糖化血红蛋白对巨大儿发病早期评价标准的探讨

The discussion on the glycosylated hemoglobin evaluation level criteria for macrosomia forecasting early

目的探讨糖化血红蛋白在预测巨大儿发病中的评价标准,为临床对巨大儿的判别发现新的评价指标。方法采用1∶2匹配的病例对照研究方法,以2012年4月—2014年8月期间在笔者所在医院妇产科分娩的孕妇为研究对象。共有378例纳入研究队列,其中病例组（分娩巨大儿孕妇）126例,对照组（分娩正常体重胎儿孕妇）252例。使用含有EDTA-K2采血管,分别采集研究对象24~28 w静脉血和分娩前静脉血进行糖化血红蛋白水平检测,并进行统计学分析。结果研究对象中,病例组孕妇24~28 w静脉血糖化血红蛋白水平为（5.63±0.33）%高于对照组（4.52±0.29）%（P〈0.05）;病例组孕妇分娩前的糖化血红蛋白水平为（5.79±0.39）%高于对照组（4.89±0.41）%（P〈0.05）;24~28 w（OR=4.575,95%CI=1.391~15.051）和分娩前（OR=6.971,95%CI=2.196~22.130）的糖化血红蛋白水平均与巨大儿的发病风险相关;通过ROC曲线分析得出,研究对象24~28 w时的糖化血红蛋白对巨大儿发病的评价基准水平为5.59%,灵敏度为72.7%,特异度为90.9%。结论孕妇糖化血红蛋白水平与巨大儿发病风险呈正相关,妊娠24~28 w时糖化血红蛋白5.59%为基线水平可以对巨大儿发病早期评价提供可靠的依据。

Objective To discuss the glycosylated hemoglobin evaluation level criteria for macrosomia forecasting and establish the new standard for macrosomia diagnosing. Methods A 1 ∶2 case-control study was conducted in the department of the obstetrics and gynecology in author＇s hospital from April 2012 to August2014. There were total 378 cases collected in this research;them were divided into two groups：the case group contained 126 cases delivered macrosomia,and the other 252 cases delivered normal weight neonates were as control group. The level of the glycosylated hemoglobin was detected when blood drew in 24-28 w pregnancy and before delivery. Results The glycosylated hemoglobin average level [（5.63±0.33）%] in the case group was higher than the control group [（4.52±0.29）%] in 24-28 w pregnancy;the glycosylated hemoglobin average level [（5.79±0.39）%] in the case group was also higher than the control group[（4.89±0.41）%] before delivery;the level of the glycosylated hemoglobin was relative with macrosomia incidence in 24-28 w pregnancy（OR=4.575,95%CI=1.391-15.051） and before delivery（OR=6.971,95%CI=2.196-22.130）;ROC curve was used for data analysis,these results showed that the glycosylated hemoglobin level was 5.59% in 24-28 w pregnancy which can forecast macrosomia effectively,its sensitivity was 72.7%,specificity is 90.9%. Conclusion The glycosylated hemoglobin level of the pregnant women is positively correlated with macrosomia,and the 5.59% level can be used in early macrosomia diagnosis effectively.