早孕期空腹血浆血糖与妊娠期糖代谢异常的相关性  

Relationship between fasting plasma glucose in early pregnancy and gestational glucose metabolic disorders

作　　者：吴春凤[1,2] 杨慧霞[1] 

机构地区：[1]北京大学第一医院妇产科,100034 [2]首都医科大学燕京医院附属密云医院妇产科

出　　处：《中华围产医学杂志》2011年第3期166-169,共4页Chinese Journal of Perinatal Medicine

摘　　要：目的 探讨早孕期空腹血浆血糖（fasting plasma glucose，FPG）与妊娠期糖代谢异常的相关性。方法 选取2009年1月1日至2009年5月31日在北京大学第一医院妇产科产前保健及分娩的单胎非孕前糖尿病且早孕期5～13周检测FPG、资料齐全的孕妇656例，对其早孕期FPG孕24周后50g葡萄糖负荷试验结果（glucose challenge test，GCT）、75g葡萄糖耐量试验结果（oral glucose tolerance test，OGTT）、妊娠期糖尿病（gestational diabetes mellitus，GDM）和妊娠期糖耐量受损（gestational impaired glucose tolerance，GIGT）发病情况进行受试者工作特性（receiver operating characteristic，ROC）分析。结果 （1）早孕期FPG与孕24周后GCT的ROC分析：最大曲线下面积0.539，95％CI：0．493～0．586，两者无明显相关性（P=0．057）。（2）早孕期FPG与孕24周后FPG异常的ROC分析：最大曲线下面积0．796（95％CI：0．672～O．920），如取5．05mmol／L为界值，敏感性为54．5％，特异性为83．2％，两者存在相关性（r=0．432，P=0．000）。（3）早孕期FPG与孕24周后OGTT 1、2、3h血糖无相关性（r=0．093、0．036和0．107，P=0．122、0．549和0．074），OGTT服糖前与服糖后1、2、3h血糖分别呈正相关（r=0．493、0．421和0．368，P均=0．000）。（4）本研究中共656例早孕期孕妇的FPG值均〈6．1mmol／L，诊断GDM 22例，GIGT 27例，早孕期FPG对预测最终发生GDM及GIGT无相关性。结论 早孕期FPG不能取代现有的50g GCT作为孕期糖代谢异常的早期筛查指标，但早孕期FPG的检测是必要的。Objective To investigate the relationship between early pregnancy fasting plasma glucose （FPG） and gestational glucose metabolism disorders. Methods Six hundred and fifty-six pregnant women who were singleton, non-diabetes before pregnancy and had FPG examined during 5-13 weeks of pregnancy were admitted into this study from January 1, 2009 to May 31, 2009. All these subjects had routine prenatal examination and finally delivered in the Department of Obstetrics of Peking University First Hospital. The FPG, 50 g glucose challenge test （OCT） after 24 weeks of pregnancy, 75 g oral glucose tolerance test （OGTT）, gestational diabetes mellitus （GDM）, gestationai impaired glucose tolerance （GIGT） were analyzed with receiver operating characteristic （ROC） curve. Results （1） Relationship between FPG and GCT were analyzed with ROC curve. The maximum area under curve was 0. 539 （95%CI： 0.493-0.586） and there was no correlation between the FPG and GCT results（P=0.057）. （2） Relationship between early pregnancy FPG and abnormal FPG examined after 24 gestational weeks were also analyzed . The maximum area under curve was 0.796 （95% CI： 0.672-0.920）. If 5. 05 mmol/L was taken as the cutoff value, the sensitivity and specificity was 54. 5% and 83. 2%, respectively. There was significant relationship between the two values （r=0.432, P=0. 000）. （3） There were no relationship between early pregnancy FPG and the blood glucose value of 1, 2 and 3 h in 75 g OGTT （r=0.093, 0.036 and 0.107, P=0.122, 0.549 and 0.074 respectively）. OGTT 0 h value was positively related to OGTT 1, 2 and 3 h glucose level （r=0.493, 0.421 and 0.368, P=0.000, respectively）. （4） All early pregnant FPG values in this study were under 6.1 mmol/L. Twenty-two GDM and 27 GIGT patients were diagnosed in this study. Early pregnancy FPG did not relate to the GDM and GIGT diagnosis. Conclusions Early pregnancy FPG could not replace 50 g GCT as an early screening for glucose metabolic abnormality in preg

关 键 词：空腹血糖 早孕期 糖代谢异常 ROC曲线 

分 类 号：R714.256[医药卫生—妇产科学]