糖化血红蛋白联合非传统血糖监测指标对妊娠期糖尿病患者急慢性并发症的预测价值  

The predictive value of glycosylated hemoglobin combined with unconventional blood glucose monitoring indicators for acute and chronic complications in patients with gestational diabetes

作　　者：王冰蓉 孙阳[2] 李益颖 周云[2] 林丽珍[2] 陈宇清[2] WANG Bing-rong;SUN Yang;LI Yi-ying;ZHOU Yun;LIN Li-zhen;CHEN Yu-qing(Fujian University of Traditional Chinese Medicine,Fuzhou 350001,China;The Department of Gynecology and Obstetrics,Fujian Provincial Hospital,Fuzhou 350001,China)

机构地区：[1]福建中医药大学,福州350001 [2]福建省立医院妇产科,福州350001

出　　处：《创伤与急诊电子杂志》2019年第1期22-28,共7页Journal of Trauma and Emergency(Electronic Version)

摘　　要：目的探讨围产期糖化血红蛋白(glycohemoglobin,HbA1c)联合孕前体重指数(body mass index,BMI)及孕期体质量增长情况对妊娠期糖尿病(gestational diabetes mellitus,GDM)患者不良妊娠结局的预测价值。方法收集2015年1月1日至2017年12月31日在某三甲医院经过规范诊治并分娩的760例GDM单胎孕妇的临床资料进行回顾性分析。使用Kruskal-Wallis H秩和检验、χ^2检验、多因素logistic回归分析法并建立受试者工作曲线了解HbA1c、孕前BMI、孕期体质量增长对GDM患者不良妊娠结局的预测准确性。结果①GDM患者不良妊娠结局的主要因素包括孕前BMI、围产期HbA1c、孕期体质量增长、空腹血糖;②围产期HbA1c、孕前BMI及孕期体质量增长预测GDM患者不良妊娠结局发生的ROC曲线下面积分别是0.616、0.637、0.570(P<0.05)。其中HbA1c的预测界值为5.85%(特异度:74.4%,敏感度:48.5%)、孕前BMI为24.485 kg/m2(特异度:76.0%,敏感度:44.6%)、孕期体质量增长为13.25 kg(特异度:81.4%,敏感度:29.7%)。三者联合预测时敏感度达到82.18%,特异度为34%。结论HbA1c、孕前BMI及孕期体质量增长对GDM患者不良妊娠结局均有较高预测价值。Objective To explore the predictive value of perinatal HbA1c,pre-gestational BMI and body mass growth during pregnancy towards GD.Methods A total of 760 women who had a standard antenatal care in a third-grade hospital and gave single live births from January 1,2015 to December 31,2017 were included.Kruskal-Wallis H test,chi-square test,and multivariate logistic regression were used to analyze the association between pre-gestational BMI,perinatal HbA1c and the adverse pregnancy outcomes among GDM patients.A receiver operating characteristics curve(ROC)was established to understand the diagnostic accuracy of HbA1c,pre-gestational BMI and body mass growth during pregnancy for adverse pregnancy outcomes in GDM patients.Results①The main factors of adverse pregnancy outcomes in GDM patients include pre-pregnancy BMI,perinatal HbA1c,growth in body weight,fasting blood glucose.②Area under the curve to predict the adverse pregnancy outcomes for GDM were 0.616、0.637、0.570(P<0.05)for HbA1c,BMI and body mass growth during pregnancy,respectively.The predictive value of HbA1c,pre-pregnancy BMI and and the body mass growth during pregnancy was 5.85%(specificity:74.4%,sensitivity:48.5%),24.485 kg/m^2(specificity:76.0%,sensitivity:44.6%),and 13.25kg(specificity:81.4%,sensitivity:29.7%)respectively.The sensitivity of predictor value combined the three factors was up to 82.18%,while the specificity was just 34%.Conclusion HbA1c,pre-gestational BMI and body mass growth during pregnancy all have predictive value for adverse pregnancy outcomes in GDM patients.

关 键 词：妊娠期糖尿病 糖化血红蛋白 非传统血糖监测指标 急慢性并发症 

分 类 号：R714.256[医药卫生—妇产科学]