糖化血红蛋白联合体质指数用于筛查妊娠期糖尿病的临床价值

Clinical Value of Glycosylated Hemoglobin Combined with Body Mass Index in Screening of Gestational Diabetes Mellitus

目的研究糖化血红蛋白联合体质指数用于筛查妊娠期糖尿病的临床价值。方法选择2013年5月至2014年4月在北京市丰台区铁营医院妇产科进行产前保健或分娩的疑似妊娠期糖尿病患者65例作为研究对象。根据妊娠期糖尿病诊断金标准,65例孕妇分为阳性组(35例)和阴性组(30例)。分别评估两组孕妇的空腹血糖、糖化血红蛋白水平和体质指数。结果阳性组孕妇糖化血红蛋白水平显著高于阴性组[(8.71±0.42)%比(5.03±0.27)%,t=42.578,P<0.05];阳性组孕妇体质指数显著高于阴性组[(27.41±4.02)kg/m2比(22.34±3.11)kg/m2,t=5.614,P<0.05]。糖化血红蛋白诊断妊娠糖尿病的灵敏度、特异度、准确度分别为80.0%、90.0%、90.0%,与金标准的一致性较好(Kappa=0.69)。体质指数诊断妊娠期糖尿病的灵敏度、特异度和准确度分别为81.2%,72.7%和76.9%,与金标准的一致性较好(Kappa=0.54);联合检测对妊娠期糖尿病的灵敏度、特异度和准确度分别为94.3%,100.0%和96.9%,与金标准具有极好的一致性(Kappa=0.94,P<0.05)。结论糖化血红蛋白联合体质指数在妊娠期糖尿病筛查中的敏感性、特异性较高,在筛查妊娠期糖尿病方面具有较高的临床价值。

Objective To study the clinical value of glycosylated hemoglobin combined with body mass index （BMI） in screening of gestational diabetes mellitus. Methods Total of 65 pregnant women with suspected gestational diabetes mellitus in Department of Gynecology and Obstetrics in Tieying Hospital of Fengtai District for prenatal care and delivery from May 2013 to Apr. 2014 were included as research objects. The 65 pregnant women were divided into a positive group（n =35） and a negative group （n =30） according to the gold criterion for the diagnosis of gestational diabetes mellitus. Fasting blood glucose, HbAtc, BMI of the two groups were assessed. Results HbAlc level in the positive group was significantly higher than the nega- tive group [ （ 8.71 ± 0. 42） % vs （5.03 ± 0. 27 ） %, P 〈 0. 05 ] ; BMI in the positive group was significantly higher than the negative group [ （27.41± 4. 02） kg/m2 vs （22. 34 ± 3. 11 ） kg/m2, t = 5. 614, P 〈 0. 05 ]. The sensitivity, specificity,accuracy of HbA1c in the diagnosis of gestational diabetes were 80. 0%, 90. 0%, 90.0%, which had low consistency with the gold standard （ Kappa = 0. 69, P 〉 0. 05 ）. The sensitivity, specificity, accuracy of BMI in the diagnosis of gestational diabetes were 81.2% ,72. 7% and 76. 9% , which had good consistency with the gold standard （Kappa = 0. 54）. The sensitivity, specificity, accuracy of combined test in the diagnosis of gestational diabetes were 94. 3 %, 100. 0% and 96. 9%, which had good consis- tency with the gold standard （ Kappa = 0. 94）. Conclusion The sensitivity and specificity of HbA1c combined BMI are higher in gestational diabetes mellitus screening, thus have a higher clinical value in screening gestational diabetes.