妊娠期糖尿病患者血糖代谢表现异质性的分析

目的:探讨妊娠期糖尿病(gestational diabetes mellitus,GDM)患者的血糖代谢表现及预后。方法:从2009年1月1日—2012年3月31日在上海市第七人民医院行产前检查的孕妇中选择参加口服葡萄糖耐量试验(oral glucose tolerance,OGTT)的1683例孕妇作为研究对象,其中GDM患者208例(漏诊组116例和确诊组92例),其余1475例孕妇(对照组)糖代谢正常(normal glucose tolerance,NGT)。比较各组的空腹血糖(fasting plasma glucose,FPG)、1 h血糖(1 h plasma glucose,1 h PG)、2 h血糖(2 h PG)、糖化血红蛋白(HbA1c)阳性率、血糖曲线下面积(area under curve of glucose,AUCG)之间的差异及口服葡萄糖耐量试验(oval glucose tolerance test,OGTT)血糖图趋势。比较各组孕妇妊娠期高血压发病率、胎膜早破发病率、剖宫产率和新生儿结局。结果:1 h PG、2 h PG、HbA1c阳性率和AUCG均为确诊组漏诊组NGT组,组间比较差异有统计学意义(P0.01)。各组FPG比较:确诊组明显大于漏诊组和NGT组(P0.01),漏诊组和NGT组比较差异无统计学意义(P0.05)。3组血糖变化趋势不一,漏诊组变化介于确诊组(最高)和NGT组(最低)之间。妊娠期高血压疾病发生率和剖宫产率在NGT组、漏诊组、确诊组依次升高,NGT组与另2组比较差异有统计学意义(P0.01),但漏诊组、确诊组GDM组间差异无统计学意义(P0.05)。胎膜早破、早产、新生儿黄疸、新生儿窒息发生率及新生儿体质量在3组间差异无统计学意义(P0.05)。巨大儿和新生儿低血糖发生率在3组间差异有统计学意义(P0.01)。结论:GDM患者血糖代谢具有异质性,需要根据病情区别管理。

Analysis of Glycometabolic Heterogeneity in Gestational Diabetes Mellitus

Objective：To explore the degree of glycometabolic disorder and prognosis of patients with gestational diabetes mellitus（GDM）.Methods：The data of pregnant women who underwent prenatal examination in Shanghai Seventh＇s People＇s Hospital from Jan.1st 2009 to Mar.31 st 2012 were respectively analyzed.A total of 1683 pregnant women,who took oral glucose tolerance test（OGTT）were chosen as subjects.Among them,there were 208 patients with GDM（116 cases in misdiagnosis group and 92 cases in diagnosis group）and the other 1475 pregnant women with normal glucose tolerance（NGT）were set as control group.Fasting plasma glucose（FPG）,1 h plasma glucose（1 h PG）,2 h PG,glycosylated hemoglobin（HbA1c）positive rate,area under the curve of glucose（AUCG）and OGTT plasma glucose chart were compared among the groups.Rates of hypertension disorder complicating pregnancy,premature rupture of membrane and cesarean section and new born outcomes were compared among the three groups.Results：1 h PG,2 h PG,HbA1 c positive rate and AUCG in misdiagnosis group were lower than those in diagnosis group,but higher than those in NGT group,and the differences among groups were statistically significant（P〈0.01）.FPG in diagnosis group was significantly higher than that in misdiagnosis group and NGT group（P〈0.01）,but there was not significant difference between misdiagnosis group and NGT group（P〉0.05）.The trends of plasma glucose chart were different among the three groups,the data line of misdiagnosis group was between the lines of he other two groups.There was no significant difference in the incidences of hypertensive disorder complicating pregnancy and cesarean section between misdiagnosis group and diagnosis group（P〉0.05）,and the incidences in NGT group were significantly lower than those in the other two groups（P〈0.01）.There was no significant difference in the incidences of premature rupture of membrane,premature birth,neonatal jaundice,neonatal asphyxia,as well as birth weight am