妊娠8-14周血清糖化血红蛋白联合空腹血浆葡萄糖、胰岛素抵抗指数预测妊娠糖尿病的临床价值  

Clinical value of serum HbAlc combined with FPG and HOMA-IR in predicting gestational diabetes mellitus from 8 to 14 weeks

作　　者：张雪琼[1] 任卫红[1] 万思然 林威 ZHANG Xueqiong;REN Weihong;WAN Siran;LIN Wei(Department of Gynaecology and Obstetrics,Ya’an People’s Hospital,Yaan,Sichuan 625000,China)

机构地区：[1]雅安市人民医院妇产科,四川雅安625000

出　　处：《安徽医药》2021年第10期2032-2035,共4页Anhui Medical and Pharmaceutical Journal

摘　　要：目的探析孕8-14周血清糖化血红蛋白(HbA1c)联合空腹血浆葡萄糖(FPG)以及胰岛素抵抗指数(HOMA-IR)对妊娠糖尿病(GDM)的预测价值。方法回顾性分析2016年1月至2018年6月在雅安市人民医院进行常规性孕前检查的孕妇5124名,收集其基本资料及孕8-14周的血清中HbA1c、FPG及HOMA-IR。按其孕24-28周空腹葡萄糖耐受试验(OGTT)筛查结果分为GDM组和非GDM组。比较组间基本资料以及HbA1c、FPG、HOMA-IR差异。采用多因素logistic回归分析GDM的相关因素,并建立联合诊断模型。绘制受试者工作特征曲线(ROC),Hanley-McNeil方法比较曲线下面积。分析HbA1c联合FPG、HOMA-IR对GDM的预测价值。结果5124名孕妇中,合并GDM的孕妇有526名(10.26%),糖代谢正常孕妇4598名(89.74%)。GDM组孕妇血清中的HbA1c(5.47±0.37)%、FPG(5.18±0.32)mmol/L及HOMA-IR(3.32±0.84)均高于正常孕妇清中的HbA1c(5.01±0.14)%、FPG(5.02±0.39)mmol/L及HOMA-IR(2.17±0.26)。logistic多因素回归分析显示HbA1c(OR=1.390,95%CI:1.046-1.846)、FPG(OR=1.323,95%CI:1.020-1.717)、和HOMA-IR(OR=1.831,95%CI:1.104-3.036)是GDM发生的独立危险因素(P<0.05)。通过回归模型中的概率预测值P来拟合联合检测的ROC曲线,与各指标单独检测的结果进行比较,发现预测模型检测的曲线下面积(0.871)高于单独检测(P<0.05)。结论血清HbA1c联合FPG、HOMA-IR对妊娠糖尿病早期诊断的灵敏度较好,有良好的预测价值。Objective To investigate the predictive value of serum glycosylated hemoglobin(HbA1c)combined with fasting plasma glucose(FPG)and insulin resistance index(HOMA-IR)for gestational diabetes mellitus(GDM)at 8 to 14 weeks of gestation.Methods Five thousand one hundred and twenty-four pregnant women who underwent routine pre-pregnancy examinations in Ya’an People’s Hospital from January to February 2018 were retrospectively analyzed,the basic data,serum HbA1c,FPG and HOMA-IR from 8 to 14 weeks of gestation were collected.All subjects underwent OGTT screening at 24-28 weeks of gestation and were divided into GDM and non-GDM groups according to the GDM diagnostic method.The basic data between groups and the differences of HbA1c,FPG and HOMA-IR were compared.Multivariate logistic regression was used to analyze the relevant factors of GDM and establish a joint diagnosis model.The predictive value of HbA1c combined with FPG and HOMA-IR for GDM was analyzed,and receiver operating characteristic curve(ROC)and the Hanley-McNeil method was used to compare the area under the curve.Results Of the 5124 pregnant women,526 were pregnant with GDM,accounting for 10.26%,and 4598 were pregnant with normal glucose metabolism,accounting for 89.74%.The serum levels of HbA1c(5.47±0.37)%,FPG(5.18±0.32)mmol/L and HOMA-IR(3.32±0.84)in GDM group were higher than those in normal pregnant women[HbAlc(5.01±0.14)%,FPG(5.02±0.39)mmol/L and HOMA-IR(2.17±0.26)].Logistic multivariate regression analysis showed HbAlc(OR=1.390,95%CI:1.046-1.846),FPG(OR=1.323,95%CI:1.020-1.717),HOMA-IR(OR=1.831,95%CI:1.104-3.036)were an independent risk factors for GDM(P<0.05).The ROC curve of the joint detection was fitted by the probability prediction value p in the prediction model,and the results of the separate detection of each index were compared.The combination module displayed a higher AUC(0.871)compared with individual detection and has good predictive value(P<0.05).Conclusion Serum HbAlc combined with FPG and HOMA-IR has good sensitivity and specific

关 键 词：糖尿病 妊娠 糖化血红蛋白 血糖 胰岛素抵抗指数 妊娠初期 

分 类 号：R714.256[医药卫生—妇产科学]