孕7～15周空腹血糖水平和血脂水平诊断GDM发生的价值

The Value of Fasting Blood Glucose and Serum Lipid Level in the Diagnosis of GDM at 7 ～ 15 Weeks of Gestation

目的:探讨孕7~15周空腹血浆葡萄糖水平和血脂水平对妊娠期糖尿病(gestational diabetes mellitus,GDM)发生的临床预测价值。方法:回顾性分析2012年5月至2016年12月来我院行常规产前检查的1480例孕妇的临床资料。根据75 g口服葡萄糖耐量试验(OGTT)。结果:将孕妇分为GDM组(152例)和对照组(1328例),通过单因素及多因素分析GDM发生的危险因素,绘制独立危险因素的ROC曲线,计算AUC,判断各指标在GDM诊断中的预测效果。结果:GDM组的年龄(30.78±3.28)、BMI(22.55±2.87)、孕次(2.12±1.08)和FPG水平(4.98±0.37)、TG水平(1.51±0.68)、TC水平(4.71±0.76)、LDL-C水平(2.12±0.49)均高于对照组,差异有统计学意义(均P<0.05),HDL-C水平(1.99±0.35)低于对照组,差异也有统计学意义(P<0.05);年龄大、BMI高、孕次多、FPG及TG高是独立危险因素,差异有统计学意义(均P<0.05)。ROC曲线分析显示BMI、FPG、TG的AUC分别为0.811、0.792、0.729。结论:年龄大、BMI高、孕次多、FPG及TG高是GDM发生的独立危险因素,诊断价值BMI>FPG>TG,通过对这指标的评估可帮助临床医生预测GDM的高危孕妇,有利于指导临床医生对孕妇进行更好的管理,降低GDM的发生率。

Objective： To explore the value of the diagnosis of gestational diabetes mellitus by using fasting plasma glucose and lipid profiles between 7 and 15 gestational weeks. Methods： A retrospective analysis was carried out on the clinical data of 1480 pregnant women who had prenatal care from May 2012 to December 2016. Based on the result of oral glucose tolerance test,pregnant women were divided into two groups：GDM group（ n = 152） and the control group（ n = 1328）. The risk factors of GDM were compared. Area under curve（ AUC） was calculated according to receiver operator characteristic（ ROC） curve to evaluate the diagnostic value of independent risk factor. Results： The result of univariate analysis showed that the age（ 30.78±3.28）,BMI（ 22.55±2.87）,gravidity（ 2.12±1.08）,FPG（ 4.98 ± 0.37）,TG（ 1.51 ± 0.68）,TC（ 4.71 ± 0.76）,LDL-C（ 2.12 ± 0.49） in GDM group were significantly higher than those in control group（ P〈0. 05）.The level of HDL-C（ 1.99± 0.35） in the GDM group was lower than the control group（ P〈0.05）. Multiple factors analysis showed that age,BMI,gravidity,FPG,TG were the independent risk factors. ROC curve analysis indicated that the AUC of BMI,FPG,TG was 0.811,0.792,0.729,respectively. Conclusion： Pregnant women with old age,or with the high level of BMI,FPG and TG are the risk factors of GDM. The diagnostic value of BMI is higher than FPG and TG,and the value of FPG is higher than TG. Monitor these factors to help the doctor determine whether the pregnant women have high risk of GDM. Thus have a better guide to clinicians,and reduce the occurrence of GDM.