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目的探讨糖化血红蛋白(HbA1c)在妊娠期糖尿病(GDM)诊断中的临床意义。方法收集湖南省妇幼保健院2011年6-9月产前门诊建卡检查孕妇,以《妇产科学》诊断GDM标准,其中正常妊娠50例,产前检查诊断为GDM孕妇74例,妊娠期糖耐量受损孕妇66例。分别检测空腹血糖(FPG)、口服糖负荷试验(OGCT)和HbA1c,并比较各组孕妇三指标的阳性率和敏感度、可靠性、特异度及阳性预测值。结果与正常妊娠组相比,GDM组和糖耐量受损组的GCT及HbA1c水平均显著升高(P<0.05);与糖耐量受损组相比,GDM组的GCT及HbA1c水平同样均显著升高(P<0.05);GDM组和糖耐量受损组FPG、OGCT、HbA1c诊断阳性率大小顺序为HbA1c>OGCT>FPG;GDM筛查中HbA1c敏感性、可靠性、特异性及阳性预测值分别为93.1%、97.9%、98.2%和81.8%,均显著高于FPG、OGCT(P<0.05)。结论 HbA1c在GDM患者诊断中具有快速,阳性率、敏感性、可靠性和特异性高等特点,在临床GDM诊断中起着重要作用。
Objective To investigate the clinical significance of glycosylated hemoglobin (HbA1c) in the diagnosis of gestational diabetes mellitus (GDM). Methods Hunan Provincial Maternal and Child Health Care Hospital was collected from June to September in 2011 to check the pregnant women and to diagnose GDM with “Obstetrics and Gynecology”, including 50 normal pregnant women, 74 prenatal diagnoses as GDM pregnant women, 66 cases of impaired pregnant women. The fasting blood glucose (FPG), oral glucose load test (OGCT) and HbA1c were detected respectively. The positive rate, sensitivity, reliability, specificity and positive predictive value of three indicators in each group were compared. Results Compared with normal pregnancy group, GCT and HbA1c levels were significantly increased in GDM group and impaired glucose tolerance group (P <0.05). GCT and HbA1c levels in GDM group were also significantly higher than those in normal glucose tolerance group (P <0.05). The positive rates of FPG, OGCT and HbA1c in GDM group and impaired glucose tolerance group were HbA1c> OGCT> FPG. The sensitivity, specificity, specificity and positive predictive value of HbA1c in GDM screening 93.1%, 97.9%, 98.2% and 81.8% respectively, which were significantly higher than those of FPG and OGCT (P <0.05). Conclusion HbA1c has a fast, positive rate, sensitivity, reliability and specificity in the diagnosis of GDM. It plays an important role in the diagnosis of GDM.