妊娠早期空腹血糖、体质量指数与血红蛋白联合检测对妊娠糖尿病的预测价值
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摘要
目的探讨妊娠早期空腹血糖(FPG)、体质量指数(BMI)及血红蛋白(HGB)联合检测对妊娠糖尿病(GDM的预测价值。方法采用巢式病例对照研究方法,选取2015年1月至2017年6月于遵义医学院附属医院首次产检的759例孕妇作为观察队列,收集一般临床信息及检验指标,随访至妊娠24～28周行葡萄糖耐量试验(OGTT)试验,随访过程中,排除失访者62例,据2011年美国糖尿病协会(ADA)标准,筛选出妊娠糖尿病孕妇107例为GDM组,同时筛选出年龄与之匹配的糖耐量正常孕妇590例为NC组。采用t检验、χ2检验、ROC曲线等统计方法对数据进行处理。结果 (1) GDM组孕妇的FPG、BMI和HGB分别与NC组比较明显增高[(4.83±0.40) mmol/L vs (4.45±0.32) mmol/L,(23.42±2.86) kg/m2vs (21.2±2.69) kg/m2,(128.23±7.08) g/L vs (120.73±6.91) g/L],差异均有统计学意义(P<0.05);(2)采用ROC曲线得到FPG用于预测GDM的曲线下面积(AUC)为0.776,95%CI 0.743～0.806,P=0.000;BMI的AUC为0.719,95%CI 0.684～0.752,P=0.000;HGB的AUC为0.779,95%CI 0.746～0.809,P=0.000,取各自的最大约登指数所对应的诊断截断值分别为BMI>22.46,FPG>4.59 mmol/L,HGB>123.19 g/L。以三者联合作为筛查方法,预测GDM的AUC为0.871,95%CI 0.844～0.895,P=0.000,其诊断灵敏度为80.37%,特异度为79.66%。结论早期使用FPG、BMI和HGB联合检测能够提高筛查GDM的特异度及敏感度,对GDM发生具有一定的预测价值。
Objective To explore the predictive value of fasting glucose(FPG), body mass index(BMI), and hemoglobin(HGB) in early pregnancy for gestational diabetes mellitus(GDM). Methods A nested case-control study method was used to select 759 pregnant women who underwent the first prenatal examination in the Affiliated Hospital of Zunyi Medical College from January 2015 to June 2017 as the observation cohort. General clinical information and test indicators were collected, and oral glucose tolerance test(OGTT) was conducted at 24 to 28 weeks of gestation. During the follow-up, 62 cases were excluded. According to the 2011 American diabetes association(ADA) standard, 107 pregnant women with gestational diabetes were selected as GDM group, and 590 pregnant women with normal glucose tolerance matched by age were selected as NC group. The data were processed by student's t-test, Chi-square test, ROC curve. Results(1) FPG, BMI, and HGB of pregnant women in GDM group were significantly higher than those in NC group(P<0.05):(4.83±0.40) mmol/L vs(4.45±0.32) mmol/L,(23.42±2.86) kg/m2 vs(21.2±2.69) kg/m2,(128.23±7.08) g/L vs(120.73 ± 6.91) g/L.(2) The area under the curve(AUC) of FPG for predicting GDM was 0.776, with 95% CI0.743-0.806, P=0.000; the AUC of BMI was 0.719, with 95%CI 0.684-0.752, P=0.000; the AUC of HGB was 0.779,with 95%CI 0.746-0.809, P=0.000. The diagnostic cutoff values corresponding to the respective approximate densities were BMI>22.46, FPG>4.59 mmol/L, and HGB>123.19 g/L, respectively. Using the combination of the three as the screening method, the AUC for predicting GDM was 0.871, with 95%CI 0.844-0.895, P=0.000. The diagnostic sensitivity and specificity were 80.37% and 79.66%. Conclusion Combined detection of FPG, BMI and HGB in early pregnancy can improve the specificity and sensitivity for screening GDM, which has certain predictive significance for the occurrence of GDM.
Objective To explore the predictive value of fasting glucose(FPG), body mass index(BMI), and hemoglobin(HGB) in early pregnancy for gestational diabetes mellitus(GDM). Methods A nested case-control study method was used to select 759 pregnant women who underwent the first prenatal examination in the Affiliated Hospital of Zunyi Medical College from January 2015 to June 2017 as the observation cohort. General clinical information and test indicators were collected, and oral glucose tolerance test(OGTT) was conducted at 24 to 28 weeks of gestation. During the follow-up, 62 cases were excluded. According to the 2011 American diabetes association(ADA) standard, 107 pregnant women with gestational diabetes were selected as GDM group, and 590 pregnant women with normal glucose tolerance matched by age were selected as NC group. The data were processed by student's t-test, Chi-square test, ROC curve. Results(1) FPG, BMI, and HGB of pregnant women in GDM group were significantly higher than those in NC group(P<0.05):(4.83±0.40) mmol/L vs(4.45±0.32) mmol/L,(23.42±2.86) kg/m2 vs(21.2±2.69) kg/m2,(128.23±7.08) g/L vs(120.73 ± 6.91) g/L.(2) The area under the curve(AUC) of FPG for predicting GDM was 0.776, with 95% CI0.743-0.806, P=0.000; the AUC of BMI was 0.719, with 95%CI 0.684-0.752, P=0.000; the AUC of HGB was 0.779,with 95%CI 0.746-0.809, P=0.000. The diagnostic cutoff values corresponding to the respective approximate densities were BMI>22.46, FPG>4.59 mmol/L, and HGB>123.19 g/L, respectively. Using the combination of the three as the screening method, the AUC for predicting GDM was 0.871, with 95%CI 0.844-0.895, P=0.000. The diagnostic sensitivity and specificity were 80.37% and 79.66%. Conclusion Combined detection of FPG, BMI and HGB in early pregnancy can improve the specificity and sensitivity for screening GDM, which has certain predictive significance for the occurrence of GDM.
引文
[1]王晨,杨慧霞.早孕期空腹血糖对妊娠糖尿病的预测价值[J].中国糖尿病杂志, 2016, 8(7):405-409.
[2]冯艳,宋新娜,徐晓萌,等.孕期部分应激激素改变与妊娠糖尿病致病关系探讨[J].中华糖尿病杂志, 2016, 8(2):93-96.
[3]苏日娜,杨慧霞.妊娠合并糖尿病患者血糖管理新进展[J].中华糖尿病杂志, 2015, 7(11):718-720.
[4] CHAN JC, ZHANG Y, NING G. Diabetes in China:a societal solution for a personal challenge[J]. Lancet Diabetes Endocrinol, 2014, 2(12):969-979.
[5] MENKE A, CASAGRANDE S, GEISS L, et al. Prevalence of and trends in diabetes among adults in the United States, 1988-2012[J].JAMA, 2015, 314(10):1021-1029.
[6] GONZALES GF, STEENLAND K, TAPIA V. Maternal hemoglobin level and fetal outcome at low and high altitudes[J]. Am J Physiol Regul Integr Comp Physiol, 2009, 297(5):R1477.
[7] International Association of Diabetes and Pregancy Study Groups Consensus Panel. International association of diabetes and pregnancy study groups recommendations on the diagnosis and classification of hyperglycemia in pregnancy[J]. Diabetes Care, 2010, 33(3):676-682.
[8] American Diabetes Association. Standards of medical care in diabetes-2013[J]. Diabetes Care, 2012, 36(suppl 1):S11-S66.
[9] ZHANG F, DONG L, ZHANG CP, et al. Increasing prevalence of gestational diabetes mellitus in Chinese women from 1999 to 2008[J]. Diabet Med, 2011, 28(6):652-657.
[10] RISKINMASHIAH S, YOUNES G, DAMTI A, et al. First-trimester fasting hyperglycemia and adverse pregnancy outcomes[J]. Diabetes Care, 2009, 199(6):1639-1643.
[11] SWEETING AN, ROSS GP, HYETT J, et al. Gestational diabetes mellitus in early pregnancy:evidence for poor pregnancy outcomes despite treatment[J]. Diabetes Care, 2016, 39(1):75.
[12] KOUHKAN A, KHAMSEH ME, MOINI A, et al. Diagnostic accuracy of body mass index and fasting glucose for the prediction of gestational diabetes mellitus after assisted reproductive technology[J]. Int J Fertil Steril, 2019, 13(1):32-37.
[13] NISHIKAWA E, OAKLEY L, SEED PT, et al. Maternal BMI and diabetes in pregnancy:Investigating variations between ethnic groups using routine maternity data from London, UK[J]. PLo S One, 2017,12(6):e0179332.
[14] BLACK MH, SACKS DA, LAWRENCE JM, et al. The relative contribution of prepregnancy overweight and obesity, gestational weight gain, and IADPSG-defined gestational diabetes mellitus to fetal overgrowth[J]. Diabetes Care, 2013, 36(1):56-62.
[15] WEERAKIET S, LERTNARKORN K, PANBURANA P, et al. Can adiponectin predict gestational diabetes?[J]. Gynecological Endocrinology, 2006, 22(7):362-368.
[16] LAO TT, CHAN LY, TAM KF, et al. Maternal hemoglobin and risk of gestational diabetes mellitus in Chinese women[J]. Obstet Gynecol, 2002, 99(5):807-812.
[17] GONZALES GF, TAPIA V, GASCO M, et al. Association of hemoglobin values at booking with adverse maternal outcomes among Peruvian populations living at different altitudes[J]. Int J Gynaecol Obstet, 2012, 117(2):134-139.
[18] TARIM E, KILICDAG E, BAGIS T, et al. High maternalhemoglobin and ferritin values as risk factors for gestationaldiabetes[J]. Int J Gynaecol Obstet, 2004, 84(3):259-261.
[2]冯艳,宋新娜,徐晓萌,等.孕期部分应激激素改变与妊娠糖尿病致病关系探讨[J].中华糖尿病杂志, 2016, 8(2):93-96.
[3]苏日娜,杨慧霞.妊娠合并糖尿病患者血糖管理新进展[J].中华糖尿病杂志, 2015, 7(11):718-720.
[4] CHAN JC, ZHANG Y, NING G. Diabetes in China:a societal solution for a personal challenge[J]. Lancet Diabetes Endocrinol, 2014, 2(12):969-979.
[5] MENKE A, CASAGRANDE S, GEISS L, et al. Prevalence of and trends in diabetes among adults in the United States, 1988-2012[J].JAMA, 2015, 314(10):1021-1029.
[6] GONZALES GF, STEENLAND K, TAPIA V. Maternal hemoglobin level and fetal outcome at low and high altitudes[J]. Am J Physiol Regul Integr Comp Physiol, 2009, 297(5):R1477.
[7] International Association of Diabetes and Pregancy Study Groups Consensus Panel. International association of diabetes and pregnancy study groups recommendations on the diagnosis and classification of hyperglycemia in pregnancy[J]. Diabetes Care, 2010, 33(3):676-682.
[8] American Diabetes Association. Standards of medical care in diabetes-2013[J]. Diabetes Care, 2012, 36(suppl 1):S11-S66.
[9] ZHANG F, DONG L, ZHANG CP, et al. Increasing prevalence of gestational diabetes mellitus in Chinese women from 1999 to 2008[J]. Diabet Med, 2011, 28(6):652-657.
[10] RISKINMASHIAH S, YOUNES G, DAMTI A, et al. First-trimester fasting hyperglycemia and adverse pregnancy outcomes[J]. Diabetes Care, 2009, 199(6):1639-1643.
[11] SWEETING AN, ROSS GP, HYETT J, et al. Gestational diabetes mellitus in early pregnancy:evidence for poor pregnancy outcomes despite treatment[J]. Diabetes Care, 2016, 39(1):75.
[12] KOUHKAN A, KHAMSEH ME, MOINI A, et al. Diagnostic accuracy of body mass index and fasting glucose for the prediction of gestational diabetes mellitus after assisted reproductive technology[J]. Int J Fertil Steril, 2019, 13(1):32-37.
[13] NISHIKAWA E, OAKLEY L, SEED PT, et al. Maternal BMI and diabetes in pregnancy:Investigating variations between ethnic groups using routine maternity data from London, UK[J]. PLo S One, 2017,12(6):e0179332.
[14] BLACK MH, SACKS DA, LAWRENCE JM, et al. The relative contribution of prepregnancy overweight and obesity, gestational weight gain, and IADPSG-defined gestational diabetes mellitus to fetal overgrowth[J]. Diabetes Care, 2013, 36(1):56-62.
[15] WEERAKIET S, LERTNARKORN K, PANBURANA P, et al. Can adiponectin predict gestational diabetes?[J]. Gynecological Endocrinology, 2006, 22(7):362-368.
[16] LAO TT, CHAN LY, TAM KF, et al. Maternal hemoglobin and risk of gestational diabetes mellitus in Chinese women[J]. Obstet Gynecol, 2002, 99(5):807-812.
[17] GONZALES GF, TAPIA V, GASCO M, et al. Association of hemoglobin values at booking with adverse maternal outcomes among Peruvian populations living at different altitudes[J]. Int J Gynaecol Obstet, 2012, 117(2):134-139.
[18] TARIM E, KILICDAG E, BAGIS T, et al. High maternalhemoglobin and ferritin values as risk factors for gestationaldiabetes[J]. Int J Gynaecol Obstet, 2004, 84(3):259-261.