妊娠期糖尿病诊断标准的新探讨

目的探讨适合国内孕妇的妊娠期糖尿病(GDM)诊断标准。方法选取2000年6月至2002年7月在本院行产前检查并分娩,无显性糖尿病及其他内分泌疾病的340例孕妇为研究对象,其中190例为非高危孕妇组,其余150例为高危孕妇组。每位孕妇在孕24～28周时行100g葡萄糖3小时OGTT。以正常孕妇组100g葡萄糖3小时OGTT静脉血糖值的第97.5百分位值为本研究确定的诊断标准。结果本研究确定的诊断标准即空腹5.2mmol/L;服糖后1小时10.3mmol/L;服糖后2小时8.9mmol/L;服糖后3小时7.7mmol/L为阳性。以此4项中2项以上阳性为GDM,1项阳性为糖耐量异常(IGT),4项均阴性为正常。本研究新诊断标准与Carpenter/Coustan标准诊断GDM的一致性更高,Kappa值为0.83(P<0.001)。结论当采用葡萄糖氧化酶法测定血浆葡萄糖值时,100g糖耐量试验的Carpenter/Coustan标准也是适合中国人的GDM诊断标准。

A Study of the Criteria for Gestational Diabetes Mellitus

Objective:To determine whether foreign diagnostic criteria for Gestational Diabetes Mellitus(GDM) were suitable for Chinese pregnant women.Methods:340 pregnant women were chosen to participateinthisstudy betweenJune2000andSeptember2002.Theyweredividedintotwogroups.Women(n=190)whodidnothave anyriskfactorofGDMconstitutedthenormalpregnancygroup.Thehighriskpregnancygroup(n=150)included womenwhohadatleastoneormorehighriskfactorsofGDM.Allthe340pregnantwomenparticipatinginthestudy tookthediagnostic100 goralglucosetolerancetest(100 g 3 hOGTT)between24and28weeksofgestation.The resultsof100 g 3 hOGTTwereclassifiedaccordingtothreedifferentsetsofdiagnosticcriteria:(1)Newdiagnostic criteriabasedondataobtainedfrom100 g 3 hOGTTperformedon190normalpregnantwomenofthisstudy.(2) CarpenterandCoustancriteria;(3)NationalDiabetesDataGroup(NDDG)criteria.Venousplasmaglucose(VPG) wasmeasuredbytheglucoseoxidasemethod.Results:Theresultsoforal100 g 3 hOGTTof190normalpregnan cywomenwereapproximatelynormallydistributed.97.5%percentagevaluewaschosenasthestatisticalcutoffval ueof100 g 3 hOGTT.Sothenewdiagnosticcriteriaofourstudybasedondataobtainedfrom100 g 3 hOGTT performedon190normalpregnantwomenwere5.3mmol/L,10.3mmol/L,8.9mmol/L,7.7mmol/Lat0,60, 120,180minutes.Comparedwiththenormalpregnancygroup,highriskpregnancygroupshowedhigher100 g 3 hOGTTtestresults.Kappavaluewas0.83inournewcriteriaversusCarpenterandCoustancriteria(P<0.001), 0.70inournewcriteriaversusNDDGcriteria(P<0.001).TheprevalenceofGDMwas12.9%bynewcriteria, 14.7%byCarpenterandCoustancriteria,and7.1%byNDDGcriteriarespectively.InpatientswithGDMand GIGTbynewcriteriaandCarpenterandCoustancriteria,theirincidentrateofmacrosomiawassimilar.Therate washigherthanthatbyNDDGcriteria(P<0.05).Conclusions:Whenvenousplasmaglucoselevelwasmeasured bytheglucose oxidase method,Carpenter and Coustan criteria are suitable to Chinese pregnantwomen.