妊娠早期空腹血浆葡萄糖水平与妊娠期糖尿病的相关性  

Correlations between fasting plasma glucose level in the first trimester and gestational diabetes mellitus

作　　者：杨丽[1] 范玲[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》2014年第2期88-92,共5页Chinese Journal of Perinatal Medicine

基　　金：首都医学发展科研基金（2009-3245）

摘　　要：目的 探讨妊娠早期空腹血浆葡萄糖（fasting plasma glucose,FPG）水平与妊娠期糖尿病（gestational diabetes mellitus,GDM）的关系. 方法 2011年10月至2012年9月间在首都医科大学附属北京妇产医院产前检查、妊娠8～12周FPG＜7.00 mmol/L、妊娠24～28周行75 g口服葡萄糖耐量试验的11 477例孕妇纳入研究.GDM诊断标准参照国际妊娠合并糖尿病研究组的标准.采用Mann-Whitney U检验比较正常组和GDM组妊娠早期FPG水平的差异.采用受试者工作特性（receiver operating characteristic,ROC）曲线分析妊娠早期FPG预测GDM的有效性和适用性.采用卡方检验分析FPG水平与GDM诊断率的关系. 结果 11 477例孕妇中妊娠24～28周确诊GDM 1 535例（1 3.4％）,其余9 942例作为正常组.GDM孕妇妊娠早期FPG中位水平为4.89 mmol/L（4.62～5.15 mmol/L）,高于对照组[4.75 mmol/L（4.53～4.98 mmol/L）]（Z=-13.994,P=0.000）.妊娠早期FPG预测GDM的最大曲线下面积为0.599,取FPG 4.88 mmol/L为界值预测GDM的敏感性为0.523,特异性为0.645,取5.10和5.60 mmol/L为界值时敏感性分别为0.334和0.068,特异性分别为0.811和0.983.妊娠早期FPG≤4.09、～4.60、～5.10、～5.60、～6.10及≥6.10 mmol/L时GDM的诊断率分别为8.5％（23/212）、9.9％（335/3 379）、12.3％（719/5 858）、20.7％（359/1 734）、40.2％（78/194）和52.5％（21/40）,随着妊娠早期FPG的升高,GDM的诊断率逐渐增加（x2=300.523,P=0.000）.FPG≤4.09、～4.60、～5.10、～5.60 mmol/L组GDM诊断率分别低于FPG≥5.60且＜6.10 mmol/L组及≥6.10 mmol/L组（x2值分别为67.242、164.680、128.125、37.860、55.843、76.856、58.589和23.484,P值均=0.000）;FPG≤4.09、～4.60和～5.10 mmol/L组GDM诊断率低于FPG≥5.10且＜5.60 mmol/L组（x2值分别为22.877、113.717和78.040,p值均=0.000）;FPG≥4.09且＜4.60 mmol/L组GDM诊断率低于FPG≥4.60且＜5.10 mmol/L组（x2=11.803,P=0.001）.妊娠早期FPG≥5.60且＜6.10 mmol/L组及FPG≥6.1Objective To investigate the relationships between fasting plasma glucose （FPG） level in early pregnancy and gestational diabetes mellitus （ GDM ） . Methods Data of 11 477 pregnant women who accepted prenatal care in Beijing Obstetrics and Gynecology Hospital from October 2011 to September 2012 were collected. FPG was tested during 8 to 12 weeks of pregnancy in all women and those with FPG〈7.00 mmol/L were recruited. Women accepted 75 g oral glucose tolerance test （ OGTT ）during 24 to 28 weeks of pregnancy. The GDM diagnostic criteria was with reference to the criteria of International Association of Diabetes and Pregnancy Study Group. Mann-Whitney U test was used to analyze the difference of early pregnancy FPG between normal pregnant women and GDM women. Receiver operating characteristic （ ROC ） curve was used to analyze the validity and applicability of using early pregnancy FPG in GDM diagnosis. Chi-square test was used to analyze the relationship between the FPG levels and GDM diagnosis. Results There were 1 535 （ 13.4% ） women diagnosed as GDM in 24 to 28 weeks of pregnancy （ the rest 9 942 normal cases were taken as the controls ）. The median FPG level of the GDM group was 4.89 mmol/L （ 4.62-5.15 mmol/L ） , which was higher than that of the controls [4.75 mmol/L（ 4.53-4.98 mmol/L ）] （ Z= - 13.994, P=0.000 ）. The maximum area under curve （ AUC ）, which was used to predict GDM with early pregnancy FPG, was 0.599 （ 95% CI： 0.582-0.617 ） . Taking FPG 4.88 mmol/L as the cutoff value, the sensitivity was 0.523 and the specificity was 0.645. While taking FPG 5.10 and 5.60 mmol/L as the cutoff value, the sensitivity was 0.334 and 0.068, and the specificity was 0.811 and 0.983, respectively. When the FPG level ≤ 4.09, -4.60, -5.10, -5.60, -6.10 and 〉I 6.10 mmol/L, the GDM diagnostic rate gradually increased [8.5%（ 23/212 ）, 9.9%（ 335/3 379 ）, 12.3%（ 719/5 858 ）, 20.7%（ 359/1 734 ）, 40.2% （ 78/194 ） and 52.5% （ 21/40 ） ] （Z2=300.523, P=0.

关 键 词：血糖 妊娠初期 糖尿病 妊娠 

分 类 号：R714.256[医药卫生—妇产科学]