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目的探讨空腹血糖(FPG)筛查妊娠期糖尿病(GDM)的价值及其对妊娠结局的影响。方法回顾性分析2017例完成产前检查并分娩孕妇的临床资料。将研究对象按有无GDM分为GDM组216例和正常组1 801例,比较两组孕妇妊娠不同阶段FPG水平及妊娠结局,分析FPG诊断GDM的价值。结果 GDM组中新生儿出生体质量以及剖宫产率、巨大儿、需要胰岛素治疗及需要饮食运动控制的比例均高于正常组,差异均有统计学意义(均P<0.05);两组总的围生期并发症发生率比较,差异有统计学意义(P<0.05)。随着FPG值的升高,糖耐量试验(OGTT)阳性率明显升高,筛查GDM的灵敏度逐渐降低,特异度逐渐升高。当FPG<4.4 mmol/L时,如暂不行75 g OGTT,将导致有一部分孕妇漏诊。结论 GDM的不良妊娠结局与血糖水平密切相关,行FPG检查对GDM有预测意义。当FPG<4.4 mmol/L时,仍不能完全排除GDM的发生,对于高危人群应加强孕期宣教,控制体质量,必要时仍需进行OGTT试验,做到尽早发现,尽早控制,改善妊娠结局。
Objective To investigate the value of fasting plasma glucose (FPG) for screening gestational diabetes mellitus (GDM) and its effect on pregnancy outcome. Methods Retrospective analysis of 2017 cases of prenatal examination and delivery of pregnant women clinical data. The subjects were divided into GDM group with or without GDM 216 cases and normal group 1 801 cases. The FPG level and pregnancy outcome in different stages of pregnancy were compared between two groups, and the value of FPG in diagnosis of GDM was analyzed. Results Neonatal birth weight, cesarean section rate, macrosomia, need of insulin treatment and diet control in GDM group were higher than those in normal group (all P <0.05) The incidence of perinatal complications, the difference was statistically significant (P <0.05). With the increase of FPG value, the positive rate of glucose tolerance test (OGTT) increased significantly, the sensitivity of screening GDM gradually decreased, and the specificity increased gradually. When FPG is less than 4.4 mmol / L, if 75 g of OGTT is not administered temporarily, some pregnant women will miss a diagnosis. Conclusion The adverse pregnancy outcome of GDM is closely related to the blood glucose level. The FPG examination has a predictive value for GDM. When FPG is less than 4.4 mmol / L, the occurrence of GDM can not be completely ruled out. For pregnant women who are at high risk, missionary education and body mass control should be strengthened. OGTT tests should be conducted if necessary. Early detection and early pregnancy control are needed to improve pregnancy outcomes.