妊娠 8~14周血清糖化血红蛋白联合空腹血浆葡萄糖、胰岛素抵抗指数预测妊娠糖尿病的临床价值

目的 探析孕8～14周血清糖化血红蛋白(HbA1c)联合空腹血浆葡萄糖(FPG)以及胰岛素抵抗指数(HOMA-IR)对妊娠糖尿病(GDM)的预测价值.方法 回顾性分析2016年1月至2018年6月在雅安市人民医院进行常规性孕前检查的孕妇5124名,收集其基本资料及孕8～14周的血清中HbA1c、FPG及HOMA-IR.按其孕24～28周空腹葡萄糖耐受试验(OGTT)筛查结果分为GDM组和非GDM组.比较组间基本资料以及HbA1c、FPG、HOMA-IR差异.采用多因素logistic回归分析GDM的相关因素,并建立联合诊断模型.绘制受试者工作特征曲线(ROC),Hanley-McNeil方法比较曲线下面积.分析HbA1c联合FPG、HOMA-IR对GDM的预测价值.结果 5124名孕妇中,合并GDM的孕妇有526名(10.26％),糖代谢正常孕妇4598名(89.74％).GDM组孕妇血清中的HbA1c(5.47±0.37)％、FPG(5.18±0.32)mmol/L及HOMA-IR(3.32±0.84)均高于正常孕妇清中的HbA1c(5.01±0.14)％、FPG(5.02±0.39)mmol/L及HOMA-IR(2.17±0.26).logistic多因素回归分析显示HbA1c(OR=1.390,95％CI:1.046～1.846)、FPG(OR=1.323,95％CI:1.020～1.717)、和HOMA-IR(OR=1.831,95％CI:1.104～3.036)是GDM发生的独立危险因素(P<0.05).通过回归模型中的概率预测值P来拟合联合检测的ROC曲线,与各指标单独检测的结果进行比较,发现预测模型检测的曲线下面积(0.871)高于单独检测(P<0.05).结论 血清HbA1c联合FPG、HOMA-IR对妊娠糖尿病早期诊断的灵敏度较好,有良好的预测价值.

Clinical value of serum HbAlc combined with FPG and HOMA-IR in predicting gestational diabetes mellitus from 8 to 14 weeks

Objective To investigate the predictive value of serum glycosylated hemoglobin (HbA1c) combined with fasting plasmaglucose (FPG) and insulin resistance index (HOMA-IR) for gestational diabetes mellitus (GDM) at 8 to 14 weeks of gestation.Methods Five thousand one hundred and twenty-four pregnant women who underwent routine pre-pregnancy examinations in Ya''an People''sHospital from January to February 2018 were retrospectively analyzed, the basic data, serum HbA1c, FPG and (HOMA-IR from 8 to 14 weeks of gestation were collected. All subjects underwent OGTT screening at 24-28 weeks of gestation and were divided into GDM and non-GDM groups according to the GDM diagnostic method. The basic data between groups and the differences of HbA1c, FPG andHOMA-IR were compared. Multivariate logistic regression was used to analyze the relevant factors of GDM and establish a joint diagnosis model. The predictive value of HbA1c combined with FPG and HOMA-IR for GDM was analyzed, and receiver operating characteristic curve (ROC) and the Hanley-McNeil method was used to compare the area under the curve.Results Of the 5124 pregnant women, 526 were pregnant with GDM, accounting for 10.26%, and 4598 were pregnant with normal glucose metabolism, accounting for89.74%. The serum levels of HbA1c (5.47±0.37)%, FPG (5.18±0.32) mmol/L and HOMA-IR (3.32±0.84) in GDM group were higherthan those in normal pregnant women [HbA1c (5.01±0.14)%, FPG (5.02±0.39) mmol/L and HOMA-IR (2.17±0.26)]. Logistic multivariate regression analysis showed HbA1c (OR=1.390, 95%CI: 1.046-1.846), FPG (OR=1.323, 95%CI: 1.020-1.717), HOMA-IR (OR= 1.831, 95%CI: 1.104-3.036) were an independent risk factors for GDM (P<0.05). The ROC curve of the joint detection was fitted by theprobability prediction value p in the prediction model, and the results of the separate detection of each index were compared. The combination module displayed a higher AUC (0.871) compared with individual detection and has good predictive value (P<0.05).Conclu? sion Serum HbA1c combined with FPG and HOMA-IR has good sensitivity and specificity for early diagnosis of gestational diabetes, and has good predictive value.