胎肺成熟度预测在妊娠期糖尿病的应用及临床价值

目的:探讨GDM孕妇胎肺成熟度测定的应用及临床价值。方法:选择GDM孕妇共128例作为研究对象,根据血糖控制情况分为两组,血糖控制满意组,共89例;血糖控制不满意组,共39例;另外选取同期正常妊娠孕妇200例作为对照组;所有羊水标本均通过择期剖宫产时或分娩前3天经腹羊膜腔穿刺术穿刺羊膜腔获取。结果:GDM孕妇羊水LBC值随孕周增加而增多,且明显小于正常妊娠组(P>0.05);GDM血糖控制不满意组新生儿RDS发生率明显高于血糖控制满意组及正常妊娠组,差异具有统计学意义(P<0.05);GDM血糖控制满意组新生儿RDS发生率与正常妊娠组相比,差异无明显统计学意义(P>0.05);以LBC<2.0×109/L作为判断胎儿肺不成熟的临界值,以LBC>4.8×109/L作为判断胎儿肺成熟的临界值,具有较好的预测价值。结论:新生儿RDS的发生与孕期血糖控制密切相关,以羊水板层小体计数测定胎肺成熟度时,可以LBC<2.0×109/L作为判断胎儿肺不成熟的临界值,以LBC>4.8×109/L作为判断胎儿肺成熟的临界值。

Application and clinical value of the prepartal fetal pulmonary maturity test to the pregnant women with gestational diabetes mellitus

Objective To evaluate the clinical value of the fetal pulmonary maturity(FPM) test to the pregnant women with gestational diabetes mellitus(GDM).Method There were 200 normal cases and 128 GDM cases including 89 cases whose blood glucose were controlled well and 39 cases whose blood glucose were controlled badly.Amniotic fluid lamellar body count(LBC) was performed before the termination of pregnancy to the women in these 3 groups to compare the FPM and the rate of neonatal respiratory distress syndrome(NRDS).Results There was no difference in FPM and the incidence of NRDS between normal group and well-controlled group,the FPM was delayed and the incidence of NRDS increased in badly-controlled group(P<0.05).If cutoff value LBC<2.0×109/L was defined to predict fetal lung immaturity and LBC>4.8×109/L was defined to predict fetal lung maturity,LBC was a valid and rapid test for the determination of fetal maturity.Conclusion The incidence of NRDS is dependent on the stable of blood sugar in GDM women.LBC can be used as a favorable predictor for fetal lung maturity.