葡萄糖激发试验对妊娠糖尿病的评估研究

Evaluation of GCT to screening for GDM in pregnant females

目的为了确定口服50克葡萄糖激发试验(50-gram glucose challenge test,50 g GCT)筛查妊娠糖尿病(gestational diabetes mellitus,GDM)的评估价值。方法回顾性研究孕24～28周在我院做50 gGCT的孕妇,按照是否存在葡萄糖不耐受的危险因素,分为试验组和对照组,GCT>=7.2 mmol/L(130mg/dl),作2 h～75 g口服葡萄糖耐量试验(2 hour～75 gram oral glucose tolerance test,2 h～75 g OGTT),并分析试验检测的血糖值。结果试验组362人,发现了48例(13.3%)妊娠糖尿病,对照组874人,患病76例(8.7%),(P=0.816),本研究的总患病人数为124例(患病率10.1%)。筛查值为7.2 mmol/L和7.8 mmol/L(140 mg/dl)的敏感度和阴性预测值相似,而7.2 mmol/L的特异度为64.8%,7.8 mmol/L的特异度较高,为78.1%,但这没有统计学意义(P=0.619)。结论 50 g GCT所用的血糖阈值应该取7.8 mmol/L,因为与7.2 mmol/L相比,它有高敏感度和较高的特异度。24～28孕周做50 g GCT,1小时后如果静脉血糖水平低于7.8 mmol/L,GDM发生的可能性很小。

Objective To determine the predictive value of 50g GCT in the GDM. Methods A retrospective study was done involving those pregnant women who performed 50g GCT at 24 to 28 weeks gestation, divided into test group and control group according to whether the presence of glucose intolerance risk factors. A diagnostic 2h - 75g OGTY was done for those women if GCT 〉 = 7.2 mmol / L, the data was analyzed. Results Gestational diabetes mellitus was found in 48 （ 13.3% ） of the test group and 76 （ 8.7% ） of the control group （P = 0. 816）, an overall prevalence was 124 （10. 1% ） for the study. The sensitivity and negative predictive value at screening value of 7.8 mmol / L were similar to those of 7.2 mmol / L, and the specificity was 64.8% at 7.2 mmol / L and 78.1% at 7.8 mmol / L. This was however not statistically significant （P =0. 619）. Conclusions The plasma glucose value of 7.8mmol / L in the GCT should be used because of its high sensitivity and higher specificity than does the 7.2mmol / L screening value. GDM is unlikely to be present if the venous plasma glucose level is less than 7.8mmol / L, one hour after administration of 50g oral glucose load at 24 to 28 weeks gestational age.