糖化血红蛋白早期预测妊娠期糖尿病的临床效果和应用价值

目的:探讨糖化血红蛋白早期预测妊娠期糖尿病的临床效果和应用价值。方法:将386例孕妇根据建卡进行系统性产检的按孕周分为早孕组196例(孕周<24周)和中孕组190例(孕周24～28周),将同期已确诊为妊娠期糖尿病的56例晚孕患者(孕周>34周)纳入对照组。采用空腹血糖(FPG)测定法、糖化血红蛋白(HbA1c)法和50 g葡萄糖负荷试验(GCT)进行筛查,采用75 g糖耐量实验进行确诊并对确诊的妊娠期糖尿病患者纳入早期干预组并进行合理的指导和治疗,对照组患者进行常规的入院治疗,比较3种筛查方法的可靠性以及对照组和治疗组的妊娠结局。结果:HbA1c在妊娠期糖尿病的筛查中灵敏度、特异度和阳性预测值分别为85.3%、97.6%和95.65%,优于FPG和GCT的筛查,其差异有统计学意义(P<0.05)。经早期筛查诊断并进行治疗的孕妇其妊娠期合并症发病率明显低于对照组,进行早期干预治疗的孕妇早产率和新生儿并发症发病率也明显低于对照组,差异均有统计学意义(P<0.05)。结论:HbA1c对妊娠期糖尿病诊断的特异度和灵敏度高,方便可靠,利用其对妊娠期糖尿病进行早期诊断和治疗可有效减少母婴并发症,值得在临床推广应用。

Clinical effect and application value of glycosylated hemoglobin for early prediction of gestational diabetes mellitus

Objective:To explore the clinical effect and application value of glycosylated hemoglobin for early prediction of gestational diabetes mellitus.Methods:A total of 386 pregnant women who received systematical prenatal examination were divided into early pregnancy group(196 women,< 24 gestational week) and mid-pregnancy group(190 women,24-28 gestational weeks),56 women of late pregnancy(> 34 gestational week) who were diagnosed as gestational diabetes mellitus(GDM) during the same period were selected as control group.The screening methods included fasting blood glucose test,glycosylated hemoglobin(HbA1c) test,and 50-gram glucose challenge test(GCT),75-gram oral glucose tolerance test(OGTT) was used for definite diagnosis,the GDM patients with definite diagnosis were designed as early intervention group,and they received reasonable guidance and treatment,the patients in control group received routine treatment in hospital;the reliabilities of three screening methods and the pregnancy outcomes in control group and treatment group were compared.Results:The sensitivity,specificity,and positive predictive value of HbA1c in GDM screening were 85.3%,97.6%,and 95.65%,respectively,which were statistically significantly higher than those of fasting blood glucose test and GCT(P<0.05).The incidence rates of pregnancy complications in pregnant women after early screening,early diagnosis,and early treatment were statistically significantly lower than those in control group,the rate of premature delivery and incidence rates of neonatal complications in early intervention group were statistically significantly lower than those in control group(P<0.05).Conclusion:The specificity and sensitivity of HbA1c for diagnosis of GDM are high,and the method is convenient and reliable,which can effectively reduce maternal and infantile complications for early diagnosis and treatment of GDM,so it is worthy to be popularized and applied in clinic.