糖化血红蛋白联合空腹血糖检测在妊娠期糖尿病筛查中的应用价值

Combination of HbA1c and FPG Examination in Screening of Gestational Diabetes Mellitus

目的:评估糖化血红蛋白(HbA1c)联合空腹血糖(FPG)用于筛查妊娠期糖尿病(GDM)的可能性。方法:选择2011年9月1日至2012年8月31日在我院妇产科产前保健及分娩的孕妇,对其同时进行75 g口服葡萄糖耐量试验(OGTT)和HbA1c检查,筛查出198例孕妇为GDM组,并随机抽取血糖正常的健康孕妇198例为非GDM组,分析两组HbA1 c、FPG及OGTT结果。结果:GDM组HbA1c水平高于非GDM组(P<0.01)。HbA1 c、FPG、OGTT筛查GDM的受试者工作特征(ROC)曲线下面积分别为0.819、0.795、0.831。当HbA1c的诊断界点为5.25%时,筛查GDM的灵敏度为74.4%、特异度为78.9%。取HbA1c该诊断界点,单独采用HbA1 c或HbA1 c联合FPG诊断,与OGTT诊断的吻合度均有统计学意义,对应的κ系数分别为0.530(P=0.000)、0.608(P=0.000)。结论:HbA1 c联合FPG可能成为GDM筛查的良好指标。

Objective：To evaluate the feasibility of combination of glycosylated hemoglobin Alc （HbAlc） and fasting plasma glucose（FPG） in screening of gestational diabetes mellitus（GDM）. Methods ：According to the 75 g oral glucose tolerance test （OGl-r） and HbAlc measurement during 24 -28 pregnant weeks, 198 cases were as assigned into GDM group and 198 cases were assigned into non-GDM group based on the International Association of Diabetes and Pregnancy Study Groups （IADPSG） guidelines. The results of HbAlc, FPG and OGTT between two groups were analyzed. Results：HbAlc level in GDM group was high- er than that in non-GDM group （P〈0.01）. The area under receiver operating characteristic （ROC） curve of HbAlc,FPG and OGl-r was 0. 819, 0. 795 and 0. 831, respectively. When the cut-off value of HbAlc was 5.25% ,the sensitivity of results was 74. 4% and the specificity was 78.9%. The kappa coefficient for i- dentifying GDM between OGTT and HbA1 c was 0. 530 （ P = 0. 000）, but 0. 608 （ P = 0. 000） if HbAlc com- bined with FBG. Conclusions：HbAlc combined with FPG can be of some value in screening of GDM.