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目的:评价不同妊娠期糖尿病(GDM)诊断标准对妊娠结局的影响,探讨糖化血红蛋白(HbA1C)对妊娠期糖尿病是否有诊断价值。方法:对2012年2月1日—2013年1月31日在我院产检并分娩的1 000例单胎孕妇于24~28周行75 g葡萄糖耐量试验,分别测空腹、1 h、2 h和3 h的血糖及糖化血红蛋白,分别按新、旧标准进行诊断。旧标准诊断出GDM 51例,新标准诊断出GDM 201例。选择旧标准漏诊而采用新标准确诊的GDM孕妇共150例,随机分入GDM新标准组和GDM旧标准组,每组各75例,对各组妊娠结局进行比较分析。另外对新诊断标准诊断出的GDM及健康孕妇各200例的糖化血红蛋白进行相关性分析。结果:GDM新标准组与GDM旧标准组巨大儿、妊娠期高血压疾病、胎儿窘迫、羊水异常差异显著。GDM组与健康孕妇组HbAlc水平分别为(4.91±0.44)%与(4.90±0.40)%,差异不显著。以妊娠期糖尿病新标准为金标准,对HbA1c诊断GDM的行ROC曲线分析,ROC曲线下面积(95%CI)为0.631(0.558~0.704)。结论:虽然新诊断标准降低了空腹血糖的界值,增加了妊娠糖尿病的检出率,但是对GDM患者及早进行管理,可以减少妊娠期高血压、巨大儿、胎儿窘迫和羊水异常等并发症的发生。新诊断标准适合中国人群,而糖化血红蛋白不适于诊断GDM。
Objective: To evaluate the effect of different gestational diabetes mellitus (GDM) diagnostic criteria on pregnancy outcome and to investigate whether HbA1C has diagnostic value in gestational diabetes mellitus. Methods: A total of 1 000 singleton pregnant women who were examined and delivered in our hospital from February 1, 2012 to January 31, 2013 were given 75 g glucose tolerance test at 24-28 weeks. The fasting, 1 h, 2 h And 3 h of blood glucose and glycosylated hemoglobin, respectively, according to new and old standards for diagnosis. The old standard diagnosis of 51 cases of GDM, the new standard diagnosis of 201 cases of GDM. A total of 150 GDM pregnant women who were missed by the old standard and diagnosed by the new standard were randomly divided into new GDM group and old GDM group, with 75 cases in each group. The pregnancy outcomes of each group were compared. In addition, the diagnostic value of the new diagnosis of GDM and healthy pregnant women, 200 cases of glycated hemoglobin were analyzed. Results: There was a significant difference between the GDM new standard group and the GDM old standard group in macrosomia, gestational hypertension, fetal distress and amniotic fluid abnormalities. The levels of HbAlc in GDM group and healthy pregnant women were (4.91 ± 0.44)% and (4.90 ± 0.40)%, respectively, with no significant difference. With the new standard of gestational diabetes as the gold standard, ROC curve analysis of HbA1c in the diagnosis of GDM showed that the area under the ROC curve (95% CI) was 0.631 (0.558-0.704). CONCLUSIONS: Although the new diagnostic criteria lower the threshold for fasting plasma glucose and increase the detection rate of gestational diabetes, early management of GDM may reduce complications such as gestational hypertension, macrosomia, fetal distress, and amniotic fluid abnormalities occur. The new diagnostic criteria for the Chinese population, and glycated hemoglobin is not suitable for the diagnosis of GDM.