妊娠期糖尿病孕妇糖化白蛋白、糖化血红蛋白与新生儿体重关系

Relationship between the levels of glycated albumin and glycosylated hemoglobin in pregnant with gestational diabetes mellitus and their neonatal weight

目的:探讨糖化白蛋白(GA)、糖化血红蛋白(HbA1c)与妊娠期糖尿病(GDM)孕妇分娩新生儿体重的关系。方法:选取2018年1月—2018年12月在本院住院分娩的孕妇,其中妊娠期糖尿病孕妇131例为GDM组,血糖正常的健康孕妇89例为对照组。高效液相色谱法检测HbA1c,酶法检测GA。采用Pearson相关分析评价HbA1c、GA与GDM孕妇新生儿出生体重关系,采用受试者工作特征(ROC)曲线分析HbAlc预测巨大儿的最佳临界值。结果:GDM组HbA1c、GA水平、新生儿出生体重及发生巨大儿比例均高于对照组(P<0.05)。Pearson相关性分析显示,新生儿出生体重与HbA1c呈正相关(r=0.342,P<0.05),与GA无相关性(r=0.045,P>0.05)。巨大儿发生率HbA1c低组最低(12.5%),中组次之(14.3%),高组最高(29.2%)(P<0.05)。GDM组HbA1c水平诊断巨大儿的ROC曲线下面积(AUC)和95%CI分别为0.684和(0.554~0.767),当截断点为6.3%时,诊断灵敏度75.9%、特异度60.3%。结论:GDM孕妇HbA1c水平与新生儿出生体重有关,HbA1c水平越高分娩巨大儿概率越高,其水平对巨大儿预测有一定指导意义。

Objective: To investigate the relationship between the levels of glycated hemoglobin(HbA1 c) and glycosylated albumin(GA) of pregnant women with gestational diabetes mellitus(GDM) and their neonatal weight. Methods: From January 20 to December 2018, 131 pregnant women with GDM were selected in study group, and 89 healthy pregnant women with normal blood glucose level were selected in control group. The level of HbA1 c was detected by high performance liquid chromatography, and the level of GA was detected by enzymatic method. Pearson correlation analysis was used to evaluate the relationship between the levels of HbA1 c and GA of the women with GDM and their neonatal birth weight, and the receiver operating characteristic(ROC) curve was used to analyze the optimal threshold value of HbAlc for predicting macrosomia. Results: The levels of HbA1 c and GA of the women, the neonatal birth weight, and the proportion of macrosomia in the study group were significant higher than those in the control group(P<0.05). Pearson correlation analysis showed that the birth weight of newborn was positively correlated with the HbA1 c level of the women(r=0.342, P<0.05), but the birth weight of newborn had no correlation with the GA level of the women(r=0.045, P>0.05). The incidence of macrosomia(12.5%) of women with low HbA1 c level was the lowest, followed by the women with moderate HbA1 c level(14.3%), and that(29.2%) of the women with high HbA1 c level was the highest(P<0.05). In the study group, the area under the ROC curve(AUC) and 95%CI of the HbA1 c level for diagnosing macrosomia were 0.684 and 0.554-0.767, respectively. And when the cutoff point was 6.3%, the diagnostic sensitivity and the specificity of the HbA1 c level for diagnosing macrosomia were 75.9% and 60.3%, respectively. Conclusion: The level of HbA1 c of pregnant women with GDM is related to the neonatal weight.The higher the HbA1 c level, the higher the probability of having macrosomia. The level of HbA1 c has guiding significance for predicting macrosomia.