糖化血红蛋白及糖化白蛋白在妊娠期糖尿病诊断中的价值

目的评估糖化血红蛋白(HbA1c)和血清糖化白蛋白(GA)在妊娠期糖尿病(GDM)患者早期监测中的作用。方法根据美国糖尿病协会(ADA)建议,以口服75 g葡萄糖耐量试验(OGTT)测定值作为诊断GDM的标准,将98例妊娠妇女(孕期22~24周)分为正常妊娠组50例、GDM组48例,同时测定2组的HbA1c和GA,并进行统计学分析及受试者工作特征(ROC)曲线分析。结果 GDM组的HbA1c和GA明显高于正常妊娠组(P0.01)。当HbA1c的Cut-off值为5.15%时,ROC曲线下面积为0.954±0.020,敏感性为87.5%,特异性为92.0%。当GA的Cut-off值12.50%时,ROC曲线下面积为0.910±0.029,敏感性为81.3%,特异性为84.0%。HbA1c和GA联合诊断GDM的敏感性为70.8%、特异性为98.0%。结论当HbA1c5.15%和GA12.50%时,诊断GDM的敏感度和特异性较高。HbA1c和GA联合检测对GDM有重要价值。

Significance of glycosylated hemoglobin A1c and glycated albumin for the diagnosis of gestational diabetes mellitus

Objective To evaluate the utilities of glycosylated hemoglobin A1 c （HbA1 c ） and serum glycated albumin（GA）for the early monitoring of gestational diabetes mellitus（GDM）.Methods A total of 98 pregnant women with their estimated gestational age between 22 and 24 weeks were enrolled for GDM diagnosis using 75 g oral glucose tolerance test （OGTT）based on American Diabetes Association （ADA）criteria,and were classified into normal pregnancy group （50 cases）and GDM group （48 cases）.HbA1 c and GA were also determined simultaneously,and the results were analyzed statistically and by receiver operating characteristic （ROC）curve.Results The HbA1 c and GA levels in GDM group were significantly higher than those in normal pregnancy group（P〈0.01 ）.The area under ROC curveofHbA1cwas0.954＆#177;0.020atthecut-offvalueof5.15% withsensitivityof87.5% andspecificityof92.0%. The area under ROC curve of GA was 0.91 0 ＆#177;0.029 at the cut-off value of 1 2.50% with sensitivity of 81 .3% and specificity of 84.0%.The sensitivity was 70.8%,and the specificity was 98.0% in diagnosing GDM by the combined determination of HbA1c and GA.Conclusions When HbA1c 〉5.15% and GA〉12.50%,there are high sensitivity and specificity for the diagnosis of GDM.The combined determination of HbA1 c and GA has the significance for the diagnosis of GDM.