妊娠期糖尿病高危孕妇的早期筛查与诊断

Early glucose challenge test in pregnant women with risk factors of GDM in China

目的了解国内对具有妊娠期糖尿病（GDM）高危因素的孕妇早期（孕24周前）进行葡萄糖负荷试验（GCT）的现状及意义。方法对全国GDM发病情况调查的数据进行再次分析，按孕妇具有GDM高危因素的程度对所有对象进行分组，统计早期筛查后GDM和妊娠期糖耐量受损（GIGT）的发生率、早期筛查率。采用ADA的GDM诊断标准。结果共16286例孕妇纳入分析，其中具有至少1项高危因素者共10468例（64．3％），随着高危因素数目的增加，GDM发生率逐渐增高，早期筛查例数为1687例（16．1％），提前诊断的GDM仅占所有具有高危因素人群中实际发生GDM病例的11．9％。早期筛查人群中，随高危因素数目增多，GDM诊断率逐渐升高（P〈0．01）。调查发现人体质量指数（BMI）≥24、年龄≥30岁、有DM家族史、南方人等4项高危因素为GDM的独立高危因素，按此4项高危因素进行上述各项分析结果相似。对16项高危因素和4项高危因素的分析进行比较，具有任何一项高危因素的孕妇中，GDM（X^2=0．802，P〉0．05）和GIGT（6．3％和6．4％,X^2=0．220，P〉0．05）发生率差异无统计学意义。结论对GDM高危孕妇应进行早期筛查，但国内早期筛查率较低。早期筛查阴性高危孕妇，应在孕24～28周重复GCT。

Objective To understand the current status and clinical relevance of early （ 〈 24 weeks）glucose challenge test （GCT） in pregnant women with risk factors of gestational diabetes mellitus （GDM） in China. Methods Data from the survey of incidence of GDM in China were re-analyzed. The incidence of abnormal glucose metabolisms and the rate of early GCT in all women were calculated according to different numbers of risk factors. Sixteen risk factors were included in the survey. However, 4 independent risk factors were considered separately in this re-analysis. The ADA criteria for GDM diagnosis were applied. Results A total of 16 286 pregnant women were included in this analysis and 64. 3% （ 10 468 ） presented with at least one risk factor. The incidence of GDM became elevated with the increasing number of risk factors （P 〈 0. 001 ）. Early GCT was performed in 1687 （16. 1% ） pregnant women and the early detected GDMs only accounted for 11.9% of all GDMs among those with at least one risk factor. Among those who had early GCT, the GDM diagnosis rate increased with the number of risk factors （ P 〈 0. 001 ）. Previous analysis in this survey identified 4 independent risk factors for GDM among 16 risk factors： BMI ≥ 24, age over 30 years old, family history of DM and southerners. Similar analysis was performed according to the above 4 risk factors and similar results were found as those found for 16 risk factors. No significant difference was found in the GDM and GIGT incidence between the two analyses in those with at least one risk factor. Conclusion Early GCT is necessary for pregnant women with risk factors of GDM, but the screening rate in China is low. GCT should be repeated for those women with risk factors of GDM and normal GCT at early screening.