上海朱泾地区孕妇不同孕期空腹血糖及晚孕期糖化血红蛋白特点分析  被引量:7

Fasting plasma glucose during different trimesters and hemoglobin A1c in the third trimester of pregnant women in Zhujing Region of Shanghai

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作  者:田海荣[1] 季业[1] 黄忠华 钱欢 汤仙娥 李自云[1] 沈英娣[1] 金治娟 刘波[1] 刘芳[3] Tian Hairong;Ji Ye;HuangZhonghua;Qian Huan;Tang Xian'e;Li Ziyun;Shen Yingdi;Jin Zhijuan;Liu Bo;Liu Fang(Department of Endocrinology,2Department of Obstetrics and Gynecology Jinshan Branch of Shanghai Sixth People' s Hospital,Shanghai 201599,China;3 Department of Endocrinology & Metabolism,Shanghai Sixth People's Hospital,Shanghai Jiao Tong University,Shanghai 200233,China)

机构地区:[1]上海市第六人民医院金山分院内分泌科,201599 [2]上海市第六人民医院金山分院妇产科,2015993 [3]上海交通大学附属第六人民医院内分泌代谢科

出  处:《中华妇幼临床医学杂志(电子版)》2018年第3期311-316,共6页Chinese Journal of Obstetrics & Gynecology and Pediatrics(Electronic Edition)

基  金:上海市科学技术委员会医学和农业领域科技支撑项目(15411953100)~~

摘  要:目的探讨上海朱泾地区孕妇不同孕期空腹血糖(FGP)及晚孕期糖化血红蛋白(HbA1c)的特点。方法选择2014年1月1日至12月31日,在上海市第六人民医院金山分院接受产前检查并进行75g口服葡萄糖耐量试验(OGTT)筛查的606例孕妇为研究对象。按照75g OGTT筛查结果,将其分为妊娠期糖尿病(GDM)组(n=136)和非GDM组(n=470)。采用回顾性分析方法,采集2组受试者的年龄、人体质量指数(BMI)等一般临床资料,以及2组孕妇早、中、晚孕期FPG浓度和晚孕期HbA1c水平。根据四分位数法,将所有受试者晚孕期HbA1c水平划分为4个范围:Q1(HbA1c值<5.1%)、Q2(5.1%≤HbA1c值<5.2%)、Q3(5.2%≤HbA1c值<5.5%)和Q4(HbA1c值≥5.5%)。采用成组t检验,比较2组孕妇的年龄、BMI、不同孕期FPG浓度和晚孕期HbA1c水平。采用χ~2检验,对晚孕期HbA1c水平处于不同范围的所有受试者的GDM发生率进行整体比较,而进一步的两两比较,则调整检验水准后再进行比较。绘制晚孕期HbA1c水平预测GDM发生的受试者工作特征(ROC)曲线,计算ROC曲线下面积(ROC-AUC),根据约登指数最大原则,确定晚孕期HbA1c水平预测GDM发生的最佳临界值,同时计算预测GDM发生的敏感度、特异度。本研究符合2013年修订的《世界医学协会赫尔辛基宣言》。结果 (1)GDM组孕妇的年龄、BMI均大于对照组,并且差异均有统计学意义(t=5.306、5.250,P<0.001)。GDM组孕妇中,中孕期FPG浓度最高,为(4.9±0.6)mmol/L,中孕期FPG浓度高于早、晚孕期FPG浓度,并且差异均有统计学意义(t=2.087、1.960,P=0.039、0.041)。非GDM组孕妇中,早孕期FPG浓度最高,为(4.7±0.3)mmol/L,早孕期FPG浓度高于中、晚孕期FPG浓度,并且差异亦均有统计学意义(t=15.230、5.613,P<0.001)。GDM组孕妇早、中、晚孕期FPG浓度均分别高于对照组,并且差异均有统计学意义(t=5.416、15.526、4.471,P<0.001)。GDM组孕妇晚孕期HbA1c水平为(5.6±0.4)%,明显高于非GDM组的(5.4±0.Objective To investigate features of fasting plasma glucose(FPG)during different trimesters and hemoglobin A1 c(HbA1 c)in the third trimester of pregnant women in Zhujing Region of Shanghai.Methods A total of 606 cases of pregnant women who received prenatal examination and75 g oral glucose tolerance test(OGTT)in Jinshan Branch of Shanghai Sixth People′s Hospital from January 1 to December 31,2014 were collected as research subjects.According to the results of 75 g OGTT,they were divided into gestational diabetes mellitus(GDM)group(n=136)and non-GDM group(n=470).The clinical data,such as age,body mass index(BMI),as well as the concentration of FPG during different pregnancy trimesters and level of HbA1 cin the third trimester were collected retrospectively in both two groups by retrospective analysis method.According to the quartile method,level of HbA1 cin the third trimester of all subjects were divided into four ranges:Q1(HbA1 clevel5.1%),Q2(5.1%≤HbA1 clevel5.2%),Q3(5.2%≤HbA1 clevel5.5%),and Q4(HbA1 clevel≥5.5%),respectively.The age,BMI,concentrations of FPG and the level of HbA1 cbetween two groups were compared by independent-samples t test.Chi-square test was used to compare the GDM incidence of all subjects with different ranges of HbA1 clevel in the third trimester,and further comparison was conducted by adjusting inspection level. Then receiver operator characteristic(ROC)curve of HbA1 clevel in the third trimester for predicting the incidence of GDM was drawn,and the area under ROC curve(ROC-AUC)was calculated.The optimal critical value of HbA1 clevel in the third trimester for predicting the incidence of GDM was obtained when the Youden index reaching the maximum value.And its sensitivity and specificity were calculated.This study met the requirements of the World Medical Association Declaration of Helsinki revised in 2013.Results(1)The age and BMI of GDM group were higher than those in non-GDM group,and there were statistically signific

关 键 词:糖尿病 妊娠 空腹血糖 血红蛋白A 糖基化 葡糖耐量试验 ROC曲线 预测 孕妇 

分 类 号:R714.256[医药卫生—妇产科学]

 

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