糖化血红蛋白检测在妊娠合并糖尿病诊疗中的价值

妊娠合并糖尿病包括孕前糖尿病(PGDM)和妊娠期糖尿病(GDM),与母儿近远期并发症有关。糖化血红蛋白(HbA1c)可反映近2~3个月血糖水平,近年来用作非妊娠期糖尿病的诊断标准之一。很多学者对不同妊娠时期HbA1c水平能否预测GDM的发生、母儿不良妊娠结局和母亲产后糖尿病发生风险以及不同种族HbA1c水平差异、HbA1c水平的影响因素等方面进行了大量研究,多数认为HbA1c作为GDM的诊断指标敏感度不高,可能增加漏诊率,但其单独或与更多指标联合是筛查和诊断GDM的有力补充,可以减少口服葡萄糖耐量试验(OGTT)的检测。孕期不同时点的HbA1c水平均可能与妊娠结局有关,而产前HbA1c水平对识别可能进展为2型糖尿病的高危GDM孕妇也有一定的价值。不过,对HbA1c的截断值、包含HbA1c的不同筛查诊断策略意见尚不统一,仍需更多的研究进一步明确。

The Value of Glycated Hemoglobin Testing in Screening and Prediction Pregnancies Complicated Diabetes Mellitus

Pregnancies complicated with diabetes mellitus including pre-gestational diabetes mellitus (PGDM) and gestational diabetes mellitus (GDM), are at risk of developing a number of serious obstetric complications as well as having long-term implications for the wellbeing of mother and infant. Glycated hemoglobin (HbA1c) may reflect glucose levels over the previous 2-3 months, and acts as one of the diagnostic criteria outside of pregnancy recently. Many studies had been carried through about the role of HbA1c in pregnancy, included how can HbA1c in different gestational weeks predict GDM subsequently and adverse pregnancy outcomes even postpartum diabetes risk, the difference of HbA1c levels in different races and the influence factors of HbA1c levels. Further, whether HbA1c level is various in different ethnical and the influence factors of HbA1c level had been investigated. Most authors believed that HbA1c, as a diagnostic indicator of GDM, is not highly sensitive and may increase the rate of missed diagnosis. HbA1c alone or in combination with more indicators is a powerful supplement in screening and diagnosis of GDM and can reduce the number of oral glucose tolerance test (OGTT). HbA1c levels at different time points during pregnancy may be correlated with pregnancy outcomes, and prenatal HbA1c levels are also of certain value in identifying high-risk GDM pregnant women who may progress to T2DM. On account of the cut-off value of HbA1c, the strategies of GDM screen and diagnosis with HbA1c are inconsistent, more researches are needed further.