上海交通大学学报（医学版）

›› 2013, Vol. 33 ›› Issue (4): 471-.doi: 10.3969/j.issn.1674-8115.2013.04.019

• 论著（临床研究） • 上一篇    下一篇

妊娠6～24周空腹血糖预测妊娠期糖尿病的意义

车荣华, 黄亚绢   

  1. 上海交通大学附属第六人民医院妇产科, 上海 200233
  • 出版日期:2013-04-28 发布日期:2013-05-03
  • 通讯作者: 黄亚绢, 电子信箱: huang_yajuan@hotmail.com。
  • 作者简介:车荣华（1973—）, 女, 副主任医师, 硕士生, 现在上海市闵行区中心医院妇产科工作； 电子信箱: lkcrh70@126.com。

Significance of fasting plasma glucose screening at gestational 6-24 weeks for gestational diabetes mellitus

CHE Rong-hua, HUANG Ya-juan   

  1. Department of Obstetrics and Gynecology, the Sixth People´s Hospital, Shanghai Jiaotong University, Shanghai 200233, China
  • Online:2013-04-28 Published:2013-05-03

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摘要：

目的 探讨妊娠6～24周空腹血糖（FPG）筛查妊娠期糖尿病（GDM）的价值及对母儿妊娠结局的影响。方法 对完成产前检查并分娩的2 200例孕妇的临床资料进行回顾性分析。将研究对象分为GDM组和正常组，比较两组妊娠结局及妊娠不同阶段FPG水平，采用受试者工作特征（ROC）曲线分析FPG诊断GDM的价值，采用多因素Logistic回归分析GDM的相关危险因素。结果 GDM组新生儿出生体质量以及剖宫产、巨大儿、需要饮食运动控制、需要胰岛素治疗的比例均高于正常组，差异有统计学意义（P<0.05）；两组总的围生期并发症发生率比较，差异也有统计学意义（P<0.05）。GDM组孕周<24周及孕周≥24周时的FPG值均明显高于正常组（P<0.001）；GDM组FPG值在孕24周前后比较，差异无统计学意义（P>0.05）；正常组FPG值在孕24周前后比较，差异有统计学意义（P<0.05）。ROC曲线分析显示最佳的切点值在4.6 mmol/L，特异度为60.0%，灵敏度为68.4%，ROC曲线下面积为0.706 (95%CI为0.673～0.739)；且随着FPG值的升高，糖耐量试验阳性率明显升高。多因素Logistic回归分析显示FPG与GDM呈正相关（OR值为5.886，P=0.000, 95%CI为4.193～8.262）。结论 GDM 的不良妊娠结局与血糖水平密切相关，行FPG检查对GDM有预测意义；早期筛查FPG有利于对GDM进行早期干预，从而减少母儿并发症。

关键词: 妊娠期糖尿病, 空腹血糖, 妊娠结局, 筛查

Abstract:

Objective To investigate the value of fasting plasma glucose screening at gestational 6-24 weeks for gestational diabetes mellitus (GDM), and explore the influence of （FPG） on pregnancy outcomes. Methods The clinical data of 2 200 pregnant women undergoing antenatal examination and delivery were retrospectively analyzed. These women were divided into GDM group and normal group.The pregnancy outcomes and FPG levels at different gestational stages were compared between groups,the area under receiver operating characteristic (ROC) curve was used to determine the value of FPG in diagnosis of GDM, and multivariate Logistic regression analysis was employed to explore the risk factors of GDM. Results The neonatal birth weight and rates of cesarean section, macrosomia, diet and exercise therapy and insulin therapy in GDM group were significantly higher than those in normal group (P<0.05).There were also significant differences in total perinatal complications between two groups (P<0.05). The FPG levels in women at less than 24 gestational weeks and at no less than 24 gestational weeks in GDM group were significantly higher than that in normal group (P<0.001).There was no significant difference between FPG level of women at less than 24 gestational weeks and that at no less than 24 gestational weeks in GDM group （P>0.05）, while there were significant differences between FPG level of women at less than 24 gestational weeks and that at no less than 24 gestational weeks in normal group （P<0.05）. The area under ROC curve for FPG to predict GDM was 0.706 (95%CI 0.673-0.739), the optimal cutoff value was 4.6 mmol/L, and the sensitivity and specificity were 68.4% and 60.0% respectively. The positive rate of OGTT increased with FPG. Multivariate Logistic regression analysis revealed that FPG was positively related to GDM (OR 5.886, P=0.000, 95%CI 4.193-8.262). Conclusion The unfavorable pregnancy outcomes are closely related to plasma glucose level, and FPG screening for GDM has a higher predictive value. FPG screening in early pregnancy may help to treat GDM in the early stage, and decrease maternal and neonatal complications.

Key words: gestational diabetes mellitus, fasting plasma glucose, pregnancy outcome, screening