糖化血红蛋白对妊娠期糖尿病筛查及年龄依赖性发病率的价值探讨

目的探讨糖化血红蛋白(HbA1c)筛查妊娠期糖尿病(GDM)及年龄依赖性发病率的价值。方法美国糖尿病协会(ADA)葡萄糖耐量试验(OGTT)作为诊断GDM标准,将1 600例妊娠妇女(孕期24~28周)分为健康妊娠组1 319例、GDM组281例,同时测定2组HbA1c和空腹血糖(FPG)、1h及2h血糖,并进行统计学及受试者工作特征(ROC)曲线分析。结果 GDM组的HbA1c值显著高于健康妊娠组(P0.05)。当HbA1c诊断截点4.895%时,ROC曲线下面积(AUC)0.905,敏感性85.8%,特异性81.9%;FPG、1h血糖和2h血糖诊断GDM的ROC AUC分别为0.879、0.796及0.762。随着年龄的增加,不同年龄阶段GDM组中大于HbA1c诊断截点(4.895%)比例呈上升的趋势。结论随着年龄的增加,不同年龄阶段GDM组中HbA1c诊断GMD比例呈上升的趋势。OGTT与HbA1c联合检测能提高GDM诊断准确性,在GDM诊断及监测中有重要价值。

To investigate the value of HbA1c for diagnosing gestational diabetes mellitus and incidence of age-dependent

Objective To investigate the value of HbA1c for diagnosing gestational diabetes mellitus and inci‐dence of age‐dependent .Methods A total of 1 600 pregnant with their estimated gestational age between 24 and 28 weeks were enrolled for GDM diagnosis using oral glucose tolerance test(OGTT) based on American Diabetes Asso‐ciation(ADA) criteria ,and were classified into normal pregnancy group(1 319 cases) and GDM group(281 cases) . HbA1c ,FPG ,1 hour glucose and 2 hour glucose were also determined simultaneously ,and the results were analyzed statistically and by receiver operating characteristic(ROC) curve .Results The HbA1c level in GDM group signifi‐cantly higher than those in normal pregnancy group(P<0 .05) .The area under ROC curve of HbA1c was 0 .905 at the cut‐off value of 4 .895% with sensitivity 85 .8% and specificity of 81 .9% .The area under ROC curves of FPG ,1 hour GLU and 2 hour GLU were 0 .879 ,0 .796 and 0 .762 .With the increase of age ,there was an upward trend of the ratio more than the HbA1c diagnostic cut off point(4 .895% ) in different age stages GDM groups .Conclusion With the increase of age ,there’s an upward trend of the ratio for diagnosing gestational diabetes mellitus in different age stages GDM groups .The combined determination of HbA1c and OGTT can improve the accuracy of diagnosing GDM and it has the significance for diagnosing GDM .