妊娠14～18周糖筛查的可行性分析  

The Feasibility Analysis of Glucose Screening during 14～18 Gestational Weeks

作　　者：张文淼[1] 李云云[1] 包影[1] 李莹[1] 

机构地区：[1]温州医学院附属第一医院,浙江温州325000

出　　处：《实用妇产科杂志》2011年第10期781-784,共4页Journal of Practical Obstetrics and Gynecology

摘　　要：目的:探讨将妊娠期糖筛查时间提早到孕14～18周的可行性。方法:收集孕前无糖尿病史的孕妇共2691例,其中875例于孕14～18周行首次糖筛查(早期筛查组)使用50g糖筛查(GCT)(部分空腹进行,另部分随机进行),GCT阳性时行75g糖耐量试验(OGTT),除确诊的妊娠期糖尿病(GDM)和糖耐量异常(IGT)病例外,其余的至孕24～28周再次行糖筛查;另1816例至孕24～28周(常规筛查组)进行糖筛查。结果:①早期筛查组在孕14～18周第1次筛查发现GCT阳性103例(11.8%),确诊为GDM和IGT23例;24～28周复查确诊GDM和IGT30例,常规筛查组确诊GDM和IGT112例,两组IGT和GDM总发病率比较,差异无统计学意义(P>0.05);②早期筛查组中,对第1次筛查的GCT值≥7.8mmol/L、≥7.5mmol/L并<7.8mmol/L和<7.5mmol/L分组,其再次筛查时GCT阳性的分别占首次筛查的77.5%、15.9%和5.5%,3组间再次GCT阳性率比较差异有高度统计学意义(P<0.01)。③两组GCT筛查时,空腹糖筛查的GCT阳性率(9.0%)明显低于随机糖筛查组(14.2%)(P<0.05),但两组确诊的总的IGT和GDM发生率比较,差异无统计学意义(P>0.05)。④GDM的高危因素比较:早期筛查组中孕14～18周和孕24～28周与常规筛查组两两相比,差异均无统计学意义(P>0.05)。结论:无论是否存在高危因素,将糖筛查时间提早到14～18周至少可以检出半数糖代谢异常患者,故推行早期糖筛查是可行的。Objective：To explore the feasibility of glucose screening during 14～18 gestational weeks.Methods：2691 pregnancy women without the history of diabetes mellitus before pregnancy were enrolled in our study. 875 pregnant women who received first 50g glucose screening test（GCT） during 14～18 gestational weeks were selected for study group（early screening group） . Part of pregnant women received GCT at fasting and others time at random. Oral glucose tolerance test（OGTT） were performed when the result of GCT was positive. All of the cases except those who had been diagnosed as gestational diabetes mellitus（GDM） and impaired glucose tolerance（IGT） received repeated GCT during 24～28 gestational weeks. Other 1816 cases received first GCT during 24～28 gestational weeks（routine screening group） .Results：①Results of GCT were positive in 103 cases for the first screening during 14～18 gestational weeks in early screening group（11.8%） .23 cases were diagnosed as GDM and IGT. 30 cases were diagnosed as GDM and IGT during 24～28 gestational weeks when rechecked. 112 cases were diagnosed as GDM and IGT in routine screening group. There was no significant difference in the incidence of GDM and IGT between two groups（P0.05）;② All the cases in early screening group were divided into three groups according to the results of GCT at first time（GCT≥7.8 mmol/L、7.5≤GCT7.8 mmol/L、GCT 7.5 mmol/L） . The positive rate of repeated GCT results in the first GCT results were 77.5%、15.9%和5.5% respectively. There was significant difference in the positive rate of repeated GCT results in three groups（P0.01） .③The positive rate of first GCT results at fasting were significantly lower than that at random（9.0% vs 14.2%） ,whereas there was no significant difference in the incidence of GDM and IGT between two groups（P0.05） .④There was no significant difference in the high risk factors of GDM between early screening group（14～18 and 24～28 gestational weeks） and routin

关 键 词：妊娠期糖尿病 早期 糖筛查 

分 类 号：R714.54[医药卫生—妇产科学]