孕早中期血清铁蛋白、血红蛋白、糖化血红蛋白预测GDM价值

Value of serum ferritin,hemoglobin,and glycosylated hemoglobin during the first and the second trimester of pregnancy for predicting their risk of gestational diabetes mellitus

目的:探究孕早中期血清铁蛋白(SF)、血红蛋白(Hb)、糖化血红蛋白(HbA1c)预测妊娠期糖尿病(GDM)发生价值。方法:收集2017年6月-2019年6月本院行孕早中期(孕12~16周)筛查的单胎妊娠孕妇300例临床资料,均孕早中期检测血SF、Hb、HbA1c水平及行75 g口服葡萄糖耐量试验(OGTT)筛查GDM,按是否发生GDM分为GDM组与非GDM组,比较两组SF、Hb、HbA1c,用受试者工作曲线(ROC)分析3项指标预测GDM发生风险及与空腹血糖(FPG)相关性。结果:GDM组孕妇FPG、1h血糖、2h血糖及HbA1c均高于非GDM组,发生早产、胎膜早破、羊水过多、巨大儿等不良妊娠结局发生率高于非GDM组,Hb、HbA1c、SF水平均高于非GDM组(均P<0.05);孕早中期Hb、HbA1c、SF中SF预测GDM效能最高,cut-off值为132.96μg/L,曲线下面积(AUC)为0.860,敏感度79.3%、特异性96.7%;其次为HbA1c,cut-off为5.16%,AUC为0.774,敏感度67.2%、特异性90.1%;Hb预测效能最低,cut-off为118.63 g/L,AUC为0.740,敏感度70.7%、特异性83.1%;GDM孕妇孕早中期Hb、HbA1c、SF均与FPG呈正相关(r=0.223、0.431、0.521,P<0.05)。结论:GDM孕妇孕早中期SF、Hb、HbA1c水平高于非GDM孕妇,SF预测GDM综合效能最高,其次为HbA1c;孕早中期监测SF、HbA1c、Hb可作为早期GDM诊断参考依据。

Objective:To explore the value of the levels of serum ferritin(SF),hemoglobin(Hb),and glycosylated hemoglobin(HbA1c)of the pregnant women during the first and the second trimester of pregnancy for predicting their risk of gestational diabetes mellitus(GDM).Methods:The clinical data of 300 singleton pregnant women during 12-16 gestational weeks between June 2017 and June 2019 were collected.During the first and the second trimester of pregnancy,the levels of SF,Hb,and HbA1c of these women were detected,and 75g oral glucose tolerance test(OGTT)for screening GDM was conducted.These women were divided into group A(women with GDM)and group B(women without GDM).The levels of SF,Hb,and HbA1c of the women were compared between the two groups.The receiver operating characteristic(ROC)curve was used to analyze the value of the levels of SF,Hb,and HbA1c of the women for predicting the risk of GDM,and used to analyze their correlation with the level of fasting plasma glucose(FPG).Results:The levels of FPG,1h and 2h blood glucose,and HbA1c of the women in group A were significant higher than those of the women in group B(P<0.05).The incidences of premature delivery,premature rupture of membranes,polyhydramnios,and fetal macrosomia of the women in group A were significant higher than those of the women in group B(P<0.05).The SF level of the pregnant women during the first and the second trimester of pregnancy for predicting their GDM was the highest(P<0.05),which’s cut-off value,area under the curve(AUC),sensitivity,and specificity were 132.96μg/L,0.860,79.3%,and 96.7%,respectively.The levels of HbA1c and SF of the pregnant women during the first and the second trimester of pregnancy for predicting their GDM was the second highest,which’s cut-off value,AU,sensitivity,and specificity were 5.16%,0.774,67.2%,and 90.1%,respectively.The Hb level of the women during the first and second trimester of pregnancy for predicting their GDM was lowest,which’s cut-off value,AU,sensitivity,and specificity were 118.63 g/L,0.740,70.7%,and 83.1%,respectively.The levels of Hb,HbA1c,and SF of the women with GDM during the first and the second trimester of pregnancy were positively correlated with their FPG level(r=0.223,0.431,0.521,P<0.05).Conclusion:The SF,Hb and HbA1c levels of the pregnant women with GDM during the first and the second trimester of pregnancy are significant higher than those of the pregnant women without GDM.The comprehensive efficiency of the SF level for predicting GDM is the highest,and then followed by the HbA1c level.Monitoring the SF,HbA1c and Hb levels of the women with GDM during the first and the second trimester of pregnancy can provide evidences for early diagnosing GDM.