糖化血红蛋白联合空腹血糖检测在妊娠期糖尿病诊断中的应用价值

目的：建立天津市中心妇产科医院（我院）孕妇孕中期糖化血红蛋白（HbA1c）的正常参考区间，并探讨HbA1c联合空腹血糖（FPG）检测在妊娠期糖尿病（GDM）诊断中的应用价值。方法：依据2010年国际妊娠合并糖尿病研究组织（IADPSG）推荐的GDM诊断标准，从2016年5-12月期间在我院行75 g口服葡萄糖耐量试验（OGTT）产前检查的孕24～28周的孕妇中筛查出196例GDM孕妇作为GDM组，以同期健康孕妇320例作为对照组（健康孕妇组），同时收集其相关的临床资料。采用高效液相色谱法检测HbA1c水平，采用受试者工作特征（ROC）曲线分析HbA1c联合FPG用于筛查GDM的价值。结果：①GDM组的年龄、孕前体质量和孕前体质量指数（BMI）均高于健康孕妇组（P＜0.01），2组孕妇的孕周和身高比较差异无统计学意义（P＞0.05）；②GDM组HbA1c水平和OGTT各时点血糖水平均高于健康孕妇组，差异有统计学意义（P＜0.01）；③320例健康孕妇HbA1c水平符合正态分布，其孕中期HbA1c水平的正常参考区间（取其第2.5～97.5百分位数）为4.4%～5.8%；④当HbA1c为5.35%时，其预测GDM的敏感度（44.9%）和特异度（77.5%）最高，此时HbA1c诊断GDM的ROC曲线下面积（AUC）为0.665（95%CI：0.617～0.713）；HbA1c（≥5.35%）联合FPG（≥5.1 mmol/L）诊断GDM的AUC为0.933（95%CI：0.909～0.957）。结论：建立了我院孕妇孕中期HbAlc的正常参考区间。HbAlc联合FPG检测简单、方便，有望成为GDM诊断的有力补充。

The Application Value of Glycosylated Hemoglobin Level Combined with Fasting Blood Glucose in Diagnosis of Gestational Diabetes Mellitus

Objective：To establish the normal reference interval in the second trimester pregnant women of glycosylated hemoglobin (HbA1c) in the Tianjin Central Hospital of Gynecology Obstetrics, and evaluate the application value of HbA1c combined with fasting blood glucose (FPG) in the detection of gestational diabetes mellitus (GDM). Methods：According to the GDM diagnostic criteria of International Association of Diabetes and Pregnancy Study Groups (IADPSG) recommended, 196 GDM pregnant women and 320 health control with 75 g oral glucose tolerance test (OGTT) examination in our hospital from May 2016 to December 2016 during 24 to 28 weeks of pregnancy were enrolled, and the related clinical data were collected. Results：①The age, pre-pregnancy weight and pre-pregnancy BMI of the GDM group were significantly higher than those of health control group(P＜0.01), no significant difference were found in the gestational age and height between the two groups (P＞0.05). ②The average value of HbA1c, the blood glucose levels of OGTT in GDM women were significantly higher than the health control group (P＜0.01). ③The HbA1c level of all the 320 healthy pregnant women was in normal distribution. The HbA1c reference interval of the normal pregnant women in the second trimester of pregnancy was 4.4%-5.8%. ④The highest sensitivity and specificity in prediction of GDM were 44.9% and 77.5% respectively when the HbA1c was 5.35%. The ROC curve area of HbA1c in diagnosis of GDM was 0.665 (95%CI: 0.617-0.713); The curve area of the HbA1c（≥5.35%）combined with FPG（≥5.1 mmol/L） in diagnosis of GDM was 0.933 (95%CI: 0.909-0.957). Conclusions：The normal reference range of HbA1c of the pregnant women in our hospital was established. HbA1c combined with FPG detection was simple and convenient, and can be used as a powerful supplement to GDM diagnosis.