育龄妇女年龄、孕前BMI和孕早期空腹血糖水平分布在妊娠期糖尿病预测中的价值

Value of Age,Pre-Pregnancy Body Mass Index and Fasting Blood Glucose in Early Pregnancy in Predicting Gestational Diabetes Mellitus among Fertile Women

目的探讨育龄妇女年龄、孕前体质指数(BMI)和孕早期空腹血糖(FBG)在预测妊娠期糖尿病(GDM)中的价值。方法随机抽取2018年1月~2019年12月于宜宾市妇产儿童医院规律孕期保健的孕妇1263例,根据身高体重计算BMI,于孕13周以前采用己糖激酶法测定孕早期FBG,孕24~28周采用75g口服葡萄糖耐量试验(OGTT)诊断GDM,了解孕早期FBG和GDM发病情况,用受试者工作曲线(ROC)探讨年龄、BMI和孕早期FBG在GDM预测中的价值。结果孕早期空腹血糖平均为4.55±0.59mmol/L,不同年龄段、BMI和胎次孕妇的孕早期FBG值和FBG区段差异均有统计学意义(t/F/χ^(2)=3.18~58.360,P<0.05)。妊娠24~28周共诊断出GDM患者192例,发病率15.20%,≥30岁组高于<30岁组(22.45%vs 11.43%),≥24 kg/m2组高于18.5~23.9 kg/m2及<18.5 kg/m2组(22.64%vs 12.95%vs 9.23%,差异有统计学意义(χ^(2)=18.899,P<0.05)。孕早期不同FBG区段(<4.20,4.20~4.59,4.60~4.99,5.00~5.39和≥5.40 mmol/L)的孕妇GDM发病率分别为9.14%,11.59%,19.17%,30.69%和35.82%,差异有统计学意义(P<0.05)。GDM组和非GDM组孕早期FBG,年龄和BMI差异有统计学意义(t=11.645,8.657,5.861,均P<0.01)。孕早期FBG,年龄和BMI预测GDM的ROC曲线下面积分别为0.809,0.739和0.651,FBG,年龄和BMI的最佳切点值分别为4.59 mmol/L,26.5岁和22.05 kg/m2,此时灵敏度分别为79.2%,94.8%和68.2%,特异度分别为71.4%,50.5%和64.6%。结论妊娠期糖尿病发病率较高,孕早期FBG,年龄和BMI与GDM发病有关,孕早期高FBG,高BMI和高龄会增加GDM风险。

Objective To discuss the value of age,pre-pregnancy body mass index(BMI)and fasting blood glucose(FBG)in early pregnancy in predicting gestational diabetes mellitus(GDM)among fertile women.Methods From January 2018 to December 2019,1263 pregnant women had been selected from Yibin Maternity and Children’s Hospital.BMI was calculated according to height and weight,FBG was measured by hexokinase method 13 weeks before pregnancy and GDM was diagnosed by oral glucose tolerance test(OGTT)of 75 in 24~weeks of pregnancy.The incidence of FBG and GDM in early pregnancy was understood.The value of age,BMI and FBG in GDM prediction was discussed by receiver operating characteristic(ROC).Results The average FBG in early pregnancy was 4.55±0.59 mmol/L with age,BMI and frequency of gravidity difference(t/F/χ^(2)=3.18~58.360,all P<0.05).A total of 192 GDM gravidas was diagnosed in pregnancy 24 weeks to 28 weeks with incidence at 15.20%by one-step method,incidence of over 30 years old higher than below 30 years old(22.45%vs 11.43%),BMI≥24 kg/m2 higher than 18.5~23.9 kg/m2 and<18.5 kg/m2(22.64%vs 12.95%vs 9.23%),the difference were statistically significant(χ^(2)=18.899,P<0.05).Incidence of GDM in different FBG sections(<4.20,4.20~4.59,4.60~4.99,5.00~5.39 and≥5.40 mmol/L)were 9.14%,11.59%,19.17%,30.69 and 35.82%respectively with significant difference(P<0.05).There were statistical difference of FBG in early pregnancy,age and BMI between GDM group and non-GDM group(t=11.645,8.657,5.864,all P<0.01).The area under the curve(AUC)of FBG in early pregnancy,age and BMI for predicting GDM were 0.809,0.739 and 0.651 with best tangent point value 4.59 mmol/L,26.5 years old and 22.05 kg/m2 respectively,the sensitivity of FBG,age and BMI for predicting GDM was 79.2%,94.8%and 68.2%,the specificity was 71.4%,50.5%and 64.6%respectively Conclusion The incidence rate of gestational diabetes was high,FBG age and BMI in early pregnancy,were related to the on set of BMI,high FBG,BMI and advanced age in early pregnancy could increase the risk of GDM.