三种妊娠期糖尿病诊断标准在临床中的诊断价值

The values of three kinds of diagnostic criteria in clinical diagnosis of gestational diabetes mellitus

目的:通过妊娠期糖尿病患者75 g葡萄糖耐量试验的结果,比较三种诊断标准诊断妊娠期糖尿病(GDM),探讨其在临床中的诊断价值。方法:对482例50 g糖筛阳性患者进行75 g葡萄糖耐量试验(OGTT),利用第7版《妇产科学》、ADA及NDDG诊断标准对其进行诊断分组,然后对三组进行分析比较。结果:利用第7版《妇产科学》标准,GDM的诊断率为47.30%;利用ADA诊断标准,GDM的诊断率为39.83%;利用NDDG诊断标准,GDM的诊断率为26.14%。第3组分别与第1组、第2组诊断率比较,差异均有统计学意义(P<0.05)。第3组分别与第1组、第2组比较,在孕妇年龄、孕前体重指数、孕期体重增长率、妊娠期高血压、剖宫产率、巨大儿发生率及新生儿平均出生体重方面差异均有统计学意义(P<0.05)。结论:①第7版《妇产科学》的GDM诊断标准和ADA诊断标准都适合在临床应用,ADA的诊断标准更适合临床应用。②NDDG诊断标准界值过高,临床应用时较易漏诊患者,不推荐临床使用。

Objective：To compare the values of three kinds of diagnostic criteria in clinical diagnosis of gestational diabetes mellitus（GDM） by 75 g oral glucose tolerance test（OGTT） results.Methods：482 GDM patients with positive results of 50 g glucose screening received OGTT,and they were divided into three groups according to the diagnostic criteria of the seventh edition of ＂Obstetrics and Gynecology＂,ADA and NDDG,then the patients in the three groups were analyzed and compared.Results：The diagnosis rate of GDM was 47.30% according to the criterion of the seventh edition of ＂Obstetrics and Gynecology＂;the diagnosis rate of GDM was 39.83% according to the diagnostic criterion of ADA;the diagnosis rate of GDM was 26.14% according to the diagnostic criterion of NDDG.There was significant difference in diagnosis rate of GDM between the third group and the first group,the second group,respectively（P〈0.05）.There was significant difference in maternal age,pre-pregnancy body mass index,pregnancy weight growth rate,pregnancy-induced hypertension,cesarean section rate,the incidence of macrosomia and average birth weight of neonates between the third group and the first group,the second group,respectively（P〈0.05）.Conclusion：The diagnostic criteria of GDM and ADA from the seventh edition of ＂Obstetrics and Gynecology＂ are suitable for clinical application,the diagnostic criterion of ADA is more suitable for clinical application.The diagnostic value of NDDG is high,so it is easy to induce missed diagnosis,which is not recommended for clinical use.