全国部分城市妊娠期糖尿病发病情况的调查及适宜诊断标准的探讨

目的 了解我国妊娠期糖代谢异常的发病现状,探讨适合我国卫生经济条件的妊娠期糖代谢异常的诊断标准.方法 前瞻性研究2006年4月1日-9月30日在全国18个城市25家医院行产前检查并进行首次50 g口服葡萄糖负荷试验(GCT)的16 286例孕妇的临床资料,并对GCT检查结果异常(服糖后1 h血糖≥7.8 mmol/L)者行75 g口服葡萄糖耐量试验(OGTT),对结果进行统计学分析.比较采用美国糖尿病学会(ADA)标准和美国国家糖尿病数据组(NDDG)标准诊断妊娠期糖代谢异常的发生率,以及妊娠期糖尿病(GDM)、妊娠期糖耐量受损(GIGT)及糖代谢正常孕妇OGTr各时间点(空腹、1 h、2 h、3 h)血糖的平均值.结果 按NDDG标准诊断,GDM及GIGT的发生率分别为2.763%(450/16 286)和3.862%(629/16 286);按ADA标准诊断则分别为5.078%(827/16 286)和5.268%(858/16 286);符合ADA标准中2项及以上异常者为841例,符合NDDG标准中1项及以上异常者为1034例,同时符合以上两个条件者为792例,分别占两者的94.2%(792/841)和76.6%(792/1034).采用ADA标准诊断的糖代谢正常者OGTF各时间点(空腹、1 h、2 h、3 h)血糖值的95%可信区间上限依次为5.3、10.4、8.7、7.7 mmol/L,与NDDG标准(分别为5.4、10.8、9.1、7.8 mmol/L)基本一致.结论 目前,妊娠期糖代谢异常发生率呈现增加趋势.ADA标准适合我国GDM的诊断,据我国目前的卫生经济情况,对NDDG标准中l项及以上异常者或对ADA标准中2项及以上异常者进行干预都是合理的.

Investigation into the prevalence and suitable diagnostic criteria of gestational diabetes mellitus in China

Objective To investigate the incidence of glucose metabolism disorder during pregnancy and establish the diagnosis criteria for gestational diabetes mellitus (GDM) among Chinese patients.Method A prospective popolation-bused study of 16 286 pregnant women,who received 50 g glucose challenge test (GCT) for the first time between Apr 1,2006 and Sept 30,2006,was performed throughout 18 cities in China. Results According to national diabetes data group (NDDG)criteria,the overall incidence of GDM and glucose impaired glucose tolerance (GIGT) was 2.763% (450/16 286) and 3.862% (629/16 286),respectively; it changed to 5.078% (827/16 286)and 5.268% (858/16 286) when using American diabetes association (ADA) criteria.If the women who had 2 or more abnormal oral glucose tolerance test (OGTT) values meeting or exceeding ADA criteria was classified as group 1,and the women who had one or more meeting or exceeding NDDG criteria was group 2,the ratio of women who met both the criteria of ADA and NDDG in group 1 was 94.2%.The 95% CI of normal glucose when using ADA criteria were fasting glucose 5.3 mmol/L,1 hour 10.4 mmol/L,2 hour 8.7 mmol/L,3 hour 7.7 mmol/L,which is close to ADA criteria.Conclusions ADA criterion is more suitable for Chinese patients.According to NDDG criteria,it is reasonable to treat the patient with 1 or more abnormal OGTT values,and if choosing ADA criteria,2 or more abnormal OGrIT values is more reasonable.