广东地区12000例妊娠期糖尿病筛查结果

目的探讨广东地区50g葡萄糖负荷试验（GCT）筛查妊娠期糖尿病（GDM）的阈值、孕妇年龄对GDM发生的影响以及广东地区GDM的检出率。方法采用回顾性研究,对本院2005年1月至2007年12月全部孕妇实施50g葡萄糖负荷试验,异常者再行75g口服葡萄糖耐量（OGTT）实验,依据美国糖尿病资料小组（NDDG）的诊断标准诊断妊娠期糖尿病和糖耐量受损（IGT）。结果12000例孕妇GCT1h平均血糖水平为（7.37±1.75）mmol/L;以7.80mmol/L为切点,GCT血糖异常率为35.3%;IGT的检出率为6.9%,GDM的检出率为5.4%。GCT1h血糖≥11.1mmol/L者中,GDM的发生率为74.7%（195/261）,其中36.8%（96/261）根据空腹血糖水平可以作出诊断。24岁以下孕妇GDM的发生率为0.83%,显著低于年龄≥24岁的孕妇,GCT的异常率和IGT及GDM的发生率随年龄的增加呈上升趋势。196例GCT1h血糖〈7.8mmol/L存在高危因素的孕妇复行GCT和OGTT后,诊断为IGT和GDM的患者分别为23、17例,分别占总检出率的2.8%（23/824）和2.6%（17/648）。结论广东地区GCT筛查GDM以7.80mmol/L为切点是合理的,但1次GCT1h血糖正常的高危孕妇,复行GCT及OGTT是有必要的;GCT≥11.1mmol/L,仍有部分孕妇必须通过OGTT才能确诊;孕妇年龄与GDM发生密切相关,应加强高龄孕妇血糖的监测及GDM管理。

Testing of Gestational Diabetes in 12000 Pregnant Women in Guangdong

Objective To determine the cutoff value of the 50 g glucose challenge test （GCT） in gestational diabetes mellitus （GDM） and to study the threshold value of GCT, maternal age of GDM, and the rate of GDM in Guangdong. Methods Clinical data of 12 000 pregnant women between January 2005 and December 2007 in our Hospital were retrospectively analyzed. Pregnant women with abnormal blood glucose level were re-tested with 75 g OGTT. Diagnosis of gestational diabetes mellitus （GDM） and impaired glucose tolerance （IGT） were based on the criteria of National Diabetes Data Group （NDDG）. Results （1） The 1 h average blood glucose level of GCT was （7.37±1.75） mmol/L. The rate of abnormal OGTT was 12.3% （GDM 5.40%, IGT 6.87%）. The abnormal rate of GCT was 35.3% when 7.8 mmol/L was used as the cutoff value. 2.8% （23/824） of IGT and 2.6% （17/648） of GDM were misdiagnosed. （2） For those women with 1 h blood glucose 11.1 mmol/L, the incidence of GDM was 74.7% （195/261）. In which 36.8% （96/261） of GDM was diagnosed according to the fasting blood glucose. （3） The incidence of GDM among the women younger than 24 years old was 0.83%. The incidence of GDM was significantly lower than the others. The rate of abnormal GCT and the incidence of GDM and IGT were increased with age. Conclusion 7.8 mmol/L as the cutoff value of the GCT was appropriate for the screen of GDM in Guangdong. For those women with the level of 1 h blood glucose ≥ 11.1 mmol/L, repeated GCT and OGTT testing are still required. The occurrence of GDM is correlated with the age of the pregnant woman. Pregnant women of advanced maternal age should be closely monitored.