妊娠期糖尿病(A2级)的高危因素分析及早期诊断

Analysis of blood glucose monitoring time in early period of gestational diabetes mellitus

目的探讨妊娠期糖尿病(GDM)妊娠早期血糖监测的时机和方法,以期提高GDM患者孕期保健指导的针对性,减少GDM的母婴危害。方法随机选择孕期需胰岛素控制血糖的GDM患者(GDMA2)100例为观察组,同期体检的仅需饮食控制血糖的GDM患者(GDMA1)100例为对照组。分析两组患者常见风险因素的差异,比较两组患者孕早期空腹血糖水平、孕24周口服葡萄糖耐量实验(OGTT)及糖化血红蛋白(HbA1c)结果的差异。结果纳入的GDM病例中孕前体重指数(BMI)>25kg/m2者过半(GDMA1,58%;GDMA2,53%);GDMA2组患者有糖尿病家族史及不良孕产史的比例较高(P<0.05),孕24周HbA1c水平及OGTT结果亦显著高于GDMA1组(P<0.05);GDMA2孕妇24周HbA1c>6.0%者的比例为81%,显著高于GDMA1孕妇的比例(28%)(P<0.05)。结论对于有糖尿病家族史及既往不良孕产史的肥胖孕妇应加强早期血糖监测。在孕24周之前检测HbA1c可能有助于早期发现GDM。

Objective：To explore the optimum time and method for monitoring blood glucose in order to improve health care for patients with gestational diabetes mellitus（GDM）and reduce the harm to mother and infant.Methods：A hundred patients with GDM controlled by insulin were selected as experimental group （GDMA 2 group）,and another hundred patients with GDM controlled by diet as the control group（GDMA 1 group）.The differences of the common risk factors,the fasting blood glucose in early pregnancy,and the oral glucose tolerance test （OGTT）and glycosylated hemoglobin（HbA1c）at 24 weeks gestation were compared between the two groups.Results：The body mass index（BMI）of more than half of the recruited patients before gestation was over 25 kg/m2 （GDMA1,58%;GDMA2,53%）.The percentage of the patients with family history of diabetes mellitus and adverse pregnancy history in GDMA2 group were significantly higher than that in GDMA1 group（P〈0.05）.The values of HbA1c and OGTT at 24 gestational weeks in GDMA2 group were significantly higher than those in GDMA1 group（P〈0.05）.The percentage of the patients whose HbA1c was more than 6.0% in GDMA2 group（81%）was significantly higher than that in the GDMA1 group（28%） （P〈0.05）.Conclusions：Patients with family history of diabetes and adverse pregnancy history should monitor blood glucose in early prgnancy.HbA1c screening assay combined with conventional blood glucose monitoring can contribute to diagnose and treat gestational diabetes mellitus.