妊娠期口服葡萄糖负荷试验合理血糖界值的探讨

Cut-off value for glucose challenge test in Chinese women during pregnancy

目的探讨目前适合我国卫生经济条件的妊娠期葡萄糖负荷试验（GCT）的筛查界值。方法资料来源于2006年4月1日至2006年9月30日在全国18个城市25家医院保健并进行首次50gGCT的16286例孕妇，对其GCT结果进行统计和分析。结果以NDDG标准诊断妊娠期糖尿病（GDM），50gGCT的界值选取7．2mmol／L时的敏感度和特异度分别为98．2％和59．0％，选取7．8mmol／L时分别为96．0％和73．0％，选取8．3mmol／L时分别为90．2％和81．5％；以ADA标准诊断GDM，选取GCT界值为7．2mmol／L时敏感度为97．9％，特异度为60．4％；选取7．8mmol／L时分别为96．2％和74．7％；而选取8．3mmol／L则分别为87．0％和83．1％。以NDDG标准诊断妊娠期糖代谢异常（包括GDM及妊娠期糖耐量受损），选取7．2mmol／L时敏感度和特异度分别为97．7％和61．4％，选取7．8mmol／L时分别为95．4％和75．8%，选取8．3mmol／L时分别为84．9％和84．1％。结论据我国目前的卫生经济情况，以7．8mmol／L作为50gGCT的界值是合理的。

Objective To explore the cut-off value of 50 g glucose challenge test （GCT） for gestational diabetes mellitus （GDM）, which is suitable for Chinese women. Methods A multi-centered prospective population-based survey on 16 286 pregnant women, who received 50 g GCT for the first time between Apr. 1, 2006 and Sept. 30, 2006, was performed at 25 hospitls of 18 cities in China. Relative data were retrieved and analyzed. Results Based on the ADA criteria for diagnosis of GDM, the sensitivity and specificity of GCT were 97.9%and 60.4%, 96.2% and 74. 7%, and 87.0% and 83. 1% at a cutoff value of 7.2 mmol/L, 7.8 mmol/L and 8. 3 mmol/L, respectively. When NDDG criteria for GDM diagnosis was applied, the sensitivity and specificity of GCT were 98.2% and 59.0% respectively at a cut-off value of 7.2 mmol/L, 96.0% and 73.0% at 7.8 mmol/L and 90. 2% and 81.5% at 8. 3 mmol/L. In diagnosing glucose metabolism disorders （GDM and GIGT）, the sensitivity and specificity of C, CT were 97. 7%and 61.4%, 95.4% and 75.8%, and 84. 9% and 84.1% at the cutoff value of 7.2 mmol/L, 7.8 mmol/L and 8.3 retool/L, respectively. Conclusions A cut-off value at 7.8 mmol/L for GCT is appropriate for Chinese women.