] 

机构地区：[1]第三军医大学新桥医院妇产科,重庆400037

出　　处：《重庆医学》2004年第12期1826-1828,共3页Chongqing medicine

摘　　要：目的　初步了解本地妊娠期糖耐量降低 (GIGT)和妊娠期糖尿病 (GDM)的患病率 ;分析适合本地GDM筛查的GCT切点和孕妇高危年龄界定。方法　对 5 83例孕妇以口服 5 0 g葡萄糖负荷试验 (GCT)的方法行GDM筛查 ,取 1h静脉血糖值≥7.8mmol/L为阳性。阳性者不控制饮食 3d后行口服葡萄糖耐量实验 (OGTT) ,若 2项或 2项以上等于或超过上限值诊断为GDM ;4项中有 1项≥上限值或第 2小时在 6 .7～ 9.1mmol/L之间 ,诊断为GIGT。结果　 (1)GCT阳性率 2 4 .0 1% ,确诊GDM15例 ,GIGT6 1例 ,GDM和GIGT患病率分别为 2 .5 7%和 10 .4 6 %。若取 8.3mmol/L为GCT切点 ,将减少 2 5 .71%的OGTT检查率而能发现 10 0 %的GDM和 91.8%的GIGT。 (2 )有DM家族史者 6 6 .6 7%发生不同程度糖耐量异常 ;且有DM家族史者占GDM组患者的 7/15 (46 .6 7% ) ,DM家族史为高危因素之首。 (3)年龄≥ 2 5岁者占 74 .96 % ;而 6 8.88%集中在 2 5～ 30岁之间。结论　本地GIGT和GDM有相当的患病率 ,应加强筛查工作。GDM筛查GCT的切点取值以 8.3mmol/L为宜。高危年龄界定在≥ 2 5岁漏诊率最低。为减少漏诊 ,建议在城市实行普遍筛查。Objective To investigate the local incidence of gestational impaired glucose tolerance (GIGT) and gestational diabetes mellitus (GDM).To study the appropriate cutoff value of the 50g glucose challenge test and maternal age to screen GDM. Methods Five hundreds and eighty-three pregnant women were screened for GDM by means of the 50g oral glucose challenge test.Those whose one-hour blood glucose value was beyond 7.8mmol/L received 75g oral glucose tolerance test 3 days later without dietary control. If two values of four were abnormal, GDM was diagnosed .GIGT was diagnosed if only one value was abnormal or the 2nd hour value ranged from 6.7-9.1mmol/L.Results (1)24.1% of all the pregnant women showed abnormal blood value in GCT. 15 cases (2.57%) was diagnosed GDM, 61 cases (10.46%) were GIGT. If the value of 8.3 mmol/L was used as the cut-point of 50g GCT to screen the GDM,25.71% of the pregnant women would avoid being tested by OGTT with all of the GDM and 91.8% of the GIGT still being recognized .(2)66.67% of those who had family history of diabetes mellitus were found to have different degree of glucose intolerance.46.67%of the diagnosed GDM had such a history.(3)Maternal age positively correlated with the rate of abnormal GCT and the incidence of GIGT and GDM.74.96% of all the pregnant women were beyond 25 years old,68.88% of which clustered between 25 to 30 years old. Conclusion There was considerable incidence of GIGT and GDM in Chongqing .Screening of GDM should be reinforced. The value of 8.3 mmol/L used as the cut-point of 50g GCT to screen the GDM is more locally appropriate. When those aged more than 25 years were all screened, the misdiagnose rate was low. To further reduce misdiagnose rate, universal screening should be suggested in big cities.

关 键 词：糖尿病 妊娠 葡糖耐量实验 血糖 

分 类 号：R714.2[医药卫生—妇产科学]