妊娠期糖尿病不同诊断方法与妊娠结局相关性分析与探讨  

Evaluation on Influence on Gestational Diabetes Mellitus (GDM) by Different Diagnostic Criteria

作　　者：张彩虹[1] 徐明娟[1] 

机构地区：[1]第二军医大学附属长海医院妇产科,上海200433

出　　处：《辽宁中医药大学学报》2014年第11期153-155,共3页Journal of Liaoning University of Traditional Chinese Medicine

摘　　要：目的：评价不同妊娠期糖尿病（GDM）诊断标准对妊娠结局的影响,探讨糖化血红蛋白（HbA1C）对妊娠期糖尿病是否有诊断价值。方法：对2012年2月1日—2013年1月31日在我院产检并分娩的1 000例单胎孕妇于24~28周行75 g葡萄糖耐量试验,分别测空腹、1 h、2 h和3 h的血糖及糖化血红蛋白,分别按新、旧标准进行诊断。旧标准诊断出GDM 51例,新标准诊断出GDM 201例。选择旧标准漏诊而采用新标准确诊的GDM孕妇共150例,随机分入GDM新标准组和GDM旧标准组,每组各75例,对各组妊娠结局进行比较分析。另外对新诊断标准诊断出的GDM及健康孕妇各200例的糖化血红蛋白进行相关性分析。结果：GDM新标准组与GDM旧标准组巨大儿、妊娠期高血压疾病、胎儿窘迫、羊水异常差异显著。GDM组与健康孕妇组HbAlc水平分别为（4.91±0.44）%与（4.90±0.40）%,差异不显著。以妊娠期糖尿病新标准为金标准,对HbA1c诊断GDM的行ROC曲线分析,ROC曲线下面积（95%CI）为0.631（0.558~0.704）。结论：虽然新诊断标准降低了空腹血糖的界值,增加了妊娠糖尿病的检出率,但是对GDM患者及早进行管理,可以减少妊娠期高血压、巨大儿、胎儿窘迫和羊水异常等并发症的发生。新诊断标准适合中国人群,而糖化血红蛋白不适于诊断GDM。Objective：To evaluate the influence on pregnancy outcome by different diagnostic criteria of gestational diabetes mellitus（GDM）,and explore the value of glycosylated hemoglobin（HbA1）in the screening and diagnosis of GDM.Methods：A total of 1000 patients in our department between February 2012 and January 2013 did 75 g oral glucose tolerance test（OGTI）between 24~28 weeks,and determined fasting plasma glucose（FPG）,1 hour plasma glucose（1 hPG）2 hours plasma glucose（2 hPG）,3 hours plasma glucose（3 hPG）and glycosylated hemoglobin（HbA1C）.51 and 201 GDM were diagnosed according to old and new diagnosis standards respectively.150 cases diagnosed GDM by new standard and not by old standard were assigned into the GDM new standard group and GDM old standard group randomly,75 cases in each group.We compared the pregnancy outcome.In addition,we compared the difference of glycosylated hemoglobin between GDM and normal pregnant women 200 cases respectively.Results：Forfetal macrosomia,hypertensive disorders complicating pregnancy（HDCP）,fetal distress and polyhydramnios in GDM new standard group were statistically significantly lower than those of old standard group（P0.05）.HbAlc level was（4.91 ＋ 0.44）% and（4.90 ＋ 0.40）% respectively in two groups,and no diference was observed.The area under the ROC curve（95% CI）of HbA1 c screening GDM was 0.631（0.558~0.704）.Conclusion：Although the new diagnostic criteria reduced fasting blood glucose Cut-off value,increased the rate of gestational diabetes mellitus,managing GDM patients early can reduce the forfetal macrosomia,HDCP,fetal distress and polyhydramnios.So new diagnostic criteria is suitable for the Chinese people while HbA1 c is not suitable for diagnosis of GDM.

关 键 词：诊断标准 妊娠期糖尿病 妊娠结局 糖化血红蛋白 

分 类 号：R714.256[医药卫生—妇产科学]