口服葡萄糖耐量试验中空腹血糖水平在妊娠期糖尿病诊断中的作用  

Value of fasting plasma glucose in oral glucose tolerance test on gestational diabetes mellitus diagnosis

作　　者：邹丽颖[1] 范玲[1] 翟燕红[1] 

机构地区：[1]首都医科大学附属北京妇产医院产科,100026

出　　处：《中华围产医学杂志》2012年第11期660-663,共4页Chinese Journal of Perinatal Medicine

基　　金：首都医学发展科研基金（2009-3245）

摘　　要：目的探讨妊娠24～28周间口服葡萄糖耐量试验（oralglucosetolerancetest，0GTT）中空腹血糖值在诊断妊娠期糖尿病（gestationaldiabetesmellitus，GDM）中的作用。方法对2010年1月1日至12月31日间，于首都医科大学附属北京妇产医院产前检查，妊娠早期空腹血糖正常（〈7．0mmol／L），妊娠24--28周50g葡萄糖负荷试验≥7．8mmol／L并行75gOGTT的6516例孕妇的OGTT结果进行分组分析。采用卡方检验，了解按OGTT空腹血糖水平分组后GDM的诊断情况。结果按国际糖尿病与妊娠研究组（InternationalAssociationofDiabetesandPregnancyStudyGroups，IADPSG）的GDM诊断标准，单纯依据0GTT空腹血糖升高（≥5．1mmol／L）可诊断15．0％（980／6516）的GDM患者，剔除这部分患者后，余OGTT空腹血糖〈5．1mmol／L的5536例孕妇纳入分组分析。以OGTT中空腹血糖值每升高0．1mmol／L为1个分界进行第1次分组，结果显示，随着空腹血糖水平的升高，GDM的诊断率逐渐增加（X2=282．175，P=0．000）。按照空腹血糖在4．0～4．8mmol／L间每升高0．2mmol／L为1个分界进行第2次分组分析，显示随着空腹血糖水平的升高，各组GDM诊断率仍呈现升高趋势（X2=274．364，P=0．000）。两种分组结果均显示，当OGTT中空腹血糖水平〈4．2mmol／L（1226／5536，占22．1％）时，GDM诊断率为3．6％（44／1226），可以考虑对该部分患者暂时不行0GTT检测；当OGTT中空腹血糖水平≥4．8mmol／L时，GDM诊断率明显增加，为26．2％（298／1138），故应提高警惕。结论妊娠24～28周行0GTT前建议先行空腹血糖筛查，空腹血糖≤4．2mmol／L的低危孕妇可免于OGTT检测。Objective To investigate the value oi lasting plasma glucose oral glucose tolerance test （OGTT） on the diagnosis of gestational diabetes mellitus （GDM）. Methods Data of 6516 pregnant women who accepted prenatal cares from Beijing Obstetrics and Gynecology Hospital, Capital Medical University between Jan. 2010 and Dec. 2010 were collected. All patients had normal FPG at first trimester, and accepted 75 g OGTT after abnormal 50 g glucose challenge test （≥7.8 retool/L）. According to the result of OGTT, they were divided into 12 groups, and Chi square test was used to analyze the role of FPG of OGTT in GDM diagnosis. Results According to the International Association of Diabetes and Pregnancy Study Groups （IADPSG） criteria, 15.0% （980/ 6516） of this group of pregnant women was diagnosed with GDM by FPG （≥5.1 mmol/L） of OGTT in this study. Then, the rest 5536 pregnant women with normal FPG of OGTT were divided into 12 groups according to FPG level （FPG level interval 0.1 mmol/L）. As FPG level rose, the incidence of GDM also rose （X2= 282. 175, P= 0.000）. Similar results also appeared when the interval was 0.2 mmol/L and the FPG level was between 4.0 and 4.8 mmol/L （X2 =274. 364, P= 0. 000）. When FPG level was lower than 4.2 mmoI/L（22.1%, 1226/5536）, the incidence of GDM diagnosed by OGTT was 3.6% （44/1226）. And when FPG level of OGTT was higher than4.8 retool/L, the incidence of GDM was 26.2%（298/1138）. Conclusions FPG screening is recommended between 24 and 28 gestational weeks before OGTT, and GDM low-risk women whose FPG 44.2 mmol/L do not need OGTT.

关 键 词：糖尿病 妊娠 葡糖耐量试验 血糖 

分 类 号：R587.1[医药卫生—内分泌]