糖化血红蛋白结合2点血糖法诊断妊娠期糖尿病的可行性研究

目的:分析糖化血红蛋白（hemoglobin A1c，HbA1c）结合2点血糖法诊断妊娠期糖尿病（gestational diabetes mellitus，GDM）的可行性。方法:选择广东医学院附属医院和东莞市厚街医院对妊娠24~28周的孕妇，进行GDM初筛后，对疑似GDM者分别进行葡萄糖耐量试验（OGTT）、HbA1c结合2点血糖法检测，评价2种方法的筛检结果及临床意义。结果:若OGTT仅取血2次，则与金标准比较1~2 h 2点法诊断敏感性、符合率均较高（P<0.01）；84例疑似GDM患者平均HbA1c水平为（8.73±0.59）%，显著超过正常界值（6%）（P<0.01）。HbA1c结合2点血糖法诊断GDM的结果与单一检测结果差异均无统计学意义（P>0.05）；以HbA1c结合2点血糖法进行鉴别诊断，灵敏度为87.5%，特异度为84.9%，曲线下面积=0.926（P<0.05）；HbA1c结合2点血糖法的社会经济效益及节省经济效益均显著高于OGTT检测（P<0.01）。结论:HbA1c结合2点血糖法能够在很大程度上减少OGTT 4次取血造成孕妇的痛苦，HbA1c应用于产科临床中，可以减少2点取血法引起的漏诊率，可使GDM患者及时得到重视及治疗，大大减少妊娠期并发症的发生。

The feasibility study of glycosylated hemoglobin combined with 2 point blood sugar test in the diagnosing of gestational diabetes mellitus

Objective：To analyze the feasibility of hemoglobin A1 c （HbA1 c） combined with 2 point blood sugar test in the diagnosing of gestational diabetes mellitus （GDM）.Methods：The pregnant women with 24 to 28 weeks from the Affiliated Hospital of Guangdong Medical College and Dongguan Houjie Hospital were screened by GDM from Jun 2012 to Feb 2013.The pregnant women with suspected GDM were detected using glucose tolerance test（OGTT） and HbA1 c combined with 2 point blood sugar test,respectively.The screening results and clinical significance of two methods were evaluated.Results：Compared with the gold standard,the sensitivity and coincidence rate of 2 points method within 1 to 2 h were higher when OGTT collected blood 2 times（P ＜ 0.01）.The average levels of HbA1c in 84 patients with suspected GDM（8.73 ±0.59）％ were significantly higher than the normal value（6％） （P ＜0.01）.The differences of HbA1c combined with 2 point blood sugar test test and a single test in the diagnosis of GDM had no statistically significant（P＞0.05）.The diagnostic sensitivity and specificity of HbA1c combined with 2 point blood sugar test were 87.5％ and 84.9％,respectively,and its area under the curve was 0.926 （P ＜ 0.05）.The economic and social benefits of HbA1 c combined with 2 point blood sugar test were significantly higher than those of 75 g OGTT test （P ＜ 0.0 1）.Conclusions：HbA 1 c combined with 2 point method can largely reduce the pregnant women pain caused by collecting blood for 4 times,missed diagnosis rate of 2 points method and incidence of pregnancy complications,which can make the GDM patients get the attention and treatment in time.