早孕期空腹血糖对妊娠期糖尿病的预测价值  

Predictive value of early pregnancy fasting blood glucose for development of gestational diabetes mellitus

作　　者：王晨[1] 杨慧霞[1] 

机构地区：[1]北京大学第一医院妇产科,100034

出　　处：《中华糖尿病杂志》2016年第7期405-409,共5页CHINESE JOURNAL OF DIABETES MELLITUS

基　　金：基金项目：国家科技支撑计划（2015BA113806）;世界糖尿病基金（wDF10-517、WDF14-908）;北京市科技专项（Z151100001615051）;妊娠合并糖尿病母胎医学研究北京市重点实验室

摘　　要：目的：探讨早孕期空腹血糖（FPG）在有妊娠期糖尿病（GDM）危险因素和无GDM危险因素人群中对GDM的预测价值。方法通过问卷调查的方式收集2013年6月至2014年9月于北京大学第一医院产科住院分娩孕妇的人口学信息和临床资料。在排除不符合入组条件的孕妇后，共有3233例孕妇入组。根据孕妇年龄、孕前体质指数及糖尿病家族史，将入组孕妇分为有GDM危险因素组（1341例）和无GDM危险因素组（1892例）。采用独立样本t检验和χ2检验进行组间比较，并采用受试者工作特征（ROC）曲线评价早孕期FPG在两组中对GDM的预测价值。结果（1）有GDM危险因素组早孕期FPG水平显著高于无GDM危险因素组[（5.1±0.4）比（5.0±0.4） mmol/L，t=6.44, P〈0.001]。（2）以无危险因素FPG最低四分位组为参照组，有GDM危险因素组，早孕期FPG达到4.75~5.00 mmol/L、5.00~5.25 mmol/L和≥5.25 mmol/L时，GDM的发生风险显著增加，OR值分别为1.84（95%CI 1.26~2.70）、2.46（95%CI 1.71~3.52）和6.99（95%CI 5.01~9.77）；而无GDM危险因素组，只有当早孕期FPG≥5.25 mmol/L时，GDM的发生风险显著增加，OR值为2.55（95%CI 1.80~3.60）。早孕期FPG每升高0.50 mmol/L，无GDM危险因素组GDM的发生风险增加1.69倍（95%CI 1.45~1.98）,有GDM危险因素组GDM的发生风险增加2.33倍（95%CI 1.96~2.61）。（3）早孕期FPG预测GDM的ROC曲线下面积对于有GDM危险因素和无GDM危险因素人群，分别为0.694（95%CI 0.661~0.732）和0.620（95%CI 0.580~0.662），且早孕期FPG对有无GDM危险因素人群GDM的预测价值分别以≥5.17 mmol/L和≥5.09 mmol/L时效果最好。结论早孕期FPG对有GDM危险因素人群GDM的预测价值更大，且早孕期FPG对有无GDM危险因素孕妇的GDM预测最佳切点不同。Objective To evaluate the value of early pregnancy fasting plasma glucose（FPG） to predict gestational diabetes mellitus（GDM） in pregnant women with or without GDM risk factors. Methods From June 2013 to September 2014, 3 223 singleton healthy pregnant women in Peking University First Hospital were recruited and their demographic/medical information were collected using. Based on age, pre-pregnancy body mass index （BMI） and family history of diabetes, participants were grouped into GDM risk factors positive group （n=1 341） and GDM risk factors negative group （n=1 892）. T-test andχ2 test were used for between-group comparison. Receiver operating characteristic （ROC） curve was used to evaluate the prediction of early pregnancy FPG for GDM. Results （1） Pregnant women with GDM risk factors had significantly higher FPG levels in early pregnancy compared to those without GDM risk factors （（5.1±0.4）vs （5.0±0.4） mmol/L, t=6.44, P〈0.001）.（2）Compared to women with FPG〈4.75 mmol/L and those without GDM risk factors, women with GDM risk factors and with 4.75≤FPG〈5.00 mmol/L, 5.00≤FPG〈5.25 mmol/L and＆nbsp;FPG≥5.25 mmol/L had a significant increased risk of developing GDM, the OR values were 1.84（95%CI 1.26-2.70）,2.46 （95%CI 1.71-3.52） and 6.99 （95%CI 5.01-9.77） respectively;while in GDM risk factors negative group, only those with FPG≥5.25 mmol/L had a significant increased risk of developing GDM, and the OR value was 2.55 （95%CI 1.80-3.60）. There was approximately a 1.6-fold increase （95%CI 1.45-1.98） in the risk of developing GDM for each 0.5 mmol/L increment in FPG in women without GDM risk factors, while a 2.33-flod increase （95%CI 1.96-2.61） in women with GDM risk factors. （3） Based on the ROC analysis, the area under the curve of early pregnancy FPG in predicting GDM for women with and without GDM risk factors was 0.694（95%CI 0.661-0.732） and 0.620 （95%CI 0.580-0.662）,respectively. The optimal cut off value was 5.17 mmol/

关 键 词：糖尿病 妊娠 空腹血糖 早孕期 

分 类 号：R714.256[医药卫生—妇产科学]