快速微血管全血糖测定在妊娠期糖尿病筛查中的应用

Diagnostic criteria of glucose screening test using capillary whole blood glucose test

目的探讨快速微血管全血糖（CBG）测定是否与静脉血浆糖（VPG）一样，可应用于门诊妊娠期糖尿病（GDM）筛查。方法选取行产前检查及分娩的1 557例孕妇为研究对象，采用美国国家糖尿病资料组（NDDG）推荐的方法进行GDM筛查。每例孕妇于孕24~28周时取肘静脉血进行VPG测定；同时在同一侧手指末端采取微血管血一滴行CBG测定，作为自身对照。分别以随机选择的340例行口服葡萄糖耐量试验（OGTT）的孕妇所诊断的GDM及筛查试验VPG≥7.8 mmol/L作为金标准，比较两种测定结果与CBG临界值的差异。结果VPG和CBG有很好的相关性（P〈0.01），CBG值略低于VPG值，VPG与CBG的受试者工作特征曲线下面积无统计学差异（P〉0.05）。以OGTT诊断的GDM作为金标准时，CBG的阈值为7.4 mmol/L，VPG的临界值为7.8 mmol/L；以VPG≥7.8 mmol/L作为金标准时，CBG的阈值为7.0 mmol/L。三种诊断标准的围生结局无统计学差异（P〉0.05）。结论CBG测定可用于门诊GDM筛查，与VPG测定有很好的一致性，其阳性诊断值较VPG略低；该方法具有微创、方便、快捷的优点。

Objective To discuss whether the capillary whole blood glucose （CBG） test can be used in glucose screening test （GST） for gestational diabetes mellitus （GDM） compared to the venous plasma glucose （VPG） method. Methods GDM screening was conducted among 1 557 pregnant women based on the NDDG diagnostic criteria. CBG and VPG were measured at the same time and same arm at the gestational age of 24 to 28 weeks. Three hundred and forty women underwent oral glucose tolerance test （ OGTT）. Receiver operation curve （ROC） was used to determine the potential cutoff level of CBG and VPG. OGTI？ diagnosed GDM and VPG≥7.8 mmol/L were adopted as golden standard for ROC respectively. Results There was good relationship between CBG and VPG （P 〈0.01） with the values of CBG a little lower than VPG. And there was no significant difference in the area under the ROC （P 〉 0.05）. The statistical and hlgh-sensitivity cutoff values were 7.4 mmol/L in CBG and 7.8 mmol/L in VPG when GDM was adopted as golden standard. The cutoff value of CBG was 7.0 mmol/L when VPG ≥ 7.8 mmol/L was adopted as golden standard. There were no significant differences in pregnant outcomes among positive cases of the three thresholds （P 〉 0.05）. Conclusion CBG test, which is convenient, effective, minimally invasive, and has a good consistency with VPG test, can be used in outpatient GDM screening.