糖化白蛋白与脂联素对妊娠糖尿病筛查的价值

Value of glycated albumin and adiponectin in screening gestational diabetes mellitus

目的探讨糖化白蛋白(GA)与脂联素(ADP)在妊娠糖尿病(GDM)筛查中的临床应用价值。方法选取2012年04月至2014年02月浙江省瑞安市人民医院妇产科具备完整孕前检查资料,并在浙江省瑞安市人民医院分娩的临床确诊妊娠糖尿病患者196例为研究对象(GDM组),同期135例健康孕妇为对照组,比较两组GA及ADP检测情况,并利用受试者工作曲线(ROC曲线)对GA及ADP对GDM的诊断进行评价。结果 GDM组口服葡萄糖耐量试验(OGTT)时的空腹血糖(FPG)、餐后1h血糖、餐后2h血糖及GA均高于对照组,GDM组ADP水平低于对照组,差异均具有统计学意义(t值分别为17.78、15.95、20.01、19.82和18.46,均P<0.05)。ROC曲线分析:GA诊断妊娠糖尿病的ROC曲线下面积(AUC)为0.837,诊断意义具有显著性(95%CI:0.723～0.936,P<0.01),GA相对于妊娠糖尿病的诊断切点为17.3%;ADP诊断妊娠糖尿病的ROC曲线下面积(AUC)为0.736,诊断意义具有显著性(95%CI:0.707～0.819,P<0.05),ADP相对于妊娠糖尿病的诊断切点为6.4mg/L。结论GA与ADP作为妊娠糖尿病的筛查指标简单、快速具有较好的诊断价值,值得临床推广应用。

Objective To investigate the clinical value of glycated albumin （ GA ） and adiponectin （ ADP ） in screening gestational diabetes mellitus （GDM）.Methods Totally 196 patients diagnosed with GDM and delivering in People ’s Hospital of Ruian City during the period of April 2012 to February 2014 were selected in study group （ GDM group） .At the same period 135 healthy pregnant women were selected in control group .GA and ADP detection were compared between two groups , and the subject working curve （ ROC curve ） was used to evaluate the diagnosis of GDM with GA and ADP .Results FPG, 1hPBG, 2hPBG and GA of GDM group were significantly higher than those of the control group （t value was 17.78, 15.95, 20.01 and 19.82, respectively, all P 〈0.05）, but ADP level was significantly lower （t =18.46, P〈0.05）.ROC curve analysis indicated that area under the ROC curve （AUC） in diagnosis of GDM by GA was 0.837, and the diagnosis was significant （95%CI： 0.723-0.936,P〈0.01）.The diagnosis cutoff point of GA to GDM was 17.3%.The area under the ROC curve （AUC） in diagnosis of GDM by ADP was 0.736, and the diagnosis was significant （95%CI：0.707-0.819, P〈0.05）.The diagnosis cutoff point of ADP to GDM was 6.4mg/L.Conclusion As simple and rapid screening indexes of GDM, GA and ADP have good diagnostic value , and they are worthy of clinical application .