孕早期FBG、HbA1c及孕前BMI对妊娠期糖尿病的联合诊断价值

Diagnostic valueof combined FBG,HbA1c and BMI before pregnancy for gestational diabetes mellitus

目的探讨孕早期空腹血糖(FBG)、糖化血红蛋白(HbA1c)及孕前体质量指数(BMI)对妊娠期糖尿病(GDM)的联合诊断价值。方法选取2019年1月至2019年9月于湖州市妇幼保健院就诊、孕周为24~28周行口服葡萄糖耐量试验(OGTT)的孕妇129例,将确诊为GDM的53例孕妇纳入观察组,其余76例健康孕妇纳入对照组,回顾性分析两组孕妇孕早期FBG、HbA1c水平及孕前BMI,通过Logistic寻求联合诊断因子并绘制ROC曲线。结果观察组孕早期的FBG、HbA1c水平及孕前BMI水平均显著高于对照组,差别具有统计学意义(t值分别为3.231、7.426、6.548,均P<0.05);观察组巨大儿、早产、新生儿低血糖的发生率均显著高于对照组,差别具有统计学意义(χ^(2)值分别为4.053、4.731、5.381,均P<0.05);孕早期FBG、HbA1c及孕前BMI单独诊断GDM的曲线下面积(AUC)分别为0.72、0.80、0.67,三者联合诊断的AUC为0.87,灵敏度、特异度分别为74.55%、91.48%。结论孕早期FBG、HbA1c及孕前BMI对妊娠期糖尿病有较好的联合诊断价值,早期诊断并及早干预有利于降低不良妊娠结局的发生率。

Objective To investigate the combined diagnostic value of fasting blood glucose(FBG),glycosylated hemoglobin(HbA1 c)and pre pregnancy body mass index(BMI)in the diagnosis of gestational diabetes mellitus(GDM).Methods A total of 129 pregnant women with gestational weeks of 24-28 weeks who underwent oral glucose tolerance test(OGTT)in Huzhou Maternity&Child Health Care Hospital from January 2019 to September 2019 were selected.Among them,53 pregnant women diagnosed as GDM were included in the observation group,while the remaining 76 healthy pregnant women were included in the control group.The levels of FBG,HbA1 c in the first trimester and pre pregnancy BMI of the two groups were retrospectively analyzed,the combined diagnostic factors were explored by Logistic regression analysis and the receiver operating characteristic(ROC)curve was performed.Results The levels of FBG,HbA1 c and pre pregnancy BMI in the observation group were significantly higher than those in the control group(t values were 3.231,7.426 and 6.548,respectively,all P<0.05).The incidence of macrosomia,premature delivery and neonatal hypoglycemia in the observation group were significantly higher than those in the control group(χ^(2) values were 4.053,4.731 and 5.381,respectively,all P<0.05).The areas under the curve(AUC)of FBG,HbA1 c in the first trimester and pre pregnancy BMI in the alone diagnosis of GDM were 0.72,0.80 and 0.67,respectively.While the AUC for combined diagnosis of these three indicators for GDM was 0.87,the sensitivity and specificity were 74.55%and 91.48%,respectively.Conclusion FBG,HbA1 c in the early pregnancy and BMI before pregnancy have a good joint diagnostic value for gestational diabetes mellitus.Early diagnosis and intervention can reduce the incidence of adverse pregnancy outcomes.