妊娠早期糖化血红蛋白联合体质量指数筛查妊娠期糖尿病的临床价值
|
摘要
目的探讨妊娠早期糖化血红蛋白(HbA1c)联合体质量指数(BMI)在妊娠期糖尿病(GDM)筛查中的应用价值。方法选择西北妇女儿童医院于2017年1月至2018年6月期间收治的124例GDM患者为研究对象,选取同期健康孕妇124例作为对照组。比较两组孕妇孕早期(8～12周)时的HBA1c及BMI等临床资料,分析HBA1c及BMI对GDM的预测诊断效能。结果观察组与对照组孕妇的年龄、孕次、产次比较差异均无统计学意义(P>0.05);但是观察组患者HbA1c及BMI分别为(5.29±1.68)%、(23.29±3.39) kg/m~2,均明显高于对照组的(4.87±1.51)%、(22.35±2.17) kg/m~2,差异均有统计学意义(P<0.05);孕早期联合HbA1c为5.15%,BMI为23.35作诊断截点,对预测GDM的灵敏度为73.0%,特异度为83.1%。结论 GDM患者孕早期就出现BMI和HbAlc明显升高,可能与GDM的发生有关;在孕早期联合筛查BMI、HbA1c对早期识别GDM有较大的临床应用价值。
Objective To explore the application value of combined detection of glycosylated hemoglobin(HbA1c) and body mass index(BMI) in screening for gestational diabetes mellitus(GDM). Methods From January 2017 to June 2018, 124 GDM patients admitted to Northwest Women and Children's Hospital were selected as the study subjects, and 124 healthy pregnant women in the same period were selected as the control group. The clinical data including HbA1c and BMI at the early stage of pregnancy(8～12 weeks) were compared between the two groups, and the predictive diagnostic efficacy of HbA1c and BMI on GDM was analyzed. Results There were no significant differences in the age, pregnancy times and delivery times between the observation group and the control group(P>0.05). The HbA1c and BMI in the observation group were respectively(5.29 ± 1.68)% and(23.29 ± 3.39) kg/m~2, which were significantly higher than corresponding(4.87±1.51)% and(22.35±2.17) kg/m~2 in the control group, and both differences were statistically significant(P<0.05). In the early pregnancy, combined detection of HbA1c(5.15%) and BMI(23.35) as the diagnostic cut-off point, the sensitivity to predict GDM was 73.0%, and the specificity was 83.1%. Conclusion GDM patients have a significant increase in BMI and HbAlc in early pregnancy, which may be related to the occurrence of GDM.Combined detection of BMI and HbA1c in early pregnancy has great clinical value for early identification of GDM.
Objective To explore the application value of combined detection of glycosylated hemoglobin(HbA1c) and body mass index(BMI) in screening for gestational diabetes mellitus(GDM). Methods From January 2017 to June 2018, 124 GDM patients admitted to Northwest Women and Children's Hospital were selected as the study subjects, and 124 healthy pregnant women in the same period were selected as the control group. The clinical data including HbA1c and BMI at the early stage of pregnancy(8～12 weeks) were compared between the two groups, and the predictive diagnostic efficacy of HbA1c and BMI on GDM was analyzed. Results There were no significant differences in the age, pregnancy times and delivery times between the observation group and the control group(P>0.05). The HbA1c and BMI in the observation group were respectively(5.29 ± 1.68)% and(23.29 ± 3.39) kg/m~2, which were significantly higher than corresponding(4.87±1.51)% and(22.35±2.17) kg/m~2 in the control group, and both differences were statistically significant(P<0.05). In the early pregnancy, combined detection of HbA1c(5.15%) and BMI(23.35) as the diagnostic cut-off point, the sensitivity to predict GDM was 73.0%, and the specificity was 83.1%. Conclusion GDM patients have a significant increase in BMI and HbAlc in early pregnancy, which may be related to the occurrence of GDM.Combined detection of BMI and HbA1c in early pregnancy has great clinical value for early identification of GDM.
引文
[1]宋晓平,张艳梅.妊娠期糖尿病对母婴结局影响分析[J].中国妇幼保健, 2013, 28(5):767-769.
[2] FEIG DS, ZINMAN B, WANG X, et al. Risk of development of diabetes mellitus after diagnosis of gestational diabetes[J]. CMAJ,2008, 179(3):229-234.
[3]俞恒.孕妇外周血糖化血红蛋白检测在妊娠期糖尿病诊断中的价值探讨[J].中国实验诊断学, 2016, 20(4):586-588.
[4]张映平,赖玉芳.妊娠期糖尿病高危孕妇早期治疗临床研究[J].海南医学, 2016, 27(14):2307-2309.
[5]杨慧霞.重视妊娠期糖尿病国际新标准的临床应用[J].国际妇产科学杂志, 2011, 38(3):172-173, 177.
[6]李利平,姜宏卫,陈治珉,等.国际糖尿病妊娠研究组新诊断标准调查妊娠期糖尿病患病率及其危险因素分析[J].中国糖尿病杂志,2015, 23(4):289-292.
[7]范岩峰,蔡李倩,黄秋云,等.妊娠期糖尿病危险因素的病例对照研究[J].中华围产医学杂志, 2014, 17(8):531-533.
[8]姚宝林,程海东.妊娠期糖尿病的病因及发病机制[J].现代妇产科进展, 2014, 23(1):73-75.
[9]余凡,廖海明,殷文静,等.妊娠期糖尿病患者血糖波动与新生儿出生体质量、母体及新生儿不良妊娠结局的相关性研究[J].中华妇幼临床医学杂志(电子版), 2016, 12(3):305-311.
[10]马静,郎廷元.妊娠期糖尿病的筛查与诊疗进展[J].现代医药卫生,2018, 34(15):2336-2339.
[11] ZHANG C, NING Y. Effect of dietary and lifesytle factors on the risk of gestational diabetes:review of epidemiologic evidence[J].Am J Clin Nutr, 2011, 94(6):1975-1979.
[12]韩颖文.妊娠期糖尿病与糖耐量异常的早期行为干预对妊娠结局的临床探讨[J].中国实验诊断学, 2014, 18(7):1148-1150.
[13]王敏.早期筛查及干预对妊娠期糖尿病患者母婴结局的影响[J].中国妇幼保健, 2015, 30(1):47-49.
[14]陆胜,季雄娟,郑慧慧.糖化血红蛋白对妊娠期糖尿病筛查及年龄依赖性发病率的价值探讨[J].检验医学与临床, 2016, 13(9):1214-1215, 1219.
[15]王菲,王来梅.妊娠糖尿病患者糖化血红蛋白与新生儿低血糖发病风险的关系[J].中国全科医学, 2015, 18(8):954-956.
[16] SOMMER C, M?RKRID K, JENUM AK, et al. Weight gain, total fat gain and regional fat gain during pregnancy and the association with gestational diabetes:a population-based cohort study[J]. Int J Obes(Lond), 2014, 38(1):76-81.
[17]李晓红,彭艳,张靖域,等.孕前体质量对妊娠期糖尿病患者妊娠结局的影响[J].海南医学, 2016, 27(19):3179-3181.
[18]刘秀敏,周俊杰,尹静.孕期体质量增加与妊娠期糖尿病关系探讨[J].武警医学, 2014, 25(3):300-302.
[2] FEIG DS, ZINMAN B, WANG X, et al. Risk of development of diabetes mellitus after diagnosis of gestational diabetes[J]. CMAJ,2008, 179(3):229-234.
[3]俞恒.孕妇外周血糖化血红蛋白检测在妊娠期糖尿病诊断中的价值探讨[J].中国实验诊断学, 2016, 20(4):586-588.
[4]张映平,赖玉芳.妊娠期糖尿病高危孕妇早期治疗临床研究[J].海南医学, 2016, 27(14):2307-2309.
[5]杨慧霞.重视妊娠期糖尿病国际新标准的临床应用[J].国际妇产科学杂志, 2011, 38(3):172-173, 177.
[6]李利平,姜宏卫,陈治珉,等.国际糖尿病妊娠研究组新诊断标准调查妊娠期糖尿病患病率及其危险因素分析[J].中国糖尿病杂志,2015, 23(4):289-292.
[7]范岩峰,蔡李倩,黄秋云,等.妊娠期糖尿病危险因素的病例对照研究[J].中华围产医学杂志, 2014, 17(8):531-533.
[8]姚宝林,程海东.妊娠期糖尿病的病因及发病机制[J].现代妇产科进展, 2014, 23(1):73-75.
[9]余凡,廖海明,殷文静,等.妊娠期糖尿病患者血糖波动与新生儿出生体质量、母体及新生儿不良妊娠结局的相关性研究[J].中华妇幼临床医学杂志(电子版), 2016, 12(3):305-311.
[10]马静,郎廷元.妊娠期糖尿病的筛查与诊疗进展[J].现代医药卫生,2018, 34(15):2336-2339.
[11] ZHANG C, NING Y. Effect of dietary and lifesytle factors on the risk of gestational diabetes:review of epidemiologic evidence[J].Am J Clin Nutr, 2011, 94(6):1975-1979.
[12]韩颖文.妊娠期糖尿病与糖耐量异常的早期行为干预对妊娠结局的临床探讨[J].中国实验诊断学, 2014, 18(7):1148-1150.
[13]王敏.早期筛查及干预对妊娠期糖尿病患者母婴结局的影响[J].中国妇幼保健, 2015, 30(1):47-49.
[14]陆胜,季雄娟,郑慧慧.糖化血红蛋白对妊娠期糖尿病筛查及年龄依赖性发病率的价值探讨[J].检验医学与临床, 2016, 13(9):1214-1215, 1219.
[15]王菲,王来梅.妊娠糖尿病患者糖化血红蛋白与新生儿低血糖发病风险的关系[J].中国全科医学, 2015, 18(8):954-956.
[16] SOMMER C, M?RKRID K, JENUM AK, et al. Weight gain, total fat gain and regional fat gain during pregnancy and the association with gestational diabetes:a population-based cohort study[J]. Int J Obes(Lond), 2014, 38(1):76-81.
[17]李晓红,彭艳,张靖域,等.孕前体质量对妊娠期糖尿病患者妊娠结局的影响[J].海南医学, 2016, 27(19):3179-3181.
[18]刘秀敏,周俊杰,尹静.孕期体质量增加与妊娠期糖尿病关系探讨[J].武警医学, 2014, 25(3):300-302.