金华地区妊娠期糖尿病高危人群筛选模型建立及针对性干预效果评价  

Establishment of screening model for high-risk population of gestational diabetes in Jinhua area and evaluation of targeted intervention effect

作　　者：牛艳昕[1] 王楠[1] 王建芳[1] 郑雪君[1] 徐秋莲[1] NIU Yan-xin;WANG Nan;WANG Jian-fang;ZHENG Xue-jun;XU Qiu-lian(Department of Gynaecology and Obstetrics,Jinhua Municipal People's Hospital,Jinhua,Zhejiang 321000,China)

机构地区：[1]金华市人民医院妇产科,浙江金华321000

出　　处：《中国妇幼保健》2024年第19期3781-3786,共6页Maternal and Child Health Care of China

基　　金：浙江省金华市科技计划项目(2022-4-168)。

摘　　要：目的 分析金华地区妊娠期糖尿病(GDM)的危险因素,建立高危人群筛选模型,并评估模型的预测效能。方法 收集金华地区4家医院2022年1—6月建卡并定期产检的孕妇的临床资料及口服葡萄糖耐量试验(OGTT)检查结果,采用单因素及多因素logistic分析GDM的危险因素,建立高危人群筛选模型,采用受试者工作特征曲线(ROC)对模型预测效能进行评估。根据建立的GDM高危人群筛选模型将入选孕妇分为A组(GDM高危孕妇,自愿接受针对性健康管理干预,28例)、B组(GDM高危孕妇,未接受针对性健康管理干预,28例)和C组(正常孕妇,未接受针对性健康管理干预,304例),前瞻性分析针对性健康管理干预对GDM高危人群的效果。结果 单因素分析显示,孕前体质量指数(BMI)、产次、胎次、流产史、既往GDM史、糖尿病家族史、多囊卵巢综合征、生殖道炎症、早期建卡空腹血糖、OGTT三项指标异常、孕期体力活动及失眠均为孕妇发生GDM的影响因素,差异均有统计学意义(均P<0.05);年龄、巨大儿史、死胎史、早产史、初潮年龄、月经周期、高血压家族史、产前被动吸烟及饮酒情况比较,差异均无统计学意义(均P>0.05),非孕妇发生GDM的影响因素;logistic回归分析结果显示,孕前BMI、产次、胎次、流产史、既往GDM史、糖尿病家族史、多囊卵巢综合征、生殖道炎症、早期建卡空腹血糖、OGTT三项指标异常、孕期体力活动及失眠是影响孕妇发生GDM的独立危险因素(P<0.05);ROC曲线检验结果显示,95%CI(0.932~0.996),P<0.05,ROC曲线下面积为0.784,灵敏度为0.76,特异度为0.64;干预3个月后,A、B组GDM发生例数分别为10例(35.71%)、15例(53.57%),差异有统计学意义(P<0.05);干预期间,A组的空腹血糖、孕晚期体质量增加、TG、SBP、DBP均低于B组,差异均有统计学意义(均P<0.05),两组TC水平比较,差异无统计学意义(P>0.05);妊娠结局和新生儿情况结果显示,A组Objective To analyze the risk factors of gestational diabetes(GDM)in Jinhua area,establish a screening model for highrisk population,and evaluate the predictive efficacy of the model.Methods The clinical data and the results of oral glucose tolerance test(OGTT)test of pregnant women who had established cards and had regular antenatal examination in four hospitals in Jinhua from January 2022 to June 2022 were collected.The risk factors of GDM were analyzed by single factor and multiple factor logistic analysis,and the screening model of high-risk population was established.The prediction efficiency of the model was evaluated by using the subject work char⁃acteristic curve(ROC).According to the established screening model of GDM high-risk population,the pregnant women were divided into group A(GDM high-risk pregnant women,who voluntarily accepted targeted health management intervention,n=28),group B(GDM high-risk pregnant women,who did not receive targeted health management intervention,n=28)and group C(normal pregnant women,who did not receive targeted health management intervention,n=304),and the effect of targeted health management intervention on GDM high-risk population was prospectively analyzed.Results The univariate analysis showed that the precursor body mass index(BMI),pari⁃ty,parity,abortion history,previous GDM history,family history of diabetes,polycystic ovary syndrome,genital tract inflammation,ear⁃ly fasting blood glucose,OGTT abnormalities,physical activity during pregnancy,insomnia were all the influencing factors of GDM in preg⁃nant women,and the differences were statistically significant(P<0.05);Age,history of macrosomia,history of stillbirth,history of pre⁃mature delivery,age of menarche,menstrual cycle,family history of hypertension,prenatal passive smoking and alcohol consumption were not statistically significant,and the influencing factors of GDM in non-pregnant women;The Results of logistic regression analysis showed that BMI before pregnancy,parity,parity,abortion history,previo

关 键 词：妊娠期糖尿病 高危人群筛选模型 针对性干预 

分 类 号：R473.71[医药卫生—护理学]