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目的探讨检测血清糖化血红蛋白(HbA1c)及D-二聚体(D-Dimer)水平对预测妊娠期糖尿病患者发生胎儿生长受限(FGR)的意义。方法选取2013—2015年唐山市妇幼保健院191例确诊为妊娠期糖尿病(GDM)患者,均于孕28~30周及分娩前1~3d采血,采用免疫比浊法监测血清HbA1c及DDimer数值。其中发生FGR者14例记为FGR组,发生巨大儿者79例记为巨大儿组,新生儿出生体重正常者98例记为正常体重组。结果 FGR组HbA1c、D-Dimer孕28~30周为(6.71±0.63)%、(508.36±72.53)ng/ml,分娩前1~3d为(6.765±0.54)%、(579.29±80.33)ng/ml;巨大儿组HbA1c、D-Dimer孕28~30周为(6.07±0.69)%、(406.32±54.07)ng/ml,分娩前1~3d为(6.04±0.72)%、(416.32±45.12)ng/ml;正常体重组HbA1c、D-Dimer孕28~30周为(5.01±0.68)%、(377.22±61.15)ng/ml,分娩前1~3d为(5.12±0.70)%、(382.78±61.70)ng/ml。分别组间比较孕28~30周及分娩前1~3d三组HbA1c、D-Dimer水平。FGR组分别与巨大儿组及正常体重组孕28~30周、分娩前1~3d测得HbA1c、D-Dimer水平相比较,差异均有统计学意义(P<0.05);巨大儿组与正常体重组孕28~30周及分娩前1~3d测得HbA1c水平比较,差异均有统计学意义(P<0.05),D-Dimer水平比较,差异均无统计学意义(P>0.05);FGR组内比较,孕28~30周与分娩前1~3d测得HbA1c水平比较,差异无统计学意义(P>0.05);D-Dimer水平比较,差异有统计学意义(P<0.05),且分娩前1~3d数值较孕28~30周呈明显升高趋势。结论检测GDM患者孕28~30周HbA1c、D-Dimer水平的变化可以作为预测患者出现FGR的早期指标。
Objective To investigate the significance of detecting serum HbA1c and D-Dimer in predicting fetal growth restriction (FGR) in gestational diabetes mellitus. Methods Totally 191 pregnant women diagnosed with gestational diabetes mellitus (GDM) in Tangshan MCH from 2013 to 2015 were enrolled in this study. Blood samples were collected from 28 to 30 weeks of gestation and from 1 to 3 days before delivery. The serum HbA1c and DDimer levels were measured by immunoturbidimetry. Among them, 14 cases with FGR were recorded as FGR group, 79 cases with huge children were recorded as giant children group, and 98 cases with normal birth weight were recorded as normal weight group. Results The levels of HbA1c and D-Dimer in FGR group were (6.71 ± 0.63)% and (508.36 ± 72.53) ng / ml at 28-30 weeks and 6.79 ± 0.95 ± 0.54 and 579.29 ± 80.33 ng / ml in the macrosomia group and (6.07 ± 0.69)% and (406.32 ± 54.07) ng / ml in the macrosomia group between 28 and 30 weeks after the first trimester, and (6.04 ± 0.72)% and (416.32 ± 45.12) (5.01 ± 0.68)%, (377.22 ± 61.15) ng / ml in the normal weight group and (5.12 ± 0.70)%, 382.78 ± 61.70) ng / ml. The levels of HbA1c and D-Dimer in three groups were compared between 28 and 30 weeks before pregnancy and 1 to 3 days before labor. The levels of HbA1c and D-Dimer in FGR group were significantly different from those in macrosomia group and normal weight group at 28-30 weeks’ gestation and 1 ~ 3 days before delivery, there was significant difference between the two groups (P <0.05) HbA1c levels were measured at 28-30 weeks of gestational age and at 1-3 days before labor, the differences were statistically significant (P <0.05), D-Dimer levels were not statistically significant (P> 0.05); FGR There were no significant differences in HbA1c levels between the 28th and 30th weeks of gestation and the 1st to 3rd days before delivery (P> 0.05). There was a significant difference between the two groups (P <0.05) 1 ~ 3d before delivery more pregnancy than 28 to 30 weeks was significantly increased. Conclusions The changes of HbA1c and D-Dimer levels in 28-30 weeks of gestation in GDM patients can be used as early predictors of FGR in patients.