妊娠期糖尿病患者分娩前糖化血红蛋白产前糖化白蛋白和口服葡萄糖耐量试验时间血糖曲线下面积对新生儿体质量的预测价值  

Predictive value of prepartum hemoglobin A_(1)c,prenatal glycated albumin and oral glucose tolerance test time-glucose area under curve for newborn weight in gestational diabetes mellitus

作　　者：谢海花[1] 郑琳 Xie Haihua;Zheng lin(Fujian Provincial Hospital South Branch,Provincial Jin shan Hospital,Fuzhou 350028,China;Fujian Provin-cial Hospital South Branch,Provincial Jin shan Hospital,Fuzhou 350028,China)

机构地区：[1]福建省立医院南院(福建省立金山医院)检验科,350001 [2]福建省立医院南院(福建省立金山医院)妇产科,350001

出　　处：《实用医技杂志》2022年第3期245-248,F0003,共5页Journal of Practical Medical Techniques

摘　　要：目的了解妊娠期糖尿病患者产前糖化白蛋白(GA)水平、口服葡萄糖耐量试验(OGTT)时间-血糖曲线下面积(AUC)和分娩前糖化血红蛋白(HbA_(1)c)对新生儿出生体质量的预测价值。方法回顾性分析2020年5月到2021年5月在福建省立金山医院有完整产检记录的孕妇607例,其中妊娠期糖尿病孕妇307例,300名健康孕妇为健康对照组。收集产检的基本信息、OGTT和分娩前HbA_(1)c、产前GA。应用SPSS 25.0统计软件分析分娩前HbA_(1)c、产前GA、OGTT时间-血糖AUC与新生儿出生体质量的关系,以及这3项指标预测巨大儿的最佳临界值。结果妊娠期糖尿病组新生儿出生体质量与OGTT时间-血糖AUC、分娩前HbA_(1)c、产前GA呈正相关(r=0.497,P<0.05;r=0.217,P<0.05;r=0.145,P<0.05)。GDM组OGTT时间-血糖AUC、分娩前HbA_(1)c、新生儿出生体质量及产前GA水平与健康对照组相比,差异有统计学意义(P<0.05)。分娩前HbA_(1)c、OGTT时间-血糖AUC、产前GA预测新生儿巨大儿的最佳截断值分别为5.35%、17.8%、12.7%,敏感度为72.7%、77.3%、52.3%;特异度分别为60.7%、73.5%、51.1%;受试者工作特征曲线(ROC)AUC分别为0.672、0.792、0.594。结论GDM患者分娩前HbA_(1)c、OGTT时间-血糖AUC和产前GA值与出生体质量具有相关性,GDM是造成新生儿巨大儿的高危因素,临床上可根据OGTT时间-血糖AUC的不同对孕妇进行个性化干预,达到优生优育的目的,根据分娩前HbA_(1)c与GA水平选择合适的产妇分娩方式。Objective To investigate the predictive value of prenatal glycated albumin(GA)level,oral glucose tolerance test(OGTT)time-glucose area under curve(AUC)and prepartal glycated Hemoglobin A_(1)c(HbA_(1)c)for newborn birth weight in patients with gestational diabetes mellitus.Methods From May 2020 to May 2021,a total of 607 pregnant women with complete obstetric examination records in Provincial Jinshan Hospital were retrospectively analyzed,including 307 pregnant women with gestational diabetes mellitus and 300 healthy pregnant women as normal control group.Basic information,OGTT,prepartal HbA_(1)c and prenatal GA were collected.The relationship between OGTT time-glucose area AUC,prepartal HbA_(1)c and prenatal GA and birth weight in gestational diabetes group,as well as the optimal critical value of these three indicators to pre-dict macrocosm were analyzed with statistical product and service solutions(SPSS)25.0 statistical software.Results In gestational diabetes group,there were positive correlation between birth weight and OGTT time-glucose area AUC,prepartal HbA_(1)c and prenatal GA(r=0.497,P<0.05;r=0.217,P<0.05;r=0.145,P<0.05).The AUC of OGTT time-glucose,prepartal HbA_(1)c,birth weight and prenatal GA levels in gestational diabetes mellitus(GDM)group were striking different from those in healthy control group(P<0.05).The optimal critical values of prepartal HbA_(1)c,OGTT time-AUC and prenatal GA for predicting neonatal macrofetus were 5.35%,17.8%and 12.7%,respectively,and the sensitivity were 72.7%,77.3%and 52.3%.The specificity were 60.7%,73.5%and 51.1%,respectively.The AUC were 0.672,0.792 and 0.594,respectively.Conclusion In gestational diabetes group,there were positive correlation between birth weight and OGTT time-glucose AUC,prepartal HbA_(1)c and prenatal GA.GDM was the risk factor of neonatal macrosomia,doctor can make different personalized intervention for the GDM pregnant women basing on OGTT time-glucose AUC to achieve the purpose of eugenic and superior nurture.According to the level of prepart

关 键 词：葡萄糖耐量试验 曲线下面积 糖基化血红蛋白A 糖尿病 妊娠 婴儿 新生 体质量 

分 类 号：R714.256[医药卫生—妇产科学]