妊娠期高血糖孕妇口服葡萄糖耐量试验的曲线信息以及2时相糖筛方法的探讨

目的分析妊娠期高血糖孕妇口服葡萄糖耐量试验(oral glucose tolerance test,OGTT)曲线的异常信息特点,对妊娠期高血糖的筛查方法进行探讨。方法收集同济医院内科内分泌研究室1 071例孕妇OGTT的资料,按《妊娠合并糖尿病诊治指南(2014)》诊断标准,将其分组为正常组、GDM组和PGDM组,对各组OGTT的不同时相特征进行统计分析。结果 (1)OGTT对孕妇GDM检出率为48.27%,对PGDM检出率为5.79%。(2)GDM中,单点、2点和3点异常者分别占GDM的58.22%、29.01%和12.77%。单点异常者以仅FPG的异常为主,占GDM的42.55%;多点异常者以伴2h PG异常者为主,占GDM的33.66%。(3)FPG或2h PG在分别伴有1h PG异常时,其异常值与3点异常的GDM在相应时相之间差异无统计学意义,P值均0.05。(4)2h PG对PGDM的检出率为100.00%,FPG+2h PG的时相组合可检出96.89%的孕期高血糖患者。结论 GDM孕妇OGTT异常的主要特征是FPG的异常,FPG或2h PG分别在伴有1h PG异常的时候,其异常值升高的幅度最大;PGDM孕妇OGTT异常的主要特征是糖负荷后的时相血糖异常。根据OGTT不同的时相信息,可为GDM孕妇选择相应的干预对策。诊断GDM仍应以OGTT为准,简易OGTT(FPG+2h PG)模式在适当情况下可用于GDM的筛查。

The curve information of oral glucose tolerance test in pregnant women with hyperglycemia and study of 2-phase-glucose-screening method

Objective To analyze the characteristics of abnormal information of oral glucose tolerance test (OGTT) curve in pregnant women with hyperglycemia,and explore the method of screening hyperglycemia during pregnancy.Methods We collected the OGTT data of 1071 pregnant women from Tongji Hospital,and divided them into normal group,GDM group and PGDM group,according to the diagnostic criteria in Guidelines for Diagnosis and Treatment of Diabetes Mellitus in Pregnancy (2014).Then we compared and analyzed characteristics at different time points of OGTT in three groups.Results 1.The detection rates of GDM and PGDM by OGTT were 48.27％ and 5.79％ respectively.2.58.22％,29.01％ and 12.77％ of GDM patients had abnormal plasma glucose levels at one time-point,two time-points and three-time-points respectively.Most patients with single abnormal point had abnormal FPG levels (42.55％ of GDM).Most patients with multiple abnormal points had abnormal 2hPG levels (33.66％ of GDM).3.When GDM patients with abnormal FPG or 2hPG accompanied by abnormal 1 hPG levels,the FPG or 2hPG levels had no significant differences between them in GDM patients with three abnormal time-points (P ＞ 0.05).4.The detection rate of PGDM by 2hPG was 100 ％,and 96.89％ of pregnant women with hyperglycemia could be detected by FPG + 2hPG combination.Conclusion The main feature of abnormal OGTT in pregnant women with GDM was the abnormality of FPG level.Abnormal FPG or 2hPG levels increased the most when accompanied by abnormal 1 hPG level.The main characteristic of abnormal OGTT in pregnant women with PGDM was the abnormality of post-load glucose levels.Clinical doctors could choose hierarchical and individualized management for pregnant women with GDM according to OGTT characteristics.Diagnosis of GDM should still be based on OGTT.Simplified OGTT (FPG + 2hPG) could be used for GDM screening where appropriate.