妊娠期糖尿病IADPSG诊断标准的探讨

目的:探讨国际糖尿病与妊娠关系研究协会(IADPSG)推荐的妊娠期糖尿病(GDM)新标准(2011年ADA诊断标准)是否适用于我国。方法:选取2011年6月至2012年2月在暨南大学附属第一医院妇产科产检的孕妇1101例,于妊娠24～28周行葡萄糖耐量实验(OGTT)。结果:(1)纳入研究的1054例孕妇OGTT空腹、1h、2h血糖的95%医学参考值分别为5.2、10.7、9.1 mmol/L;90%医学参考值分别为5.0、9.9、8.5mmol/L。(2)2011年ADA诊断标准诊断GDM的发病率为18.7%,显著高于第7版《妇产科学》诊断标准(4.2%)、日本诊断标准(4.4%)及本研究95%参考值(10.3%)(P'均<0.005);(3)空腹血糖与餐后1h血糖、餐后2h血糖的相关性较低;依据第7版《妇产科学》及2011年ADA诊断标准诊断为GDM者分别为44例和197例,其中空腹血糖≤4.4mmol/L者分别为11例(25%)和66例(33.5%)。结论:(1)在获得我国相关临床研究数据之前,IADPSG诊断标准在我国的全面推广会显著增加GDM发病率,值得商榷;(2)不建议使用空腹血糖排除GDM,即使空腹血糖≤4.4mmol/L。

Exploration on diagnostic criteria of gestational diabetes mellitus

Objective:To study the diagnostic criteria recommended by IADPSG for gestational diabetes mellitus(GDM) in Chinese pregnant women.Methods:Selected 1101 gravidas who had regular prenatal checkup during June 2011~ Feb.2012 at the First Affiliated Hospital of Jinan University as research section.Oral glucose tolerance tests(OGTT) were performed in pregnant women at 24~28 weeks of gestation.Results:(1)The fasting blood glucose,1h,2h blood glucose of the 95% medical reference value in 1054 cases of pregnant women included in the study with oral glucose tolerance test was 5.2mmol/L,10.7mmol/L,9.1mmol/L;the 90% medical reference values were 5.0mmol/L,9.9mmol/L,8.5mmol/L.(2)Rate of GDM diagnosed by diagnostic criteria of 2011 ADA was 18.7%,which was significantly higher than the seventh edition "Obstetrics and Gynecology"(4.2%),Japan(4.4%) and the 95% reference value(10.3%)(P’<0.005).(3)There was low correlation among fasting plasma glucose,1h postprandial plasma glucose and 2h postprandial plasma glucose.There were 44 cases of GDM according to the seventh edition "Obstetrics and Gynecology" diagnostic criteria,11 cases impaired fasting glucose cases accounted for 25.0% of the total;in accordance with the 2011 ADA diagnostic criteria,there were 66 with impaired fasting glucose of the diagnosis of 197 cases of GDM,accounting for 33.5% of the total number of GDM.Conclusions:Before getting our country’s related clinical research data,the applicability of IADPSG criterion in our country should be discussed.Even if fasting blood glucose≤4.4mmol/L,it does not recommend the use of fasting blood glucose to excluded the diagnosis of GDM.