D-二聚体及糖化血红蛋白预测妊娠期糖尿病患者发生胎儿生长受限的价值

Value of dimer-D and glycosylated hemoglobin in predicting fetal growth restriction in patients with gestational diabetes mellitus

目的探讨血清D-二聚体及糖化血红蛋白(HbA1c)的表达在预测妊娠期糖尿病(GDM)患者发生胎儿生长受限(FGR)中的价值及意义。方法选取2014年6月-2016年12月在兰州市第二人民医院进行产前检查并分娩的122例GDM患者为研究对象,根据相关标准和出生体重分为巨大儿组(50例)、FGR组(11例)和对照组(61例)。所有研究对象均于孕28~30周及分娩前1~3 d采集空腹肘静脉血,并采用免疫比浊法检测其血清HbA1c及D-二聚体水平。结果 FGR组孕28~30周及分娩前1~3 d D-二聚体及HbA1c水平与巨大儿组和对照组比较,差异均有统计学意义(P<0.05);巨大儿组孕28~30周及分娩前1~3 d的D-二聚体水平与对照组比较,差异均无统计学意义(P>0.05),而巨大儿组孕28~30周及分娩前1~3 d的HbA1c水平与对照组比较,差异均有统计学意义(P<0.05)。FGR组孕28~30周D-二聚体表达水平与分娩前1~3 d比较,差异有统计学意义(P<0.05),且分娩前1~3d数值明显高于孕28~30周,而孕28~30周HbA1c表达水平与分娩前1~3 d比较,差异无统计学意义(P>0.05)。结论 GDM患者发生FGR的几率随Hb A1c的升高而升高,Hb A1c可作为GDM患者血糖控制的监测指标。D-二聚体可以在一定程度上提示FGR的发生。GDM患者D-二聚体和HbA1c联合检测可以作为早期预测FGR的重要指标。

Objective To explore the value and significance of serum dimer-D and glycosylated hemoglobin（ HbA1c） expressions in predicting fetal growth restriction（ FGR） in patients with gestational diabetes mellitus（ GDM）. Methods A total of 122 GDM patients who received prenatal examination and gave birth to their babies in the hospital from June 2014 to December 2016 were selected as study subjects,then these patients were divided into macrosomia group（ 50 patients）,FGR group（ 11 patients）,and control group（ 61 patients） according to the relevant standards and birth weight,the fasting cubital vein blood samples of all the pregnant women were collected during28-30 gestational weeks and at 1-3 days before birth,the levels of serum HbA1c and dimer-D were detected by turbidimetric immunoassay.Results There were statistically significant differences in the levels of serum dimer-D and HbA1c between FGR group and macrosomia group,control group during 28-30 gestational weeks and at 1-3 days before birth,respectively（ P〈0. 05）; there was no statistically significant difference in serum dimer-D level between macrosomia group and control group（ P〈0. 05）,but there was statistically significant difference in serum HbA1c level between the two groups（ P〈0. 05）; serum dimer-D level in FGR group at 1-3 days before birth was statistically significantly higher than that during 28-30 gestational weeks（ P〈0. 05）,but there was no statistically significant difference in serum HbA1c level between 28-30 gestational weeks and 1-3 days before birth（ P〉0. 05）. Conclusion The incidence rate of FGR in patients with GDM increases with the increase of HbA1c level,and HbA1c can be used as a monitoring index of glycemic control in patients with GDM.Dimer-D can indicate the occurrence of FGR to a certain extent. Combined detection of D-Dimer and HbA1c levels in patients with GDM can be used as early predictors of FGR.