口服葡萄糖耐量试验曲线下面积在妊娠期糖尿病中的应用

Application of the area under the curve of oral glucose tolerance test in gestational diabetes mellitus

目的:研究口服葡萄糖耐量试验(OGTT)曲线下面积(AUC)对OGTT不同时间点异常的妊娠期糖尿病(GDM)孕妇的糖代谢水平的反应,为GDM的研究和治疗提供参考。方法:1111例孕妇按现行GDM诊断标准将其分为正常组和GDM组,将GDM组按其OGTT不同异常点的点数和相同点数时不同的异常时相再行分组,对各组的血糖水平和AUC值进行统计分析。结果:(1)GDM组各时相点血糖水平和AUC值均显著高于正常组(均P<0.01)GDM组与正常组的AUC值,在(11.8~16.4)mmol·h/L的范围内存在95%置信区间的重叠,在(12.5~15.7)mmol·h/L的范围内存在5%~95%百分位值的重叠。(2)GDM组中,除F+1 h组中的FPG水平和1 h+2 h组中的2 h PG水平与C组的相应时相血糖水平无统计学差异(P>0.05)外,FPG、1 h PG和2 h PG水平均随OGTT异常点数的增加而显著增高(均P<0.01)。(3)AUC值的比较:1 h组分别<F+1 h组和1 h+2 h组,2 h组<F+2 h组(均P<0.01);1 h组>2 h组,F+1 h组>F+2 h组(均P<0.01);1 h组AUC均值>F+2 h组AUC均值,但差异无统计学意义(P>0.05)。结论:在现行采用OGTT 3个时间点的血糖界值诊断GDM的标准下,AUC值不能全面地反映出GDM孕妇不同的糖代谢水平。

Objective：To investigate the application of the area under the curve（AUC） of oral glucose tolerance test（OGTT） in reflecting the glucometabolic status of patients with gestational diabetes mellitus（GDM）,so as to provide reference for the research and treatment of GDM.Methods：A total of 1111 pregnant women were divided into normal group and GDM group which were further grouped according to the different number of abnormal point and the different abnormal point that was in the same abnormal number during OGTT.The glucose level and AUC value of all the groups were analyzed.Results：（1）The differences in the levels of glucose in abnormal phases（FPG,1-h PG or 2-h PG）,and the difference in AUC values between GDM group and normal group were significant（P〈0.01）.The overlaps of 95% confidence interval and 5%-95% percentile of AUC value existed in the two groups within the range of（11.8-16.4） and（12.5-15.7） mmol·h/L respectively.（2） In GDM group,except that the FPG level in F＋1 h group and the 2-h PG level in 1 h＋2 h group had no significant difference when compared with the levels of the corresponding phase in group C respectively（P〉0.05）,the levels of FPG,1-h PG and 2-h PG increased significantly with the increase of OGTT abnormal points,P〈0.01.（3） The AUC of 1 h group was lower than that of F＋1 h group or 1 h＋2 h group,lower in 2 h group than in F＋ 2 h group;higher in 1 h group than in 2 h group,higher in F＋1 h group than in F＋2 h group（P〈0.01 for all）.The mean AUC in 1 h group was greater than in F＋2 h group,but the difference not significant（P〉0.05）.Conclusion：For GDM patients diagnosed by the current GDM diagnostic criteria of 3 time points during OGTT,AUC values can not fully reflect the differences of glucometabolic status in GDM pregnant women with different OGTT abnormalities.