妊娠中期糖化白蛋白对正常空腹血糖妊娠期糖尿病的诊断价值
摘要
目的:探讨妊娠中期糖化白蛋白(glycated albumin,GA)在空腹血糖(fasting plasma glucose,FPG)正常的妊娠期糖尿病(gestational diabetes mellitus,GDM)中的诊断价值。方法:选取2017年1月1日—6月30日在常州市妇幼保健院门诊产检的FPG<5.1 mmol/L的GDM患者186例和口服葡萄糖耐量试验(oral glucose tolerance test,OGTT)正常的孕妇171例(孕24～28周)分别作为GDM组和对照组,并依据FPG不同水平(FPG<4.4 mmol/L、4.4 mmol/L≤FPG<5.1 mmol/L)各分为2个亚组,即GDM1组(114例)、GDM2组(72例)和对照1组(91例)、对照2组(80例),比较孕妇年龄、孕前体重指数(body mass index,BMI)、体重增加值、FPG、GA以及糖化血红蛋白(HbA1c)之间的差异,ROC曲线分析血清GA预测GDM的诊断价值。结果:FPG<5.1 mmol/L时,GDM组年龄、GA及HbA1c均明显高于对照组,而对照组的体重增加值显著高于GDM组,差异有统计学意义(P <0.05);FPG<4.4 mmol/L时,GDM1组的年龄及HbA1c明显高于对照1组,差异有统计学意义(P <0.05),而两组间的GA差异无统计学意义(P>0.05);4.4 mmol/L≤FPG<5.1 mmol/L时,GDM2组的年龄、FPG、GA及HbA1c明显高于对照2组,差异有统计学意义(P <曲线下面积为0.626,P=0.045,最佳诊断界值为11.45%,预测GDM的灵敏度为77.8%、特异度为45.0%;FPG预测GDM的ROC曲线下面积为0.715,P=0.042,最佳诊断界值为4.715 mmol/L,预测GDM的灵敏度为55.6%、特异度为80.0%。结论:空腹血糖正常范围内,孕妇GA值测定对GDM具有一定的诊断价值。
引文
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[12] Hao M,Lin L. Fasting plasma glucose and body mass in-dex during the first trimester of pregnancy as predictors of gestational diabetes mellitus in a Chinese population[J].Endocr J,2017,64(5):561-569
[13]李青,包玉倩,潘洁敏,等.新诊断2型糖尿病患者糖化血清白蛋白水平与胰岛β细胞功能的关系[J].中华医学杂志,2012,92(12):814-817
[14]李青,潘洁敏,马晓静,等.糖化血红蛋白和糖化血清白蛋白联合检测在糖尿病筛查中的应用[J].中华医学杂志,2011,91(26):1813-1816
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[16]徐湘,朱晓巍,蒋艳敏,等. 2 748例住院孕妇妊娠期糖发病率及危险因素的研究[J].南京医科大学学报(自然科学版),2015,35(5):695-698
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[3]中华医学会糖尿病学分会.中国血糖监测临床应用指南[J].中华糖尿病杂志,7(10):603-613
[4] Jamilian M,Samimi M,Afshar EF,et al. Effects of seleni-um supplementation on gene expression levels of inflam-matory cytokines and vascular endothelial growth factor in patients with gestational diabetes[J]. Biol Trace Elem Res,2018,181(2):199-206
[5] Bain E,Crane M,Tieu J,et al. Diet and exercise interven-tions for preventing gestational diabetes mellitus[J]. Co-chrane Database Syst Rev,2015,4(4):CD010443
[6] Zhu WW,Fan L,Yang HX,et a1.Fasting plasma glu-cose at 24-28weeks to screen for gestational diabetes mel-litus:new evidence from China[J].Diabetes Care,2013,36:2038-2040
[7] Ozguerdinc AS,Yilmaz S,Yeral MI,et al. Prediction of gestational diabetes mellitus in the first trimester:Com-parison of C-reactive protein,fasting plasma glucose,insu-lin and insulin sensitivity indices[J]. J Matern Fetal Neo-natal Med,2014,28(16):1957-1962
[8] Eren MA,Vural M,Cece H,et al. Association of serum amyloid A with subclinical atherosclerosis in women with gestational diabetes[J]. Gynecol Endocrinol,2012,28(12):1010-1013
[9] Salmi AA,Zaki NM,Zakaria R,et al. Arterial stiffness,in-flammatory and pro-atherogenic markers in gestational di-abetes mellitus[J]. Vasa,2012,41(2):96-104
[10] Iwama N,Sugiyama T,Metoki H,et al. Maternal body mass index is a better indicator of large-for-gestational-age infants compared with a 75-goral glucose tolerance test in early pregnancy:The JAGS trial[J]. Diabetes Res Clin Pract,2017,132:10-18
[11]魏青文,颜彬,龚丽娟.糖化血红蛋白、糖化血清蛋白、C反应蛋白联合检测对早期妊娠期糖尿病的诊断价值[J].中国计划生育和妇产科,2018,10(1):54-56
[12] Hao M,Lin L. Fasting plasma glucose and body mass in-dex during the first trimester of pregnancy as predictors of gestational diabetes mellitus in a Chinese population[J].Endocr J,2017,64(5):561-569
[13]李青,包玉倩,潘洁敏,等.新诊断2型糖尿病患者糖化血清白蛋白水平与胰岛β细胞功能的关系[J].中华医学杂志,2012,92(12):814-817
[14]李青,潘洁敏,马晓静,等.糖化血红蛋白和糖化血清白蛋白联合检测在糖尿病筛查中的应用[J].中华医学杂志,2011,91(26):1813-1816
[15]马付坚,梁林慧,黄艳.糖化白蛋白筛查妊娠糖尿病的研究进展[J].检验医学与临床,2016,13(z1):316-319
[16]徐湘,朱晓巍,蒋艳敏,等. 2 748例住院孕妇妊娠期糖发病率及危险因素的研究[J].南京医科大学学报(自然科学版),2015,35(5):695-698