应用6种妊娠期糖尿病诊断标准的回顾性分析

Retrospective Analysis on the Application of Six Diagnosis Criteria for Gestational Diabetes Mellitus

目的:旨在探讨2011年新版妊娠糖尿病诊断标准与以往4种标准、孕早期空腹血糖(FPG)的应用及6种方法与巨大儿的相关性。方法:回顾性分析2009年10月-2010年10月在我所早孕期建卡且孕中期均为50g糖筛查(GCT)阳性的孕妇268例,使用2011年新版标准分别与第7版《妇产科学》、世界卫生组织(WHO)、美国糖尿病学会(ADA)和欧洲糖尿病协会(EASD)所立的标准及孕早期空腹血糖(FPG)标准进行回顾性分析。结果:(1)WHO确诊的患者与新版标准比较,符合率为61.1%(55/90),7版、ADA和EASD标准中的患者均包含在新版标准中;GCT阳性孕妇中GDM发生率分别为33.6%(90/268)、7.8%(21/268)、8.6%(23/268)、29.9%(80/268)和6.0%(16/268);新版标准确诊患者量较7版、ADA、WHO和EASD标准分别增加了3.3倍、2.9倍、0.1倍和2.1倍;KAPPA值分别为0.288、0.313、0.484、0.223(P值均<0.01)。(2)GCT阳性者有9.3%(25/268)FPG≥5.1mmol/L,后者与新版、7版、ADA、WHO及EASD的KAPPA值分别为0.134(P=0.003)、0.019(P=0.416)、0.085(P=0.164)、0.079(P=0.104)、0.079(P=0.181)。(3)巨大儿与孕早期FPG≥5.1mmol/L、新版、7版、ADA、WHO及EASD的相关系数分别为0.079(P=0.195)、0.054(P=0.381)、0.152(P=0.013)、0.091(P=0.139)、0.138(P=0.024)、0.031(P=0.610)。结论:孕早期空腹血糖作为GDM的诊断标准需慎重;新版孕中期OGTT标准可能会产生较多患者,基层医院在处理上要做好充分准备;WHO标准与新版标准一致性良好,在巨大儿的相关性上有优势。

Objective：To analyze the application of six criteria for gestational diabetes and to explore the relevance be- tween the six criteria and fetal macrosomia（FM）. Methods： Clinical data of 268 singleton-pregnant women who were positive of glucose challenge test（GCT） created file in the maternity and child care center of taicang and accepted ante- natal examination from October 2009 to October 2010. Six criteria, inc]uding one of diagnosis criteria for gestational di- abetes mellitus （2011,short for NO）, one of obstertrics and gynecolgy （seventh edition, short for SE）, one of World Health Organization（short for WHO）, one of American Diabetes Association（short for ADA）, one of European Associ- ation for the Study of Diabetes（short for EASD）and fasting plasma glucose level in first trimester（short for FTFPG）, were used to diagnose gestational diabetes mellitus（GDM） and retrospectively analyzed. Results. （1）The accordant rate of WHO and NC was 61.1% （55/90）. All of positive cased of SE, ADA and EASD were included into NC. GDM in- cidence among positive cases of GCT of WHO, NC, SE, ADS and EASD respectively was 29. 9% （80/268）, 33. 6~ （90/268） ,7. 8^（21/268）, 8. 6~ （23/268）and 6. 0% （16/268）, the number of GDM patient accordingly by NC in- creased more than four times. KAPPA was respectively 0. 288（P^0. 01） ,0. 313（P^0. 01） ,0. 484（P^0. 01） ,0. 223 （P^0. 01）. （2）There were 9. 3^（25/268）of FPG^5. 1 mmol/L in the positive cases of GCT and KAPPA of FTFPG, NC, SE, ADA, WHO and EASD was 0. 134（P=0. 003） ,0. 019（P=0. 416） ,0. 085（P=0. 164） ,0. 079（P^-0. 104）, O. 079（P=0. 181） respectively. （3）The correlation coefficient between FM and FTFPG, NC, SE, ADA, WHO and EASD was 0. 079（P=0. 195）,0. 054（P=0. 381）,0. 152（P=0. 013）,0. 091（P=0. 139）,0. 138（P=0. 024）,0. 031 （P=0. 610）. Conclusion.FPG^5. 1 mmol/L in the first trimester is not fit for diagnosis criteria as GDM. The patient might be more than before when the new criteria （2011） is used and manpower and material resources need be well pre- pare＆ The WHO criteria can be considered as diagnosis criteria of the positive women through GCT because it has a good relevance with the new one and fetal macrosomia.