妊娠期糖尿病筛查方法的多中心研究

Multicenter study on screen method for gestational diabetes

目的 探讨随机血糖测定用于妊娠期糖尿病 (GDM)筛查的可行性。方法 检测 10 3 8例妊娠 2 4～ 3 2周孕妇的随机血糖 ,随后立即行 5 0g葡萄糖负荷试验 (GCT)。不控制饮食 3d后行75g葡萄糖耐量试验 (OGTT) ,4项检测值中≥ 2项异常 ,即诊断为GDM ,1项异常或 2h血糖为 6 7～9 1mmoL/L(12 0～ 164mg/dl)则诊断为糖耐量低减 (IGT)。结果 (1) 948例完成了上述系列检测 ,诊断GDM 42例 (4 4% ) (GDM组 ) ,IGT 3 72例 (3 9 2 % ) (IGT组 ) ,血糖正常 5 3 4例 (正常组 )。 (2 )正常组不同时间 (空腹和餐后 1h、2h、3h内 )测得的随机血糖均有差异 ;GCT除餐后 1h血糖高于空腹外 ,其余不同餐后时间比较均无差异 ;随机血糖和GCT检测结果之间无明显相关性。 (3 )选择随机血糖≥6 4mmol/L(115mg/dl)为切点 ,诊断IGT的灵敏度为 5 0 0 % ,特异性为 67 7% ,与选择GCT≥ 7 8mmol/L(140mg/dl)为切点的灵敏度为 5 1 1% ,特异性为 71 2 %相接近 ;GDM以≥ 6 4mmoL/L (115mg/dl)为切点 ,诊断GDM的灵敏度远远高于IGT ,可达 80 0 % ,特异性为 61 2 %。 (4)选择GCT≥ 8 3mmol/L(15 0mg/dl)为切点 ,与现用的≥ 7 8mmol/L比较 ,灵敏度下降 2 0 % ,但特异性提高 10 0 %以上。结论 (1)

Objective To investigate the feasibility of using random blood glucose to screen gestational diabetes mellitus (GDM) Method The random blood glucose was determined in 1 038 pregnant women between 24 and 32 gestational weeks Then 50 gram glucose challenge test (50 g GCT) was performed followed immediately Finally, 75 gram oral glucose tolerance test (75 g OGTT) was done without dietary control for 3 days If two values of four were abnormal, GDM was diagnosed Impaired glucose tolerannce (IGT) was diagnosed if only one value was abnormal or the 2nd hour value ranged from120 to 164 mg/dl Results (1) The determination of the three steps was completed in 948 cases Among them, 42 cases (4 4%) were GDM, 372 cases (39 2%) were IGT and other 534 cases were normal (2) In the normal group, the random blood glucose were different in fasting and postprandial times No difference was found among blood glucose values determined of 50 g GCT at different times except that the value of 50 g GCT 1 hour postprandial was higher than the value at other times There was no significant association between random blood glucose and 50 g GCT (3) The sensitivity and specificity were 50 0% and 67 7%, when IGT was diagnosed using the cut point of 6 4 mmol/L(115 mg/dl) of random blood glucose, which was similar with 51 1% of sensitivity and 71 2% of specificity when using ≥7 8 mmoL/L (140 mg/dl) as the cut point of 50 g GCT If 6 4 mmol/L(115 mg/dl) was used as the cut point in GDM group the sensitivity would be 80 0%, which was much higher than that of IGT group and the specificity was 61 2% In this study, if the value of ≥8 3 mmoL/L (150 mg/dl) was used as the cut point of 50 g GCT to screen the GDM, the sensitivity decreased only 2 0% while the specificity increased more than 10 0%. Conclusions (1) The determination of random blood glucose to screen GDM couldn′t replace the 50 g GCT, but it can be used as a complemental method and can be used repeatedly at any gestational age and convenience the pregnant women and the doctors (2) The value of 8 3 mmol/L (150 mg/dl) was used as the cut point of 50 g GCT, the specificity would be increased and the requirement for OGTT would be lowered markedly, which would reduce ecnomic and psychological stress