不同诊断标准诊断GDM/GIGT及与不良妊娠结局关系的研究

Comparative Study on the Relationship Between the different diagnostic Criteria of GDM/GIGT and the Pregnancy Outcomes

目的:对国内诊断标准诊断的GDM/GIGT患者以NDDG标准及Cousten标准进行评价,并对本组患者的不良妊娠结局进行比较,以评价不同诊断标准对GDM/GIGT的诊断适用性。方法:收集157例2004年在本院分娩以国内诊断标准判定为GDM/GIGT患者的相关资料,分别以NDDG和Cousten标准进行评价,同时随机选择本院分娩的非GDM/GIGT产妇177例作为对照组,对各组不良妊娠结局进行比较分析。结果;国内标准判定的87例GDM患者中,NDDG标准判定28例,符合率为32.2%;Cousten标准判定61例,符合率为70.1%。国内标准判定的70例GIGT患者中,NDDG标准判定22例,符合率为31.4%;Cousten标准判定43例,符合率为61.4%。国内诊断标准判定的GDM/GIGT孕妇患者,剖宫产率、羊水过少、羊水过多、妊高征、胎位异常、胎膜早破等的发生率分别是51.3%、14.6%、3.9%、3.7%和21.1%,高于对照组的35.0%、2.8%、0.0%、1.7%和4.5%。巨大儿发生率分别是国内标准组12.5%、NDDG组11.4%和Cousten组11.6%,差别无统计学意义。NDDG标准判定的GIGT患者中,巨大儿发生率为11.5%,而国内标准组为8.6%,Cousten标准组为7.6%。结论:3种诊断标准判定孕妇GDM/GIGT的敏感性,存在一定差别,国内标准明显高于NDDG标准和Cousten标准。剖宫产率、羊水过少、羊水过多、妊高征、胎位异常、胎膜早破等不良妊娠结局指标,GDM/GIGT患者明显高于对照组。而3种诊断标准判定的GDM/GIGT患者巨大儿发生率,未显示有明显差别。

Objective： To evaluate the relationship between the different diagnostic criteria of GDM/GIGT and the pregnancy outcomes. Methods： Total of 157 pregnant women with GDM/GIGT diagnosed by China＇s criteria were re - evaluated by NDDG and Cousten criteria respectively. The pregnancy outcomes under the different criteria accordingly were analysed compared with 177 pregnant women with- out GDM/GIGT. Results： Among the 87 GDM patients diagnosed by China＇s criteria, 28 cases were positive by NDDG criteria and 61 cases by Cousten criteria. The incidences of cesarean delivery rate, oligohydramnios, polyhydramnios, pregnancy - induced hypertension syndrome, malposition and premature rupture of fetal membranes in the GDM/GIGT group diagnosed by China＇s criteria were 51.3%, 14. 6% , 3.9%, 3. 7% and 21.1% respectively, which were higher than that of control group. But there was no significant difference in the incidence of macrosomia between the groups of GDM/GIGT patients diagnosed by three criteria, despite the incidence of macrosomia in GIGT patients diagnosed by NDDG criteria was little higher than that diagnosed by China＇s criteria and Cousten criteria. Conclusion： Patients with GDM/ GIGT have higher incidences of such indexes indicating pregnancy outcomes as cesarean delivery rate, oligohydramnios, polyhydramnios, pregnancy - induced hypertension syndrome, malposition and premature rupture of fetal membranes comparing with those of controls. The China＇s criteria has higher sensitive than NDDG and Cousten criteria in the diagnoses of GDM/GIGT. Howerer, there is no differences in the incidences of macrosomia between the patients diagnosed by the three criteria.