Total serum glycosylated proteins in detection and monitoring of gestational diabetes

The goal of this study was to determine whether serum glycosylated protein levels (i.e., fructosamine) can reliably screen for gestational diabetes and whether these levels are valid markers of short-term glycemic control in the third trimester of pregnancy. Ninety-seven pregnant women at 26-28 wk gestation were evaluated over 9 mo. HbA1c and serum glycosylated protein (serum fructosamine) were determined at the baseline venipuncture of the 100-g oral glucose tolerance test performed to detect gestational diabetes. Of the 97 women studied, 13 tested positive for gestational diabetes (National Diabetes Data Group criteria). There were significant differences in the fasting and 1-, 2-, and 3-h glucose values between nondiabetic and diabetic patients (P less than 0.005 at each time point). No difference was noted in the baseline serum glycosylated protein level (2.02 +/- 0.08 vs. 1.98 +/- 0.02 mM, NS) or HbA1c level (4.42 +/- 0.2 vs. 4.6 +/- 0.3%, NS) between gestational and nondiabetic patients. Diabetic patients were followed at 2-wk intervals, with serum glycosylated protein analysis, HbA1c, fasting glucose, and mean glucose determined by outpatient monitoring. Serum glycosylated protein correlated significantly to fasting blood glucose (r = 0.81, P less than 0.001) and mean outpatient glucose (r = 0.62, P less than 0.001) at the 2-wk follow-up visits. No correlation was found between HbA1c and fasting blood glucose (r = 0.11, NS) or mean outpatient glucose (r = -0.12, NS) during the follow-up period. The serum glycosylated protein level (serum fructosamine) is not a useful screening test for gestational diabetes. However, this assay shows potential as an objective marker of short-term control in evaluating the maternal glycemic state.     

Longitudinal assessment of glycosylated blood protein concentrations in normal pregnancy and gestational diabetes

Longitudinal changes in glycosylated hemoglobin concentration (GlyHb) and glycosylated serum protein concentration (GSP) in both normal pregnancy and pregnancy complicated by gestational diabetes were determined using affinity chromatography, a method in which nonenzymatically glycosylated proteins are specifically measured. At 7-10 wk gestation, GlyHb in women who developed diabetes (N = 21) was higher than GlyHb in normal women (N = 49) (6.7 +/- 0.2% versus 5.7 +/- 0.2%, respectively, P less than 0.001) and remained elevated throughout gestation. In normal pregnancy, GlyHb decreased to a nadir at 23-26 wk and returned to baseline concentration by 31-34 wk. In gestational diabetes, there was an initial increase in GlyHb to 7.1 +/- 0.5% at 11-14 wk followed by a steady decrease. At 7-10 wk, GSP in women who developed diabetes was not elevated compared with normal concentration, although at 11-14 wk there was significant difference between the two groups (P less than 0.02). In normal women, GSP remained constant throughout gestation. In gestational diabetes, GSP decreased to early pregnancy values (P less than 0.02). Glycosylated blood proteins were elevated in early gestation in women who developed gestational diabetes and may have predictive value in identifying women who will develop diabetes in pregnancy.     

糖化血红蛋白及糖化白蛋白在妊娠期糖尿病诊断中的价值

目的评估糖化血红蛋白(HbA1c)和血清糖化白蛋白(GA)在妊娠期糖尿病(GDM)患者早期监测中的作用。方法根据美国糖尿病协会(ADA)建议,以口服75 g葡萄糖耐量试验(OGTT)测定值作为诊断GDM的标准,将98例妊娠妇女(孕期22~24周)分为正常妊娠组50例、GDM组48例,同时测定2组的HbA1c和GA,并进行统计学分析及受试者工作特征(ROC)曲线分析。结果 GDM组的HbA1c和GA明显高于正常妊娠组(P0.01)。当HbA1c的Cut-off值为5.15%时,ROC曲线下面积为0.954±0.020,敏感性为87.5%,特异性为92.0%。当GA的Cut-off值12.50%时,ROC曲线下面积为0.910±0.029,敏感性为81.3%,特异性为84.0%。HbA1c和GA联合诊断GDM的敏感性为70.8%、特异性为98.0%。结论当HbA1c5.15%和GA12.50%时,诊断GDM的敏感度和特异性较高。HbA1c和GA联合检测对GDM有重要价值。     

糖化血红蛋白对妊娠糖尿病诊断作用的荟萃分析

目的用循证医学的方法评价糖化血红蛋白(HbA1c)对妊娠糖尿病的诊断作用。方法采用固定效应模型荟萃分析,统计分析最近10年在国内外期刊上发表的具有可比性的8篇文献。结果妊娠糖尿病HbA1c阳性率显著高于正常孕妇HbA1c阳性率。结论荟萃分析表明可以应用HbA1c检测来筛查、诊断妊娠糖尿病。     

应用ROC曲线评价糖化血红蛋白在妊娠期糖尿病诊断中的临床价值

目的探讨糖化血红蛋白(HbA1c)在妊娠期糖尿病(GDM)诊断中的临床价值。方法收集59例正常妊娠妇女(正常妊娠组)和66例GDM患者(GDM组),采用高效液相色谱法(HPLC)检测各组静脉血HbA1c水平,使用受试者工作特征曲线(ROC曲线)对HbA1c在GDM诊断中的统计学指标进行评价,统计工具采用SPSS17.0统计软件。结果正常妊娠组和GDM组的HbA1c检测结果分别为(5.36±0.26)%和(5.95±0.85)%,GDM组明显高于正常妊娠组,P<0.01。HbA1c用于诊断GDM的ROC曲线下面积(AUC)为0.843,P<0.01;HbA1c对GDM的诊断截断值为5.65%,其诊断灵敏度和特异度分别为69.7%和84.7%。结论 HbA1c检测具有简便、快速、准确、影响因素少的优点,可作为GDM筛查和辅助诊断的理想指标。     

妊娠期糖尿病患者糖化血清蛋白与尿酸、谷丙转氨酶的相关研究

目的：测定妊娠期糖尿病（GDM）患者的糖化血清蛋白（GSP）表达水平并探讨其与血尿酸（UA）和谷丙转氨酶（ALT）的相关性。方法：选择佛山市南海区第九人民医院住院分娩的GDM患者45人作为实验组,并以同期住院分娩的正常孕妇44人作为对照组;血清中GSP浓度测定采用酶联免疫吸附法;UA和ALT测定采用自动生化仪。结果：实验组的GSP、UA和ALT水平均明显高于对照组（P〈0．05）;GDM组GSP与UA和ALT有相关性,相关系数分别为0．523和0．459（P〈0．05）。结论：GSP测定有利于GDM的筛选和早期诊断;UA和ALT也参与了GDM的发生及发展过程。     

Fingerstick glycosylated hemoglobin, plasma protein, and albumin

We have developed techniques that permit the affinity-chromatographic determination of glycosylated hemoglobin, plasma protein, and albumin on fingerstick samples of whole blood. The fingerstick glycohemoglobin technique takes advantage of the high sensitivity of measurement of hemoglobin by absorbance at 414 nm. The glycosylated plasma protein is assayed by a highly sensitive method based on binding of Coomassie blue. An enzyme-linked immunosorbent assay is used to measure albumin in the bound and nonbound fractions of an aminophenylboronic acid chromatographic separation. The fingerstick method for assay of glycosylated plasma albumin gives results that are approximately 40% higher than comparable values obtained on the same patient with a 1-ml plasma sample determined with the bromcresol green technique. There is good correlation of fingerstick glycoalbumins with fingerstick glycohemoglobins and glycosylated plasma protein values. These procedures should be useful for children and for large-scale ambulatory screening for diabetes mellitus.     

2种进口糖化清蛋白试剂的检测性能评价

目的 评价2种进口糖化清蛋白试剂的检测性能.方法 选取2020年10月空军特色医学中心收治的糖尿病患者及同期体检健康者剩余血清制备混合血清.依据北京市临床检验中心对糖化清蛋白项目的管理要求 、美国临床和实验室标准协会关于清蛋白项目的管理要求,对日本旭化成制药株式会社(以下简称A)及日本积水医疗株式会社(以下简称B)的糖...     

糖化血红蛋白联合尿微量白蛋白检测对糖尿病肾病早期诊断的临床价值

目的探讨及评价糖化血红蛋白(Hb A1c)联合尿微量白蛋白(Um A)检测对糖尿病肾病(DN)早期诊断的临床价值。方法回顾性分析2014年6月至2016年6月于我院就诊的糖DN患者200例,按病程长短分为A组(<1年)、B组(1~5年)、C组(6~10年)、D(>10年)组,每组各50例,选取同期来我院健康体检者50例作为对照组E组。检测所有研究对象的Hb A1c及Um A水平,应用受试者工作特征(ROC)曲线评估Hb A1c及Um A的诊断效能,用Pearson相关性分析分析Hb A1c与Um A的相关性。结果观察组Hb A1c及Um A水平明显高于对照组,各观测组A、B、C、D与对照组E比较差异具有统计学意义(P<0.01),并且随着病程延长,Hb A1c及Um A水平呈上升趋势。Hb A1c联合Um A检测与单测Hb A1c及Um A相比较,诊断灵敏度、特异度、诊断符合率较高,假阳性率及假阴性率较低,差异具有统计学意义(P<0.05)。Hb A1c及Um A在ROC曲线下面积(AUC)分别为0.928、0.891,两者联合应用,AUC为0.934。Pearson相关性分析显示Hb A1c及Um A整体呈正相关(r2=0.512,P<0.05)。结论 Hb A1c及Um A是早期诊断DN的重要指标,两者联合检测对于DN的早期筛查诊断比单独使用各项指标进行诊断具有更高的灵敏度和准确性,具有临床应用价值。     

糖化血红蛋白对糖尿病的诊断价值分析

目的探讨糖化血红蛋白（HbA1c）在糖尿病（DM）诊断中的应用价值。方法 286例健康人和680例DM患者均行口服葡萄糖耐量试验（OGTT）,用特定蛋白分析仪检测HbA1c水平,用BS-420生化分析仪测定血糖,对结果进行分析。结果从健康组到DM组之间的HbA1c的变化关系可看出：DM组患者空腹血糖（FPG）、餐后2h血糖（2hPG）及HbA1c均明显高于健康组（均P〈0.01）,以HbA1c≥6.5%作为DM诊断临界值,其诊断灵敏度为99.18%,诊断特异性为94.45%,均优于以FPG≥7.0mmol/L作为诊断临界值的诊断灵敏度（76.43%）和诊断特异性（89.82%）。结论 HbA1c的值为6.5%时用于诊断DM,与FPG≥7.0mmol/L时联合应用可增加诊断DM的能力。     

妊娠相关血浆蛋白A在初产妇妊娠期糖尿病中的应用价值

目的探讨初产妇孕早期血清中的妊娠相关血浆蛋白A(PAPP-A)水平与妊娠期糖尿病(GDM)发生的关系。方法用非参数检验及Logistic回归分析对168例GDM孕妇及273例健康孕妇的年龄、体质量、PAPP-A、游离β人绒毛膜促性腺激素(fβ-HCG)水平进行回顾性分析。结果 GDM组年龄与对照组差异有统计学意义(P0.01),PAPP-A浓度及PAPP-A MoM均明显低于对照组,差异有统计学意义(P0.01)。结论初产妇孕早期低水平PAPP-A与GDM强相关,并可作为GDM的危险因素。     

First-trimester C-reactive protein and subsequent gestational diabetes

OBJECTIVE: Systemic inflammation is associated with the development of type 2 diabetes. We tested the hypothesis that increased inflammation, measured early in pregnancy, is associated with the subsequent development of gestational diabetes mellitus (GDM), a precursor of type 2 diabetes. RESEARCH DESIGN AND METHODS: We conducted a prospective nested case-control study in a pregnancy cohort. First-trimester C-reactive protein (CRP) levels were measured using a high-resolution assay in 43 women who subsequently developed GDM and in a random sample of 94 women who remained euglycemic throughout pregnancy. Median CRP levels were compared using Wilcoxon's rank-sum test. Logistic regression was used to compute unadjusted and multivariable-adjusted odds ratios for developing GDM among CRP tertiles. RESULTS: First-trimester CRP levels were significantly increased among women who subsequently developed GDM compared with control subjects (3.1 vs. 2.1 mg/l, P < 0.01). The risk of developing GDM among women in the highest CRP tertile compared with the lowest tertile was 3.2 (95% CI 1.2-8.8). After adjusting for age, race/ethnicity, smoking, parity, blood pressure, and gestational age at CRP sampling, the risk of developing GDM among women in the highest compared with the lowest tertile was 3.6 (95% CI 1.2-11.4). When BMI was included in the model, however, the association between increased CRP and GDM was attenuated (odds ratio for the highest compared with lowest tertile 1.5 [95% CI 0.4-5.5]). CONCLUSIONS: In women who develop GDM, there is evidence of increased inflammation during the first trimester. This association is mediated in part by increased BMI. Larger studies are needed to verify these results.     

糖化白蛋白在妊娠期糖尿病筛查及诊断中的价值探讨

目的：评价糖化白蛋白（GA）测定在妊娠期糖尿病诊断中的价值。方法选取2011年9月-2012年3月在我院进行产前检查并于24-28周接受50 g 葡萄糖糖尿病筛查结果异常的孕妇160例,以第7版《妇产科学》的诊断标准分为糖耐量正常组,糖耐量受损组,糖尿病组。对三组的空腹血糖（FPG）,糖化血红蛋白（HbA1c）,糖化白蛋白（GA）等进行对比研究,评价 GA 在妊娠期糖尿病诊断中的价值。结果三组的 FPG、HbA1c、GA 结果有显著性差异,三组中 GA 与 HbA1c 均具有相关性。结论糖化白蛋白（GA）的测定对妊娠糖尿病病变程度的变化具有提示作用,对妊娠期糖尿病的筛查和诊断具有价值,可作为临床应用。     

血清Hcy、RBP和Cys C联合检测在妊娠期糖尿病肾病的早期诊断价值

目的 探讨联合检测同型半胱氨酸(Hcy)、视黄醇结合蛋白(RBP)及胱抑素C(Cys C)对妊娠期糖尿病肾病(DN)的早期诊断价值.方法 选取2012年1月至2019年10月南京医科大学附属妇产医院妊娠期DN患者82例为研究对象,分为早期DN组(44例)和临床DN组(38例),另选择同期同孕周健康孕妇48例为健康对照组...     

糖化血红蛋白及糖化血清蛋白在妊娠糖尿病筛选诊断中的价值评估

目的通过测定妊娠中、晚期孕妇糖化血红蛋白(HbAlc)及糖化血清蛋白(GSP)水平,探讨其在妊娠糖尿病(GDM)筛选诊断中的价值。方法通过1 h糖筛查及75 g糖耐量试验结果将299例孕妇分为正常妊娠组(n=87)、糖耐量正常妊娠组(n=71)、妊娠糖尿病组(n=87)及妊娠糖耐量受损组(n=54),分别对各组妊娠中期及晚期的HbAlc及GSP进行动态测定。将妊娠糖尿病组分为HbAlc≥6.1%的妊娠糖尿病A组及HbAlc6.1%的妊娠糖尿病B组,并对2组各项指标进行分析。结果妊娠糖尿病组孕妇无论在妊娠中期还是妊娠晚期,其HbAlc水平均高于正常妊娠组、糖耐量正常妊娠组及糖耐量受损组,差异有统计学意义(P0.01);随着妊娠的进展,各妊娠组孕妇HbAlc水平逐渐升高,妊娠糖尿病组晚期HbAlc水平为(5.87±0.43)%。以HbAlc≥6.1%作为分界值,妊娠糖尿病组的阳性率为31.0%,而糖耐量受损组及正常糖耐量组分别为5.6%、5.6%,正常妊娠组为0.0%,HbAlc的诊断灵敏度为31.0%,假阴性率为69.0%,诊断特异性为97.5%,假阳性率为2.5%。妊娠糖尿病A组的1 h糖筛查、空腹血糖、1 h血糖均高于妊娠糖尿病B组,差异有统计学意义。各妊娠组间糖化血清蛋白比较差异无统计学意义,且随着妊娠的进展,GSP水平逐步下降,与妊娠同期的血清清蛋白水平成正比。结论尽管妊娠糖尿病组HbAlc水平明显高于正常妊娠组,但由于其诊断敏感性低,因此作为妊娠糖尿病的筛查诊断价值有限,然而其高特异性可使HbAlc升高的孕妇避免再行糖耐量试验,而且升高的糖化血红蛋白预示着较高的血糖水平,对估计GDM的预后及治疗监测可能有一定的作用。糖化血清蛋白由于各组之间无显著差异,不适合作为妊娠糖尿病的筛选诊断指标。     

The diagnostic model for early detection of gestational diabetes mellitus and gestational diabetic nephropathy

BackgroundGestational diabetes mellitus (GDM) and gestational diabetic nephropathy (GDN) have become an increasingly serious problem worldwide, which can cause a large number of adverse pregnancy consequences for mothers and infants. However, the diagnosis of GDM and GDN remains a challenge due to the lack of optimal biomarkers, and the examination has high requirements for patient compliance. We aimed to establish a simple early diagnostic model for GDM and GDN.MethodsWe recruited 50 healthy pregnant (HP), 99 GDM patients, 99 GDN patients at Daping Hospital. Renal function indicators and blood cell indicators were collected for all patients.ResultsCompared with HP, GDM, and GDN patients exhibited significantly higher urea/creatinine ratio and NEU. The diagnostic model1 based on the combination of urea/creatinine ratio and NEU was built using logistic regression. Based on receiver operating characteristic curve analysis, the area under the curve (AUC) of the diagnostic model was 0.77 (0.7, 0.84) in distinguishing GDM from HP, and the AUC of the diagnostic model was 0.94 (0.9, 0.97) in distinguishing GDN from HP. Meanwhile, the diagnostic model2 based on the combination of β2‐mG, PLT, and NEU in GDM and GDN patients was built using logistic regression, and the area under the ROC curve (AUC ROC) was 0.79 (0.73, 0.85), which was larger than the individual biomarker AUC.ConclusionOur study demonstrated that the diagnostic model established by the combination of renal function indicators and blood cell indicators could facilitate the differential diagnosis of GDM and GDN patients.     

妊娠期糖尿病尿白蛋白与妊娠结局的关系

目的 探讨妊娠30-38周妊娠期糖尿病（gestational diabetes mellitus,GDM）尿白蛋白与妊娠结局的关系。 方法 检测47例GDM（GDM组）及56例正常孕妇（对照组）妊娠30-32周、妊娠36-38周首次晨尿的白蛋白，随访两组妊娠结局。 结果 妊娠30-32周、妊娠36-38周GDM尿白蛋白分别为（5.014±2.634）mg/L、（13.716±12.707）mg/L，正常孕妇为（4.050±1.320）mg/L、(6.516±1.023)mg/L，两组尿白蛋白均随孕周增加而增多（p<0.05）；妊娠36-38周GDM组尿白蛋白高于对照组(p<0.01)，其中，GDM组尿白蛋白异常增高者，胎儿窘迫、新生儿窒息发生率高于尿白蛋白正常者（p<0.05），GDM尿白蛋白正常者围生儿结局与正常妊娠者相似（p>0.05）。结论 GDM尿白蛋白与其围生儿结局有关，尿白蛋白有望作为GDM孕妇的临床监测指标，进而指导正确治疗及适时终止妊娠，改善围生儿结局。     

Fluorometric measurement of glycosylated albumin in human serum

A simple and rapid fluorometric assay of glycosylated albumin was developed using dansylated phenyl boronic acid (N-(5-dimethyl amino-1-naphthalene sulfonyl)-3-aminobenzene boronic acid). The emission spectrum of the reagent changes upon binding to cis-diols present on glycosylated albumin in serum, allowing quantitation of glycosylated albumin. Results from the new procedure correlated well with those from commercially prepared affinity chromatography (r = 0.85).