糖化血红蛋白和糖化白蛋白在 GDM 诊断中的价值

目的：评估血清糖化白蛋白（GA）和糖化血红蛋白（HbA1c）在妊娠期糖尿病（GDM）患者早期检测中的作用。方法选择2015年1月1日至12月31日在昔阳县人民医院妇产科进行产前保健检查的单胎孕妇138例（孕期22～24周），根据美国糖尿病协会（ADA）的建议，以口服75g葡萄糖耐量试验（OGTT）测定值作为诊断GDM的标准，将138例妊娠妇女分为正常妊娠组100例，GDM组38例，同时测定两组的HbA1c、GA、FGP和OGTT。使用受试者工作特征曲线（ ROC）将HbA1c和GA水平作为GDM的筛查指标进行统计学分析。结果①GDM组HbA1c、GA明显高于正常妊娠组（ t值分别为8．622、7．554，均P＜0．05）；②相比较OGTT，HbA1c和GA的检出率存在差异（χ2值分别为62．490、40．601，均P＜0．05）；③分别应用HbA1c、GA在正常妊娠组中检出8．00％和12．00％可疑血糖异常患者；④ROC曲线分析HbA1c取5．90％，灵敏度为78．90％，特异度为89．00％～94．00％；GA取15．50％，灵敏度为65．80％～68．40％，特异度为66．00％～88．00％。结论 HbA1c在GDM诊断中敏感性高于GA，与OGTT联合对GDM的诊断有重要价值。

Significance of glycosylated hemoglobin A1c and glycated albumin in diagnosis of gestational diabetes mellitus

Objective To evaluate the application of serum glycated albumin (GA) and glycosylated hemoglobin A1c (HbA1c) in early monitoring of gestational diabetes mellitus ( GDM) .Methods A total 138 pregnant women with their estimated gestational age between 22 and 24 weeks, who taking prenatal examination in Affiliated Xiyang Country People’ s Hospital of Jinzhong College from January 1 to December 31 in 2015, were enrolled in study.Taking test value of 75g oral glucose tolerance test ( OGTT) based on American Diabetes Association ( ADA) as the criterion for diagnosis of GDM, the subjects were classified into two groups:normal pregnant group (100 cases) and GDM group (38 cases).HbA1c, GA and OGTT were determined in two groups.ROC curve analysis of HbA1c and GA was used for statistical analysis of GDM diagnosis.Results①The HbA1c and GA levels in GDM group were significantly higher than those in normal group (t value was 8.622 and 7.554, respectively, both P<0.05);②Compared to OGTT, there was significant difference in detect rates between HbA1c and GA (χ2 value was 62.490 and 40.601, respectively, both P<0.05).③About 8.00% and 12.00% cases were found with suspected pathoglycemia by testing HbA1c and GA; ④ROC curve analysis showed that when HbA1c level was 5.90%, the sensitivity and specificity was 78.90% and 89.00%-94.00%, respectively, and when GA value was 15.50%, the sensitivity and specificity was 65.80%-68.40%and 66.00%-88.00%, respectively.Conclusion HbA1c is more sensitive than GA in diagnosis of GDM, and combining OGTT may have important role in the diagnosis of GDM.