广州地区健康孕妇孕中期糖化血红蛋白参考范围的建立及联合空腹血糖检测预测妊娠期糖尿病的价值

Establishment of glycosylated hemoglobin reference range during the second trimester of pregnancy in healthy pregnant women in Guangzhou region and the value of glycosylated hemoglobin combined with fasting blood glucose in prediction of gestational diabet

目的建立广州地区健康孕妇孕中期糖化血红蛋白(Hb A1c)的正常参考范围,并探讨Hb A1c联合空腹血糖预测妊娠期糖尿病(GDM)的价值。方法选取2018年6月-2019年10月在该院定期产检并分娩的GDM孕妇160例为GDM组,选取同期636例健康孕妇为对照组。检测并比较两组孕妇口服葡萄糖耐量试验(OGTT)各时点(空腹、服糖后1 h、服糖后2 h)血糖及Hb A1c水平。制定健康孕妇孕中期Hb A1c水平参考范围;采用受试者工作特征曲线(ROC)分析Hb A1c联合空腹血糖诊断GDM的价值。结果 GDM组孕妇OGTT各时点血糖及Hb A1c水平均高于对照组(均P<0.01)。健康孕妇孕中期Hb A1c水平参考范围的95%CI为4.1%~5.7%。Hb A1c单独预测GDM的临界值为5.15%,ROC曲线下面积(AUC)为0.651,灵敏度和特异度分别为48.8%和75.4%;空腹血糖预测GDM的临界值为4.95 mmol/L,AUC为0.638,灵敏度和特异度分别为41.9%和81.0%;Hb A1c (≥5.15%)联合空腹血糖(≥4.95 mmol/L)预测GDM的AUC为0.897。结论该研究建立了广州地区健康孕妇孕中期Hb A1c正常参考范围,为广州地区各实验室建立自身的参考范围提供了参考,Hb A1c和空腹血糖预测GDM均有一定价值,但二者联合预测的准确率大大提高,并为OGTT诊断GDM提供了参考,有替代OGTT的趋势。

Objective To establish the normal reference range of glycosylated hemoglobin( HbA1c) during the second trimester of pregnancy in healthy pregnant women in Guangzhou region,explore the value of glycosylated hemoglobin combined with fasting blood glucose in prediction of gestational diabetes mellitus( GDM). Methods A total of 160 pregnant women with GDM receiving regular prenatal examination and giving birth to their babies in Guangdong Women and Children’s Hospital from June 2018 to October 2019 were selected as GDM group,and 636 healthy pregnant women during the same period were selected as control group. The levels of blood glucose levels at different time points of oral glucose tolerance test( OGTT)( fasting blood glucose,1-hour postprandial blood glucose,2-hour postprandial blood glucose) and Hb A1 c in the two groups were detected and compared. The reference range of Hb A1 c during the second trimester of pregnancy in healthy pregnant women was established. Receiver operating characteristic( ROC) curve was used to analyze the value of Hb A1 c combined with fasting blood glucose in prediction of GDM. Results The levels of blood glucose at different time points of OGTT and Hb A1 c in GDM group were statistically significantly higher than those in control group( P<0. 01). 95%CI of reference range of Hb A1 c during the second trimester of pregnancy in healthy pregnant women was 4. 1%-5. 7%. The critical value of Hb A1 c in prediction of GDM was 5. 15%,the area under ROC curve( AUC) was 0. 651,the sensitivity and specificity were 48. 8% and 75. 4%,respectively. The critical value of fasting blood glucose in prediction of GDM was 4. 95 mmol/L,AUC was 0. 638,the sensitivity and specificity were 41. 9% and 81. 0%,respectively. The AUC of Hb A1 c( ≥5. 15%) combined with fasting blood glucose in prediction of GDM was 0. 897. Conclusion The normal reference range of Hb A1 c during the second trimester of pregnancy in healthy pregnant women in Guangzhou region is established,this study provides a reference for establishement of Hb A1 c normal reference range in laboratories of Guangzhou region,Hb A1 c and fasting blood glucose have certain value in prediction of GDM,the accurate rate of Hb A1 c combined with fasting blood glucose in prediction of GDM is increased significantly,which provide a reference for diagnosis of GDM using OGTT,and there is a tendency to replace OGTT.