多次OGTT检查对高危孕妇产前诊断及母婴结局的影响

Effect of repeated OGTT examinations in prenatal diagnosis and pregnancy outcome of high risk pregnant women

目的 研究行多次OGTT检查对高危孕妇产前诊断妊娠期糖尿病的临床应用价值,并探讨母婴结局。方法 简单随机选择2012年8~11月于湖南省妇幼保健院产科门诊行产前捡查的62例高危孕妇（观察组）,分别于孕24~28周及32~35周进行75 g口服葡萄糖量试验检查。选择同期未按照医嘱及时复查的高危孕妇39例为对照组,观察高危孕妇二次筛查妊娠期糖尿病的检出率及两组孕妇胎盘异常或早产、新生儿Apgar评分和住院时间。结果 高危孕妇二次葡萄糖筛查的检出率为16.13%（10/62）,明显高于首次葡萄糖筛查的检出率4.84%（3/62）,差异有统计学意义（P〈0.05）。观察组新生儿Apgar评分为（8.89±0.06）分,高于对照组的（8.25±0.04）分,差异有统计学意义（P〈0.05）;观察组产妇和婴儿平均住院时间为（6.12±0.08）d,低于对照组的（8.61±0.17）d,差异也有统计学意义（P〈0.05）。结论 对高危孕妇增加二次葡萄糖筛查可以提高妊娠期糖尿病的检出率,为患者的早期诊断和治疗提供更合适的依据,明显改善母婴结局,适合临床推广应用。

Objective To study the clinical value of repeated OGTTs in prenatal diagnosis of gestational dia-betes in high-risk pregnant women and explore the pregnancy outcome. Methods Sixty-two cases of high-risk preg-nant women were selected in Department of obstetrics of Maternal and Child Health Hospital of Hunan Province from Aug. 2012 to Nov. 2012 （the observation group）. They were carried oral glucose tolerance tests at 24-28 weeks and 32-35 weeks. Thirty-nine high-risk pregnant women, which did not follow the doctors＆#39; instruction to repeat the test, were selected during the same period as the control group. The detection rate of gestational diabetes in high risk preg-nant women after twice screening was observed, and compare the placental abnormality, premature delivery, neonatal Apgar score and hospitalization time of two groups were compared. Results The detection rate of the second oral glucose tolerance test in high-risk pregnant was statistically significantly higher than the initial detection rate （16.13%vs 4.84%, P〈0.05）. The neonatal Apgar score of the observation group was significantly higher than that of the control group [（8.89±0.06） vs （8.25± 0.04）, P〈0.05]. Average maternal and infant hospitalization time of the observation group was significantly lower than that of the control group [（6.12±0.08） d vs （8.61±0.17） d, P〈0.05]. Conclusion Re-peated oral glucose tolerance tests in high-risk pregnant women can increase the detection rate of gestational diabetes, and provide evidence for early diagnosis and treatment of gestational diabetes in patients, which will improve maternal and neonatal outcomes and is suitable for clinical application.