摘要
目的:探究糖化血红蛋白(HbA1c)预测妊娠期糖尿病(GDM)患者妊娠结局价值。方法:回顾性分析130例GDM患者临床资料为观察组,根据其妊娠36周检出HbA1c水平分为低浓度组(<6%,45例)、中浓度组(6%~7%,49例)、高浓度组(>7%,36例),另选取同期本院行产前检查的216例健康孕妇纳入对照组。比较妊娠20周时各组HbA1c、空腹血糖(FPG)、餐后2h血糖(2h PG)水平,及早期预测GDM效能;比较妊娠36周时观察组HbA1c水平与妊娠结局关系。结果:妊娠20周时,观察组HbA1c、FPG、2h PG水平均高于对照组,HbA1c AUC大于FPG及2h PG(P<0.05),HbA1c、FPG、2h PG水平预测GDM的临界值分别为5.08%、4.46mmol/L、8.54mmol/L。观察组GDM中HbA1c高浓度组发生妊娠期高血压、羊水过多、巨大儿、胎儿宫内窘迫比例高于低浓度组(均P<0.05),而剖宫产率比较无差异(P>0.05)。Spearman相关性分析,GDM患者妊娠36周时HbA1c水平与妊娠期高血压、羊水过多、巨大儿、胎儿宫内窘迫发生率均为正相关性(均r>0,P<0.05),而与剖宫产率无相关性(P>0.05)。结论:妊娠20周检测HbA1c可实现GDM早期风险筛查,而妊娠36周检测HbA1c能一定程度预测妊娠结局,两个时期均能更稳定且准确反映孕妇受检时血糖状态,为产科临床尽早干预提供可靠参考依据。
Objective:To explore the clinical application value of glycosylated hemoglobin(HbA1c)for predicting occurance of gestational diabetes mellitus(GDM)and pregnancy outcomes of pregnant women.Methods:The clinical data of 130 women with GDM in observation group were retrospectively analyzed.According to the level of HbA1c of women in 36 gestational weeks,the women in the observation group were divided in group A(45 women with HbA1c level less than<6%),group B(49 women with HbA1c level in 6%-7%),and group C(36 women with HbA1c level more than<7%),and another 216 healthy pregnant women were included in group D during the same time.The levels of HbA1c,fasting plasma glucose(FPG)and postprandial 2h glucocortico(2h PG)of women in 20 gestational weeks were compared between the two groups.The receiver operating characteristic curve(ROC)was used to analyze the efficacy for early predictng GDM occurrence of women.The relationship between HbA1c level of women in 36 gestational weeks and their pregnancy outcomes was analyzed.Results:In 20 gestational weeks,the levels of HbA1c,FPG and 2h PG of women in observation group were significant higher than those of women in group D(P<0.05).In the observation group,the AUC of HbA1c level of women in observation group was significant more than that of levels of FPG and 2h PG.The critical points of levels of HbA1c,FPG and 2h PG levels for predicting GDM occuanced in 20 gestational weeks were 5.08%,4.46mmol/L,and 8.54mmol/L,respectively.The incidences of gestational hypertension,polyhydramnios,macrosomia and fetal intrauterine distress of women in group A were significant higher than those of women in group C(P<0.05),but there was no significant different in the cesarean section rate of women between group A and C(P>0.05).Spearman correlation analysis showed that the HbA1c level of women with GDM in 36 gestational weeks was positively correlated with the incidences of gestational hypertension,polyhydramnios,macrosomia and fetal intrauterine distress ( r>0, P <0.05), but was no correlated with the cesarean section rate ( P >0.05). Conclusion: The level of HbA1c of pregnant women in 20 gestational weeks can effectively predict the risk of GDM occurance, and the level of HbA1c of pregnant women in 36 gestational weeks can predict pregnancy outcomes. The levels of HbA1c of women in both 20 and 36 gestational weeks can reflect the blood glucose status of pregnant women, which can to provide reliable evidence for early clinical intervention.
作者
柯晓琼
夏小文
张祖艳
钱超
KE Xiaoqiong;XIA Xiaowen;ZHANG Zuyan;QIAN Chao(Yangxin Maternal and Child Health Care Hospital,Hubei Province,435200)
出处
《中国计划生育学杂志》
2020年第2期277-279,283,共4页
Chinese Journal of Family Planning
关键词
妊娠期糖尿病
糖化血红蛋白
早期筛查
妊娠结局
预测价值
Gestational diabetes mellitus
Glycosylated hemoglobin
Screening early
Pregnancy outcomes
Predicting value
