孕中期糖耐量血糖与妊娠分娩结局相关性回顾分析  

Analysis of the relationship between levels of blood glucose in mid-pregnancy and pregnancy outcome

作　　者：陈小伟[1,2] 傅顺琴 王念跃[1,3] 

机构地区：[1]东南大学医学院,南京210009 [2]江苏省南京市六合区人民医院检验科,211500 [3]江苏省南京市第二医院检验科,210009

出　　处：《检验医学与临床》2016年第21期3039-3042,共4页Laboratory Medicine and Clinic

摘　　要：目的分析本地区孕妇在孕中期血糖水平与妊娠分娩结局关系。方法选取2014年1月至2015年10月在南京六合区人民医院分娩的3 098例孕妇,回顾其在孕24~28周时检测的口服葡萄糖耐量试验（OGTT）3个时间点的血糖：空腹、服糖后1h和服糖后2h（FPG、1hPG和2hPG）。根据妊娠结局分为结局正常组2 227例和不良分娩组871例;再按孕妇有无GDM分为384例妊娠期糖尿病（GDM）组,2 714例对照（非GDM）组;另按年龄把孕妇分为3组：A组（18~〈30岁）,2 656例;B组（30~〈35岁）327例;C组（35~≤45岁）,115例。采用Logistic回归分析3个年龄组及所有孕妇OGTT3个时间点血糖值,分别得到预测概率绘制ROC曲线,以判断OGTT血糖对分娩结局的诊断效率。结果不良分娩结局组孕妇的OGTT3个时间点的血糖值均高于分娩结局正常组,差异有统计学意义（P〈0.05）。GDM组孕妇的OGTT3个时间点的血糖值均高于对照组,差异有统计学意义（P〈0.05）,GDM组妊娠高血压综合征、胎膜早破、早产、胎儿窘迫、产后出血、巨大儿发生率及剖宫产率均高于对照组,差异有统计学差异（P〈0.05）。3个年龄组孕妇不同时间点OGTT血糖值为：C组〉B组〉A组,差异均有统计学意义（P〈0.05）,3个年龄组孕妇的剖宫产、GDM、巨大儿和妊娠高血压综合征发生率为C〉B〉A,差异有统计学意义（P〈0.05）;C组妇的胎膜早破和胎儿窘迫发生率发生率均高于A、B组,差异有统计学意义（P〈0.05）;B组与C组孕妇的早产发生率均高于A组,差异有统计学意义（P〈0.05）。3个年龄组及所有孕妇FPG、1hPG和2hPG预测妊娠结局的ROC工作曲线下面积（AUC）分别为0.592、0.665、0.865和0.611。结论孕中期孕妇OGTT血糖值、GDM发生率及不良分娩结局随孕妇年龄增加而增加,GDM高血糖水平与妊娠期多种并发症关系密切。对孕期糖耐量异常者应积极干预以降低母婴并发症的发生,改善Objective To analyze the relationship between levels of blood glucose in mid-pregnancy and pregnancy outcome.Methods Totally 3 098 pregnant women were selected as subjects from January 2014 to October 2015,and the fasting plasma glucose（FPG）,glucose levels of 1hour（1hPG）and 2hours（2hPG）after oral glucose by oral glucose tolerance test（OGTT）in 24-28 weeks of pregnancy were tested.The subjects were divided into healthy outcome group（2 227cases）and unhealthy outcome group（871cases）according to their pregnancy outcomes.And women with GDM（384cases）and patients without GDM（2 714cases）were selected as GDM group and control group.In addition,women aged 18to〈30years were selected as group A（2 656cases）,who aged 30to〈35years old were selected as group B（327cases）and who aged 35 to 45years old were selected as group C（115cases）.By Logistic regression analysis,3time-point levels of OGTT blood glucose in three age groups were analyzed,and ROC curve was draw to judge the diagnostic effect of OGTT blood glucose on birth outcome.Results Blood glucose levels of pregnant women with adverse birth outcome were significantly higher than that of normal childbirth group（P〈0.05）.Blood glucose levels in GDM group were significantly higher than that of the control group（P〈0.05）.The incidence rates of pregnancy-induced hypertension syndrome,premature rupture of membranes,premature birth,fetal distress,postpartum hemorrhage,macrosomia and cesarean delivery of the GDM group were significantly higher than the control group（P〈0.05）.Blood glucose levels in the three age groups from high to low were as following：C〉B〉A,the differences between the three groups had statistical significance.The incidence rates of cesarean delivery,GDM,macrosomia and pregnancy-induced hypertension syndrome in three groups from high to low were as following：C〉B〉A,and the differences between the three groups had statistical significance（P〈0.05）.And the rates of premature rupture of memb

关 键 词：妊娠期糖尿病 血糖 糖耐量试验 分娩结局 ROC曲线 

分 类 号：R587.1[医药卫生—内分泌]