孕早期FBG、HbA1c、TC、TG联合检测在妊娠期糖尿病诊断中的应用价值分析
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摘要
目的探讨孕早期空腹血糖(FBG)、糖化血红蛋白(HbA1c)、血清总胆固醇(TC)、甘油三酯(TG)联合检测在妊娠期糖尿病(gestational diabetes mellitus,GDM)诊断中的应用价值。方法选择2016年7月—2017年8月在接受产检的GDM高危孕妇117名,根据GDM诊断标准将其分为GDM组和正常组,比较2组研究对象的糖脂代谢指标水平,同时在孕早期(怀孕12周以内)检测产妇的各糖脂代谢指标水平,并与GDM诊断结果进行对比,比较各糖脂代谢指标单独以及联合检测在GDM中的诊断价值。结果根据GDM诊断标准,结果显示117名孕妇中,有62例孕妇患GDM,另有55名孕妇经检查正常;GDM组FBG、HbA1c、TC、TG水平均明显高于对照组(均P<0.05);HbA1c检测的灵敏度、特异度、准确度、阳性预测值、阴性预测值以及Kappa值最大,分别为88.71、72.73、81.20、78.57、80.85、0.619;FBG、HbA1c、TC、TG的AUC值分别为0.868、0.885、0.681、0.688,联合检测的AUC值为0.958,联合检测的AUC值与FBG、HbA1c、TC、TG的AUC值比较,差异均有统计学意义(均P<0.05)。结论孕早期联合检测糖脂代谢指标在GDM中具有很高的诊断价值,可为临床上孕早期GDM的诊断和治疗提供参考依据。
Objective To explore the application value combined detection of fasting blood glucose(FBG), hemoglobin A1 c(HbA1 c), total cholesterol(TC) and triglyceride(TG) in diagnosis of gestational diabetes mellitus(GDM) in early pregnancy. Methods A total of 117 GDM high-risk pregnant women were selected in our hospital from July 2016 to August 2017 in the obstetrics department, and they were divided into GDM group and normal group according to GDM diagnostic criteria, the levels of glucose and lipid metabolism were compared between the two groups, at the same time, the levels of glucose and lipid metabolism were detected in early pregnancy(within 12 weeks of pregnancy), and compared with the diagnosis results of GDM, the diagnostic value of each glycolipid metabolism index alone and the combined detection in GDM were compared. Results According to the GDM diagnostic criteria, the results showed that of the 117 pregnant women, 62 were pregnant with GDM and 55 were normal; The levels of FBG, HbA1 c, TC and TG were significantly higher in the GDM group than in the control group(all P<0.05). The sensitivity, specificity, accuracy, positive predictive value, negative predictive value and Kappa value of HbA1 c detection were the highest(88.71, 72.73, 81.20, 78.57, 80.85 and 0.619, respectively). The AUC values of FBG, HbA1 c, TC and TG were 0.868, 0.885, 0.681 and 0.688, respectively, and the AUC value of the joint detection was 0.958, the AUC values of the joint detection were compared with the AUC values of FBG, HbA1 c, TC and TG, the differences were statistically significant(P<0.05). Conclusion In the early stage of pregnancy, the joint detection of glucose and lipid metabolism in GDM has high diagnostic value, which can provide a reference for the diagnosis and treatment of GDM in the early stage of pregnancy.
Objective To explore the application value combined detection of fasting blood glucose(FBG), hemoglobin A1 c(HbA1 c), total cholesterol(TC) and triglyceride(TG) in diagnosis of gestational diabetes mellitus(GDM) in early pregnancy. Methods A total of 117 GDM high-risk pregnant women were selected in our hospital from July 2016 to August 2017 in the obstetrics department, and they were divided into GDM group and normal group according to GDM diagnostic criteria, the levels of glucose and lipid metabolism were compared between the two groups, at the same time, the levels of glucose and lipid metabolism were detected in early pregnancy(within 12 weeks of pregnancy), and compared with the diagnosis results of GDM, the diagnostic value of each glycolipid metabolism index alone and the combined detection in GDM were compared. Results According to the GDM diagnostic criteria, the results showed that of the 117 pregnant women, 62 were pregnant with GDM and 55 were normal; The levels of FBG, HbA1 c, TC and TG were significantly higher in the GDM group than in the control group(all P<0.05). The sensitivity, specificity, accuracy, positive predictive value, negative predictive value and Kappa value of HbA1 c detection were the highest(88.71, 72.73, 81.20, 78.57, 80.85 and 0.619, respectively). The AUC values of FBG, HbA1 c, TC and TG were 0.868, 0.885, 0.681 and 0.688, respectively, and the AUC value of the joint detection was 0.958, the AUC values of the joint detection were compared with the AUC values of FBG, HbA1 c, TC and TG, the differences were statistically significant(P<0.05). Conclusion In the early stage of pregnancy, the joint detection of glucose and lipid metabolism in GDM has high diagnostic value, which can provide a reference for the diagnosis and treatment of GDM in the early stage of pregnancy.
引文
[1] 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.
[2] 张会芬.孕早期HbA1c检测在妊娠期糖尿病诊断中的应用价值分析[J].河南医学研究,2017,26(16):3019-3020.
[3] 吴红丽,孙健,孙冀兵,等.孕早期糖化血红蛋白水平检查在诊断妊娠期糖尿病中的效果评价[J].中国实验诊断学,2017,21(3):455-458.
[4] 余凤花,罗宋,陈妙岚,等.早孕期糖化血红蛋白检测在妊娠期糖尿病诊断中的应用[J].中国实验诊断学,2015,19(6):921-923.
[5] 朱丹婴,姜缨.妊娠早期糖脂代谢指标检测预测妊娠期糖尿病发病及母婴结局的价值[J].中国妇幼保健,2018,33(2):310-312.
[6] 李畅,史琳涛,李广琦,等.WHO与IADPSG诊断标准关于妊娠期糖尿病诊断率的比较[J].中国糖尿病杂志,2014,22(5):385-388.
[7] 焦丽娜,田序华,王静.糖化血红蛋白水平与妊娠期糖尿病患者不良妊娠结局的相关性分析[J].安徽医学,2016,37(11):1344-1347.
[8] 黄慧珍,张雪芹,刘兴会.妊娠期糖尿病对孕妇妊娠结局和新生儿的影响[J].北京医学,2016,38(1):43-45.
[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重、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] 潘宝龙,马润玫.血清脂肪因子omentin-1、chemerin的水平与妊娠期糖尿病的相关性[J].南方医科大学学报,2016,36(9):1231-1236.
[11] 肖艳,丛培红.妊娠期糖尿病孕妇外周血血红素氧合酶-1、脂代谢水平变化及临床意义[J].中国妇幼保健,2017,32(19):4628-4630.
[12] 杜习羽,董玉楠,肖立,等.视黄醇结合蛋白4在妊娠期糖尿病孕妇不同孕周中的表达及其与糖代谢指标的相关性[J].实用妇产科杂志,2016,32(10):747-751.
[13] 张惠,张眉花.糖化血红蛋白联合空腹血糖检测在妊娠糖尿病筛查中的应用价值[J].实用医技杂志,2016,23(7):732-733.
[14] 周晔,沈国松.糖化血红蛋白在孕早期妊娠糖尿病筛查中的应用[J].浙江预防医学,2014,26(2):186-187,202.
[15] 朱立平.糖尿病患者糖化血红蛋白与空腹血糖的相关性研究[J].中国现代药物应用,2017,11(23):51-52.
[16] 邱先桃,丘媛媛,高飞,等.妊娠期糖尿病患者孕晚期血清TC、TG、HDL-C、LDL-C与产后糖耐量异常的相关性分析[J].热带医学杂志,2015,15(4):517-520.
[17] 刘丹,王玥,李润,等.孕早期血脂对妊娠期糖尿病影响的前瞻性研究[J].四川大学学报(医学版),2016,47(1):64-67,72.
[18] 彭笑菊,戴楠,汪之顼,等.孕妇不同孕期血脂指标分布和变化的观察性研究[J].南京医科大学学报(自然科学版),2016,36(7):840-845.
[19] 綦小蓉,余海燕.糖化血红蛋白在围生期的运用[J].实用妇产科杂志,2014,30(7):502-505.
[20] 关莉.糖化血红蛋白与糖耐量联合检测在妊娠期糖尿病诊断中的价值[J].标记免疫分析与临床,2014,21(3):355-356.
[2] 张会芬.孕早期HbA1c检测在妊娠期糖尿病诊断中的应用价值分析[J].河南医学研究,2017,26(16):3019-3020.
[3] 吴红丽,孙健,孙冀兵,等.孕早期糖化血红蛋白水平检查在诊断妊娠期糖尿病中的效果评价[J].中国实验诊断学,2017,21(3):455-458.
[4] 余凤花,罗宋,陈妙岚,等.早孕期糖化血红蛋白检测在妊娠期糖尿病诊断中的应用[J].中国实验诊断学,2015,19(6):921-923.
[5] 朱丹婴,姜缨.妊娠早期糖脂代谢指标检测预测妊娠期糖尿病发病及母婴结局的价值[J].中国妇幼保健,2018,33(2):310-312.
[6] 李畅,史琳涛,李广琦,等.WHO与IADPSG诊断标准关于妊娠期糖尿病诊断率的比较[J].中国糖尿病杂志,2014,22(5):385-388.
[7] 焦丽娜,田序华,王静.糖化血红蛋白水平与妊娠期糖尿病患者不良妊娠结局的相关性分析[J].安徽医学,2016,37(11):1344-1347.
[8] 黄慧珍,张雪芹,刘兴会.妊娠期糖尿病对孕妇妊娠结局和新生儿的影响[J].北京医学,2016,38(1):43-45.
[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重、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] 潘宝龙,马润玫.血清脂肪因子omentin-1、chemerin的水平与妊娠期糖尿病的相关性[J].南方医科大学学报,2016,36(9):1231-1236.
[11] 肖艳,丛培红.妊娠期糖尿病孕妇外周血血红素氧合酶-1、脂代谢水平变化及临床意义[J].中国妇幼保健,2017,32(19):4628-4630.
[12] 杜习羽,董玉楠,肖立,等.视黄醇结合蛋白4在妊娠期糖尿病孕妇不同孕周中的表达及其与糖代谢指标的相关性[J].实用妇产科杂志,2016,32(10):747-751.
[13] 张惠,张眉花.糖化血红蛋白联合空腹血糖检测在妊娠糖尿病筛查中的应用价值[J].实用医技杂志,2016,23(7):732-733.
[14] 周晔,沈国松.糖化血红蛋白在孕早期妊娠糖尿病筛查中的应用[J].浙江预防医学,2014,26(2):186-187,202.
[15] 朱立平.糖尿病患者糖化血红蛋白与空腹血糖的相关性研究[J].中国现代药物应用,2017,11(23):51-52.
[16] 邱先桃,丘媛媛,高飞,等.妊娠期糖尿病患者孕晚期血清TC、TG、HDL-C、LDL-C与产后糖耐量异常的相关性分析[J].热带医学杂志,2015,15(4):517-520.
[17] 刘丹,王玥,李润,等.孕早期血脂对妊娠期糖尿病影响的前瞻性研究[J].四川大学学报(医学版),2016,47(1):64-67,72.
[18] 彭笑菊,戴楠,汪之顼,等.孕妇不同孕期血脂指标分布和变化的观察性研究[J].南京医科大学学报(自然科学版),2016,36(7):840-845.
[19] 綦小蓉,余海燕.糖化血红蛋白在围生期的运用[J].实用妇产科杂志,2014,30(7):502-505.
[20] 关莉.糖化血红蛋白与糖耐量联合检测在妊娠期糖尿病诊断中的价值[J].标记免疫分析与临床,2014,21(3):355-356.