糖化血红蛋白在筛查妊娠期糖尿病中的临床意义

目的探讨糖化血红蛋白（HbA1c）在妊娠期糖尿病（GDM）诊断中的临床意义。方法收集湖南省妇幼保健院2011年6-9月产前门诊建卡检查孕妇,以《妇产科学》诊断GDM标准,其中正常妊娠50例,产前检查诊断为GDM孕妇74例,妊娠期糖耐量受损孕妇66例。分别检测空腹血糖（FPG）、口服糖负荷试验（OGCT）和HbA1c,并比较各组孕妇三指标的阳性率和敏感度、可靠性、特异度及阳性预测值。结果与正常妊娠组相比,GDM组和糖耐量受损组的GCT及HbA1c水平均显著升高（P〈0.05）;与糖耐量受损组相比,GDM组的GCT及HbA1c水平同样均显著升高（P〈0.05）;GDM组和糖耐量受损组FPG、OGCT、HbA1c诊断阳性率大小顺序为HbA1c〉OGCT〉FPG;GDM筛查中HbA1c敏感性、可靠性、特异性及阳性预测值分别为93.1%、97.9%、98.2%和81.8%,均显著高于FPG、OGCT（P〈0.05）。结论 HbA1c在GDM患者诊断中具有快速,阳性率、敏感性、可靠性和特异性高等特点,在临床GDM诊断中起着重要作用。

Clinical Significance of Glycosylated Hemoglobin in Screening Gestational Diabetes Mellitus

Objective To explore the clinical significance of glycosylated hemoglobin(HbA1c) in diagnosing gestational diabetes mellitus(GDM).Methods Among the pregnant women who visited the clinics of Maternal and Child Health Hospital of Hunan Province and were registered with cards from June to September 2011,50 normal pregnant women(NPW),74 pregnant women with prenatal diagnosis of GDM(in accordance with Obstetrics and Gynecology) and 66 pregnant women with impaired glucose tolerance(IGT) were selected.Fasting plasma glucose(FPG),oral glucose challenge test(OGCT) and HbA1c were detected.The positive rate,sensibility,specificity,reliability and positive predictive value of FPG,OGCT and HbA1c were compared among three groups.Results The levels of GCT,HbA1c were significantly higher in GDM,IGT group than those in NPW group,and higher in GDM group than in IGT group(P<0.05).The positive rates of FPG,OGCT and HbA1c in GDM diagnosis were as follows: HbA1c>OGCT>FPG.The sensibility,reliability,specificity and positive predictive value of HbA1c in GDM screening were 93.1%,97.7%,98.2% and 81.8% respectively,all significantly higher than those of FPG,OGCT(P<0.05).Conclusions HbA1c has the characteristics of fast speed,high sensibility,reliability,specificity and positive predictive value.It plays important roles in GDM diagnosis.