糖化血红蛋白和高密度脂蛋白胆固醇联合体质量指数预测妊娠期糖尿病的价值分析  

Analysis on the value of glycosylated hemoglobin,high-density lipoprotein cholesterol combined with body mass index in predicting gestational diabetes mellitus

作　　者：魏雁虹[1] 苑丹 陈玉梅 马寅芙[1] 杨海娇 魏海峰[1] WEI Yan-hong;YUAN Dan;CHEN Yu-mei;MA Yin-fu;YANG Hai-jiao;WEI Hai-feng(Medical Laboratory Center of Jilin Province People's Hospital,Changchun,Jilin 130021,China;不详)

机构地区：[1]吉林省人民医院医学检验中心,吉林长春130021 [2]前郭县医院体检科

出　　处：《中国妇幼保健》2025年第6期995-998,共4页Maternal and Child Health Care of China

基　　金：吉林省科技发展计划项目(YDZJ202301ZYTS119)。

摘　　要：目的分析糖化血红蛋白(HbA1c)、高密度脂蛋白胆固醇(HDL-C)以及体质量指数(BMI)预测妊娠期糖尿病(GDM)的价值。方法选取2022年10月—2024年7月在吉林省人民医院就诊的204例孕妇作为研究对象,根据妊娠24~28周75 g口服葡萄糖耐量试验结果分为GDM组(96例)和非GDM组(108例)。比较两组HbA1c、HDL-C水平及BMI,通过多因素logistic回归模型分析GDM发生的危险因素,构建预测模型,绘制受试者工作特征(ROC)曲线,计算曲线下面积(AUC),评价预测模型的准确性,比较联合检测与单项检测预测GDM的效能。结果GDM组空腹血糖(FBG)水平为(5.04±0.66)mmol/L,HbA1c为(5.73±0.75)%,三酰甘油(TG)水平为(1.84±0.55)mmol/L,BMI为(27.24±4.32)kg/m^(2),HDL-C水平为(1.90±0.59)mmol/L。非GDM组FBG水平为(4.86±0.58)mmol/L,HbA1c为(5.09±0.59)%,TG水平为(1.66±0.52)mmol/L,BMI为(24.99±3.37)kg/m^(2),HDL-C水平为(2.13±0.56)mmol/L。GDM组FBG、HbA1c、TG水平及BMI均明显高于非GDM组,HDL-C水平明显低于非GDM组,差异均有统计学意义(均P<0.05)。多因素logistic回归分析结果显示:HbA1c、TG水平和BMI升高以及HDL-C水平降低均是GDM发生的独立危险因素(均P<0.05)。基于上述危险因素,构建包含HbA1c、HDL-C及BMI共3个指标的优化预测模型,模型公式为Logit(P)=-10.631+1.461(HbA1c)+0.172(BMI)-0.913(HDL-C)。ROC曲线显示:HbA1c、HDL-C及BMI预测GDM的AUC分别为0.739、0.603、0.648,3项指标联合预测GDM的AUC为0.805。HbA1c、HDL-C及BMI联合检测对GDM的预测效能优于各指标单项检测,差异均有统计学意义(均P<0.05)。结论基于HbA1c、HDL-C、BMI成功构建了GDM预测模型,适用于基层医院,能够有效实现对GDM患者的早期预警,为及时干预和管理提供有力支持。Objective To analyze the value of glycosylated hemoglobin(HbA1c),high-density lipoprotein cholesterol(HDL-C)combined with body mass index(BMI)in predicting gestational diabetes mellitus(GDM).Methods A total of 204 pregnant women were selected from Jilin Province People's Hospital from October 2022 to July 2024 as study objects,then they were divided into GDM group(96 pregnant women)and non-GDM group(108 pregnant women)according to the result of 75 g oral glucose tolerance test at 24-28 weeks of gestation.The levels of HbA1c,HDL-C,and BMI in the two groups were compared,multivariate logistic regression model was used to analyze the risk factors of GDM,the prediction model was constructed,receiver operating characteristic(ROC)curve was drawn,the area under the curve(AUC)was calculated to evaluate the accuracy of prediction model,and the efficiencies between combined detection and single detection in predicting GDM were compared.Results In GDM group,fasting blood glucose(FBG)level was(5.04±0.66)mmol/L,HbA1c was(5.73±0.75)%,triglyceride(TG)level was(1.84±0.55)mmol/L,BMI was(27.24±4.32)kg/m^(2),HDL-C level was(1.90±0.59)mmol/.In non-GDM group,FBG level was(4.86±0.58)mmol/L,HbA1c was(5.09±0.59)%,TG level was(1.66±0.52)mmol/L,BMI was(24.99±3.37)kg/m^(2),HDL-C level was(2.13±0.56)mmol/L.The levels of FBG,HbA1c,TG,and BMI in GDM group were statistically significantly higher than those in non-GDM group,the level of HDL-C in GDM group was statistically significantly lower than that in non-GDM group,there were statistically significant differences(all P<0.05).Multivariate logistic regression analysis showed that the increase of HbA1c,TG,BMI levels and the decrease of HDL-C level were independent risk factors for the occurrence of GDM(all P<0.05).Based on these risk factors,an optimized prediction model including HbA1c,BMI,and HDL-C was constructed.The model formula was logit(P)=-10.631+1.461(HbA1c)+0.172(BMI)-0.913(HDL-C).ROC curve showed that AUC values of HbA1c,HDL-C,and BMI in predicting GDM were 0.739,0.603,and

关 键 词：妊娠期糖尿病 糖化血红蛋白 高密度脂蛋白胆固醇 体质量指数 

分 类 号：R714.256[医药卫生—妇产科学]