妊娠糖尿病患者糖化血红蛋白测定的临床意义

Clinical Significance of Glycosylated Hemoglobin Test in Gestational Diabetes Mellitus

目的探讨妊娠糖尿病(GDM)患者糖化血红蛋白(HbA1c)测定的临床意义。方法测定279例妊娠糖尿病(GDM)孕妇、101例糖耐量低减(GIGT)孕妇和309例糖耐量正常(NGT)孕妇的空腹血糖(FPG)和50g糖筛查(GCT)的水平,其中50gGCT结果异常者且未达到诊断GDM的标准,再进行75g葡萄糖耐量试验(OGTT),同时对所有研究对象均进行HbA1c的测定并根据其的水平高低分组进行并发症的统计。结果(1)GDM组HbA1c、FPG、50g糖筛查结果与NGT组比较均明显增高,差异有统计学意义(P<0.01);(2)HbA1c的阳性率在GDM组为37.3%,虽然单用该指标来筛查诊断的敏感性偏低,但结合FPG可减少单用FPG来诊断的漏诊率。而且GDM患者的并发症随HbA1c的增高而增多。结论HbA1c在GDM的筛查、诊断及其预后评估中具有重要意义。

Objective To investigate the clinical significance of determination of glycosylated hemoglobin （HbAlc） in patients with gestational diabetes mellitus （GDM）. Methods The levels of fasting plasma glucose （FPG） and glucose challenge test （GCT） with 50g glucose in 309 pregnant women with normal glucose tolerance （NGT）, 101 pregnant women with gestational impaired glucose tolerance （GIGT） and 279 pregnant women with gestational diabetes mellitus （GDM） were determined. 75g glucose tolerance test （OGTT） was done to those whose abnormal GOT did not meet the diagnostic criteria for GDM. Meanwhile, the levels of HbAlc of all subjects were assessed. And all subjects were divided into some groups according to their levels of HbAl c to investigate the relationship between the complication and the level of HbAlc. Results The results of HbAl c, FPG, and GOT with 50g glucose of GDM group were significantly higher than those in NGT group（P〈 0.01）. The positive rate of HbAl c in GDM was 37.3 %. It was not sensitive if diagnosed only by this sign, but diagnosis by both FPG and this sign could solve this problem. Moreover, the incidence of complication was increasing with the rise of HbAl c titer in the study groups（P〈 0.01）. Conclusions It is of great value to determination of HbAl c in screening, diagnosing and assessing the prognoses of gestational diabetes mellitus.