186例妊娠糖尿病孕妇葡萄糖筛查及葡萄糖耐量试验结果分析

Analysis on the results of 50g GCT and 75g OTGGof 186 cases with GDM.

目的探讨妊娠糖尿病(gestational diabetes mellitus,GDM)孕妇口服50g葡萄糖筛查(GCT)和75g葡萄糖耐量试验(OGTT)的特点,分析血糖水平对GDM的诊断和治疗的价值。方法回顾性分析广东省妇幼保健院2008年186例妊娠期糖尿病患者的临床资料和GCT及OGTT的结果。结果50g GCT以7.8 mmol/L为界值,GDM的漏诊率约(7/186)3.76%,GCT平均血糖为(9.66±1.49)mmol/L;75g OGTT平均空腹血糖为(5.01±0.84)mmol/L,1h血糖为(11.15±1.71)mmol/L,2 h血糖为(9.79±1.61)mmol/L,3h血糖为(6.93±1.94)mmol/L;其中血糖值2项异常有113例,3项异常有53例,4项异常有20例;OGTT血糖2项异常与3项、4项异常的GCT均有统计学意义;75g OGTT不检测3 h血糖,将漏诊46例GDM,约24.7%;需饮食合并胰岛素治疗患者空腹及餐后2h血糖明显高于仅需饮食治疗患者。结论GCT以7.8mmol/L为界值漏诊率不高,应较适合本地区临床使用;GCT血糖值与OGTT异常程度有关;孕妇75g OGTT诊断可考虑降低空腹血糖标准,不宜省略OGTT3h血糖的检测;对空腹及餐后2h血糖水平较高的GDM患者应注意治疗方案的选择。

Objective： To explore the characteristic of 50g glucose challenge tset （50g GCT） and 75g oral glucose tolerance test （OGTT） in women with gestational diabetes mellitus （ GDM ）, and to evaluate the value of glucose to the diagnosis and treat on GDM. Methods： Clinical data and results of 50g GCT and 75g OGTT of 186 patients with GDM of Mother and Children Health Care Hospital of Guangdong Province were retrospected. Results ： The missed diagnostic rate was about 3.76% if the cut - off value of 50g GCT was 7. 8 mmol/L, the average glucose of GCT was （9. 66 ± 1.49） mmol/L; the average fasting plasma glucose （FPG） of 75g OGTT was （5.01 ±0. 84） mmol/L, lh postprandial plasma glucose （lhPG） was （ 11.15 ± 1.71 ） mmol/L, 2h postprandial plasma glucose （2hPG） was （9.79 ±1.61） mmol/L, 3h postprandial plasma glucose （3hPG） was （6.93 ±1.94）mmol/L; 46 cases of GDM, about 24. 7%, would be missed diagnosed if 3hPG of 75g OGTT was not tested; the average fasting plasma glucose and 2h postprandial plasma glucose of GDM pregnant women who should treatment with insulinum was significantly higher than those GDM pregnant women who treatment only with food and drink. Conclusion ： the cut - off value of 50g GCT was 7. 8 mmol/L which suit to apply in Guangzhou ; FPG value of 75g OGTT in patients with GDM is considered to be decreased, while lhPG and 2hPG values increase, 3hPG of 75g OGTT should no be omitted. GDM should be early diagnosed and treatment with the level of glucose.