妊娠早期糖化血红蛋白联合PAPP-A对妊娠期糖尿病的预测意义

目的:探讨妊娠早期血清学指标糖化血红蛋白(glycohemoglobin,HbA1c)联合妊娠相关血浆蛋白A(pregnancy-associated plasma protein A,PAPP-A)对妊娠期糖尿病(gestational diabetes mellitus,GDM)的预测意义。方法:随机选取2018年12月1日-2019年7月30日孕11~13+6周于我院门诊产检的妊娠妇女,进行临床资料采集并记录妊娠早期(11~13+6周)空腹血糖(fasting plasma glucose,FPG)、HbA1c、PAPP-A中位数倍数(multiple of the median,MoM)水平,根据孕24~28周进行的75 g口服葡萄糖耐量试验(oral glucose tolerance test,OGTT)结果将研究对象分为研究组和对照组,统计分析妊娠早期血清学指标预测GDM的最佳截断值并得出最适宜的联合预测方案。结果:多因素Logistic回归分析显示,高水平FPG和HbA1c、低水平PAPP-A、受孕方式采用辅助生殖技术、有家族糖尿病史以及妊娠早期体质量指数(BMI)为超重或肥胖均是GDM发生的独立危险因素。有糖尿病家族史和使用辅助生殖技术受孕发生GDM的风险显著增高(OR分别为7.206和47.512,均P<0.001)。分析不同预测指标的受试者工作特征(receiver operating characteristic,ROC)曲线及曲线下面积(area under the curve,AUC)显示,PAPP-A MoM联合HbA1c及FPG诊断时AUC最大(0.728),其后依次为PAPPA MoM联合HbA1c(0.721)、HbA1c联合FPG(0.717),均大于HbA1c(0.707)和FPG(0.647),而PAPP-A MoM的AUC为0.380,对GDM没有诊断意义。结论:具有高风险因素的孕妇,推荐在妊娠早期联合检测HbA1c与PAPPA MoM,以早期预测GDM。

Predication of Gestational Diabetes by Glycated Hemoglobin and PAPP-A in Early Pregnancy

Objective:To investigate the prediction of gestational diabetes mellitus(GDM)by serum glycohemoglobin(HbA1 c)combined with pregnancy-associated plasma protein A(PAPP-A)in early pregnancy.Methods:The pregnant women were included from December 1,2018 to July 30,2019.Clinical data,fasting plasma glucose(FPG),HbA1 c and PAPP-A median multiple of the median(MoM)were collected in early pregnancy(11 to 13+6 weeks).Based on a 75 g oral glucose tolerance test(OGTT)at 24 to 28 weeks,the pregnant women were divided into the study group and the control group.The optimal cutoff value of GDM was predicted by the statistical analysis,so as to get an optimal scheme to predict GDM in early pregnancy.Results:Multivariate logistic regression analysis showed that the independent risk-factors for GDM could include the high levels of FPG and HbA1 c,low level of PAPP-A,pregnancy with assisted reproduction technology,family history of diabetes,and overweight or obesity in early pregnancy.The risk of GDM in the women with the family history of diabetes or in those pregnanct women with assisted reproduction technology was significantly increased(OR were 7.206 and47.512,both P<0.001).Analysis of receiver operating characteristic(ROC)curves and area under the curve(AUC)as different predictive indicators showed that the PAPP-A MoM combined with HbA1 c and FPG had the highest AUC(0.728),and there after the PAPP-A MoM combined with HbA1 c(0.721)and the HbA1 c combined with FPG(0.717),were both larger than HbA1 c(0.707)and FPG(0.647).The single AUC of PAPP-A MoM(0.380)was meaningless for the diagnosis of GDM.Conclusions:The combined detection of HbA1 c and PAPP-A MoM can be recommended for those pregnancy women with high-risk factors to predict GDM in the early pregnancy.