糖化血红蛋白联合血细胞比容、甲状腺功能指标对妊娠期糖尿病的诊断价值研究

Study on clinical value of glycated hemoglobin combined with hematocrit and thyroid function indicators in the diagnosis of gestational diabetes mellitus

目的探讨糖化血红蛋白(HbA1c)联合血细胞比容(HCT)、甲状腺功能指标[血清游离三碘甲状腺原氨酸(FT3)、游离甲状腺素(FT4)、促甲状腺激素(TSH)]对妊娠期糖尿病(GDM)的诊断价值。方法回顾性分析200例进行早期GDM筛查的孕妇临床资料,所有孕妇均进行孕12~16周HbA1c、HCT、甲状腺功能指标检查及孕中期口服葡萄糖耐量实验(OGTT)检查。比较不同检查方法的检查结果,比较孕中期OGTT正常与异常孕妇的HbA1c、HCT、甲状腺功能指标,分析孕12~16周HbA1c、HCT、甲状腺功能指标检查对GDM的诊断敏感性及特异性。结果200例孕妇进行孕12~16周HbA1c、HCT、甲状腺功能指标检查,192例正常、正常率为96.0%,8例异常、异常率为4.0%;经孕中期OGTT检查,正常183例、正常率为91.5%,17例异常、异常率为8.5%;孕12~16周HbA1c、HCT、甲状腺功能指标检查的异常率与孕中期OGTT检查比较差异无统计学意义(P>0.05)。孕中期OGTT异常者的HbA1c(9.07±0.61)%、HCT(40.41±3.23)%、TSH(4.01±0.85)mlU/L均明显高于正常者的(4.69±0.35)%、(37.72±2.98)%、(1.95±0.78)mlU/L,FT_(3)(3.68±0.54)pmol/L、FT_(4)(10.22±1.59)pmol/L均明显低于正常者的(4.52±0.73)、(14.01±1.76)pmol/L,差异具有统计学意义(P<0.05)。以孕中期OGTT检查结果为金标准,孕12~16周HbA1c、HCT、甲状腺功能指标检查对GDM的诊断敏感性及特异性分别为41.2%和99.5%。结论HbA1c联合HCT、甲状腺功能指标对GDM的早期诊断具有较高的特异性,可作为GDM患者的诊断指标。

Objective To explore the value of glycated hemoglobin(HbA1c)combined with hematocrit(HCT)and thyroid function indicators[serum free triiodothyronine(FT3),free thyroxine(FT4),thyroid stimulating hormone(TSH)]in the diagnosis of gestational diabetes mellitus(GDM).Methods The clinical data of 200 pregnant women who were screened for early GDM were retrospectively analyzed.All pregnant women were examined by HbA1c,HCT,thyroid function index at 12-16 weeks of gestation and oral glucose tolerance test(OGTT)during the second trimester of pregnancy.The results of different examination methods were compared,the HbA1c,HCT and thyroid function indexes of normal and abnormal mid-trimester OGTT pregnant women were compared,and the sensitivity and specificity of HbA1c,HCT and thyroid function indicators in the diagnosis of GDM at 12-16 weeks of gestation were analyzed.Results HbA1c,HCT and thyroid function indicators were examined in 200 pregnant women at 12-16 weeks of gestation,192 cases were normal,the normal rate was 96.0%,8 cases were abnormal,the abnormal rate was 4.0%;by mid-trimester OGTT,183 cases were normal,the normal rate was 91.5%,17 cases were abnormal,the abnormal rate was 8.5%;there was no significant difference in abnormal rates between HbA1c,HCT and thyroid function indicators at 12-16 weeks of gestation and mid-trimester OGTT(P>0.05).The levels of HbA1c,HCT and TSH in pregnant women with abnormal mid-trimester OGTT were(9.07±0.61)%,(40.41±3.23)%and(4.01±0.85)mlU/L,which were obviously higher than(4.69±0.35)%,(37.72±2.98)%and(1.95±0.78)mlU/L in pregnant women with normal mid-trimester OGTT;the FT_(3) and FT_(4) in pregnant women with abnormal mid-trimester OGTT were(3.68±0.54)pmol/L and(10.22±1.59)pmol/L,which were significantly lower than(4.52±0.73)and(14.01±1.76)pmol/L in pregnant women with normal mid-trimester OGTT.The difference was statistically significant(P<0.05).The sensitivity and specificity of HbA1c,HCT and thyroid function indicators for GDM were 41.2%and 99.5%,using results of mid-trimester OGTT as the gold standard.Conclusion HbA1c combined with HCT and thyroid function indicators have high specificity for early diagnosis of GDM,and can be used as diagnostic indicators for GDM patients.