孕早期FPG、HbA_(1c)、PAPP-A联合检测对妊娠期糖尿病的预测价值

Predictive Value of Joint Detection of FPG,HbA_(1c) and PAPP-A in Early Pregnancy for Gestational Diabetes Mellitus

目的探讨孕早期空腹血糖(FPG)、糖化血红蛋白(HbA_(1c))及妊娠相关血浆蛋白A(PAPP-A)联合检测对妊娠期糖尿病的预测价值。方法选取2016年3月至2019年3月青海省妇幼保健院接诊的572例孕早期孕妇作为研究对象,剔除终止妊娠、不良妊娠结局、失访病例后最终纳入546例孕妇,根据葡萄糖耐量试验结果分为糖尿病组(48例)和非糖尿病组(498例),对比两组孕早期FPG、HbA_(1c)及PAPP-A水平,建立妊娠期糖尿病预测受试者工作特征曲线(ROC曲线),分析FPG、HbA_(1c)及PAPP-A对妊娠期糖尿病的预测价值。结果糖尿病组FPG、HbA_(1c)水平明显高于非糖尿病组[(4.99±0.38)mmol/L比(4.49±0.41)mmol/L、(5.49±0.34)%比(5.17±0.28)%](P<0.01),PAPP-A水平明显低于非糖尿病组[(0.97±0.15)比(4.49±0.41)](P<0.01)。ROC曲线分析结果显示,FPG、HbA_(1c)及PAPP-A预测妊娠期糖尿病的灵敏度分别为58.3%、68.4%、53.1%,特异度分别为61.4%、71.3%、58.6%;而三者联合检测预测妊娠期糖尿病的灵敏度为88.9%,特异度为73.5%。结论妊娠期糖尿病孕妇孕早期FPG、HbA_(1c)水平明显高于血糖正常孕妇,PAPP-A水平明显低于血糖正常孕妇,孕早期联合检测FPG、HbA_(1c)、PAPP-A水平有助于早期预防妊娠期糖尿病的发生。

Objective To investigate the predictive value of joint detection of fasting plasma glucose(FPG),glycosylated hemoglobin(HbA_(1c))and pregnancy associated plasma protein A(PAPP-A)for gestational diabetes mellitus.Methods A total of 572 early pregnant women admitted to Qinghai Maternal and Child Health Hospital from Mar.2016 to Mar.2019 were selected as the research object,excluding termination cases,adverse pregnancy outcomes,lost to follow-up,eventually 546 cases of pregnant women were included.Based on oral glucose how test results they were divided into a non-diabetic group of 498 cases,and a diabetic group of 48 cases.The levels of FPG,HbA_(1c)and PAPP-A in the first trimester of pregnancy were compared between the two groups,and the receiver operating characteristic curve(ROC curve)was established to analyze the predictive value of FPG,HbA_(1c)and PAPP-A for gestational diabetes mellitus.Results The levels of FPG and HbA_(1c)in the diabetic group were significantly higher than those in the non-diabetic group[(4.99±0.38)mmol/L vs(4.49±0.41)mmol/L,(5.49±0.34)%vs(5.17±0.28)%](P<0.01),and the level of PAPP-A was significantly lower than that in the non-diabetic group[(0.97±0.15)vs(4.49±0.41)](P<0.01).ROC curve analysis showed that the sensitivity of FPG,HbA_(1c)and PAPP-A for predicting gestational diabetes mellitus was 58.3%,68.4%,53.1%,and the specificity was 61.4%,71.3%,58.6%,respectively.The sensitivity and specificity of the joint detection for gestational diabetes mellitus were 88.9%and 73.5%,respectively.Conclusion In pregnant women with gestational diabetes,FPG and HbA_(1c)levels in early pregnancy are significantly higher than those with normal blood glucose levels,and PAPP-A level is significantly lower than those with normal blood glucose levels.Combined detection of FPG,HbA_(1c)and PAPP-A levels in early pregnancy can help to prevent gestational diabetes.