糖化血红蛋白测定在妊娠期糖尿病筛查中的应用

Application of glycosylated hemoglobin screening test in the determination of gestational diabetes

目的探讨糖化血红蛋白(glycosylated hemoglobin,HbA1c)在妊娠期糖尿病筛查中的可行性及临床意义。方法分析64例正常妊娠孕妇、23例妊娠期糖耐量受损患者、48例妊娠期糖尿病患者50 g葡萄糖筛查试验(GCT)和HbA1c含量水平,以OGTT诊断试验作为GDM的金标准,使用ROC曲线对GCT与HbA1c作为GDM的筛查指标进行统计学评价,并分别获得HbA1c切点值。结果妊娠期糖尿病组GCT和HbA1c含量均高于正常妊娠组及妊娠期糖耐量受损组,差异具有统计学意义。本组资料GCT筛查试验的ROC曲线分析获得,当GCT取7.8 mmol/L时灵敏度66.7%～70.8%和特异度62.1%～65.5%,而HbA1c取6.0%时,可以得到较高的灵敏度72.9%～75.0%和特异度85.1%～88.5%。结论 HbA1c可以作为妊娠期糖尿病筛查诊断的指标,但需进一步确定其诊断切点值。

Objective To explore the feasibility and clinical significance of glycosylated hemoglobin（HbA1c） screening test in the determination of gestational diabetes（GDM）.Methods The results of oral glucose 50 g challenge test（GCT） and HbA1c levels were analyzed in 64 normal pregnancy cases,23 gestational impaired glucose tolerance cases and 48 gestational diabetes cases.OGTT test was the gold standard in diagnosing GDM.ROC curve was used to evaluate the value of the screening test of GDM by GCT and HbA1c.Results The value of GCT and HbA1c in GDM group were higher than those in the other two groups respectively.The sensitivity and specificity of GCT were 66.7%~70.8% and 62.1%~65.5% respectively when the cut point value of GCT was 7.8mmol/L,while those of HbA1c were 72.9%~75.0% and 85.1%~88.5% respectively when the cut point value of HbA1c was 6.0% by ROC curve analysis.Conclusion HbA1c can be used as a conception of gestational diabetes diagnosis,but further studies are needed to figure out the cut point.