糖化血红蛋白在妊娠期对孕妇血糖管理的应用价值

Study on the application value of glycated hemoglobin in blood sugar management in pregnant women during pregnancy

目的评价糖化血红蛋白(HbA1c)与妊娠期糖尿病的相关性以及其对妊娠结局的影响。方法选取2016年9月-2017年6月期间在广州市妇女儿童医疗中心进行产前检查并分娩的4 049名孕妇,采用2010年国际妊娠合并糖尿病研究组织(IADPSG)推荐的诊断标准,将其分为正常对照组(n=3 211)和妊娠期糖尿病组(n=838),分析两组孕中期HbA1c的差异及其与新生儿体重的相关性。结果妊娠期妇女孕中期高水平HbA1c是妊娠期糖尿病的危险因素(OR=2.358,P<0.05),妊娠期糖尿病组HbA1c值显著高于正常对照组[(5.33±0.33)%vs.(5.25±0.29)%,t=6.122,P<0.05];HbA1c诊断妊娠期糖尿病ROC曲线下面积为0.568(95%CI:0.545 8~0.591 2,P<0.05);孕妇HbA1c与新生儿体重具有一定的相关性(OR=0.159,P<0.05)。结论孕中期HbA1c在筛查妊娠期糖尿病及评价妊娠期妇女是否纳入血糖管理方面都具有重要的临床价值。

Objective The aim of this study was to evaluate the relationship between glycated hemoglobin(HbAlc) and gestational diabetes mellitus(GDM) and its effect on pregnancy outcome.Methods This study sampled 4 049 pregnant women who underwent antenatal check-ups and delivered in our hospital from September 2016 to June 2017.The diagnostic criteria recommended by the 2010 International Association for Pregnancy Diabetes Research(IADPSG) was used.For the control group and the gestational diabetes group,the glycosylated hemoglobin differences between the two groups in the second trimester and its correlation with neonatal weight were analyzed.Results High level HbAlc was the risk factor of GDM(OR=2.358,P<0.05).HbA1c in GDM group was significantly higher than that in normal group [(5.33±0.33)% vs.(5.25±0.29)%,t=6.122,P<0.05)];the area under ROC curve of HbA1c in diagnosis of gestational diabetes was 0.568(95%CI:0.545 8-0.591 2,P<0.05);HbAlc of pregnant women had a certain correlation with neonatal weight(OR=0.159,P<0.05).Conclusion Glycosylated hemoglobin in the second trimester of pregnancy had important clinical value in screening gestational diabetes mellitus and in evaluating whether pregnant women were included in blood glucose management.