空腹血糖诊断妊娠期糖尿病的临床适宜性研究  

Study on the clinical suitability of fasting blood glucose in diagnosis of gestational diabetes mellitus

作　　者：乐江华[1] 彭凌湘 李曼[1] 

机构地区：[1]桂林医学院附属医院妇产科,广西桂林541001

出　　处：《中国妇幼保健》2017年第22期5507-5510,共4页Maternal and Child Health Care of China

基　　金：广西壮族自治区卫生厅科研课题(Z2014292)

摘　　要：目的探讨空腹血糖(FPG)筛查妊娠期糖尿病(GDM)的价值及其对妊娠结局的影响。方法回顾性分析2017例完成产前检查并分娩孕妇的临床资料。将研究对象按有无GDM分为GDM组216例和正常组1 801例,比较两组孕妇妊娠不同阶段FPG水平及妊娠结局,分析FPG诊断GDM的价值。结果 GDM组中新生儿出生体质量以及剖宫产率、巨大儿、需要胰岛素治疗及需要饮食运动控制的比例均高于正常组,差异均有统计学意义(均P<0.05);两组总的围生期并发症发生率比较,差异有统计学意义(P<0.05)。随着FPG值的升高,糖耐量试验(OGTT)阳性率明显升高,筛查GDM的灵敏度逐渐降低,特异度逐渐升高。当FPG<4.4 mmol/L时,如暂不行75 g OGTT,将导致有一部分孕妇漏诊。结论 GDM的不良妊娠结局与血糖水平密切相关,行FPG检查对GDM有预测意义。当FPG<4.4 mmol/L时,仍不能完全排除GDM的发生,对于高危人群应加强孕期宣教,控制体质量,必要时仍需进行OGTT试验,做到尽早发现,尽早控制,改善妊娠结局。Objective To explore the value of fasting blood glucose（FPG） in screening of gestational diabetes mellitus（GDM） and its effect on pregnancy outcomes.Methods The clinical data of 2 017 pregnant women completing prenatal examination and giving birth to their babies in the hospital was retrospectively analyzed.Then the pregnant women were divided into GDM group（216 cases） and normal group（1 801 cases） according to complicated by GDM or not.The levels of FPG of different stages and pregnancy outcomes in the two groups were compared.The value of FPG in diagnosis of GDM was analyzed.Results Neonatal birth weight,the rates of cesarean section,macrosomia,needing insulin treatment and diet and exercise control in GDM group were statistically significantly higher than those in normal group（all P〈0.05）.There was statistically significant difference in the total incidence rate of perinatal complications between the two groups（P〈0.05）.With the increase of FPG level,the positive rate of oral glucose tolerance test（OGTT） increased significantly,the sensitivity of GDM screening decreased gradually,while the specificity increased gradually.When FPG level was less than 4.4 mmol/L,absence of 75 g OGTT could lead to missed diagnosis of partial pregnant women.Conclusion Adverse pregnancy outcomes of GDM patients is closely correlated with blood glucose levels.FPG examination has predictive value for GDM.FPG4.4 mmol/L can not exclude the occurrence of GDM completely.Propaganda and education during pregnancy should be strengthened,and weight should be controlled,OGTT can be performed if necessary,early detection and early control can improve pregnancy outcomes.

关 键 词：妊娠期糖尿病 空腹血糖 诊断 普查 妊娠结局 

分 类 号：R714.2[医药卫生—妇产科学]