孕8～15周空腹血糖、红白细胞计数联合临床指标预测妊娠期糖尿病发生风险的临床价值

The clinical value of fasting plasma glucose,red and white blood cell cout combined clinical indicators between 8 and 15 weeks of gestation in the prediction of gestational diabetes mellitus

目的:探讨如何利用简便、经济、有效的方法早期识别妊娠期糖尿病(GDM)的高危人群。方法:采用回顾性巢式病例对照研究,收集2841例孕8～15周建卡孕妇的临床资料,其中GDM孕妇287例,随机抽取口服糖耐量试验(OGTT)正常孕妇287例作为对照组。比较两组孕妇的年龄、孕前体质量指数(BMI)、孕产史等临床指标,以及孕早期空腹血糖(FPG)、红细胞(RBC)、血红蛋白(Hb)、白细胞(WBC)、肝酶、血脂等基本情况。利用logistic回归确定GDM发生的独立危险因素,建立logistic回归模型,绘制模型受试者工作特征曲线(ROC)并记录曲线下面积。结果:多因素分析显示,孕妇年龄≥35岁、孕前BMI超重或肥胖、孕次≥3次、产次≥1次、FPG、RBC、WBC升高均是GDM发生的独立危险因素,将上述危险因素纳入logistic回归分析,根据变量回归系数表建立回归方程模型,预测GDM发生风险的曲线下面积(AUC)为0.805,界值为0.56,敏感度为66.8%,特异度为79.0%。Hosmer-Lemeshow拟合优度检验P=0.802。结论:将孕8～15周时空腹血糖水平、红细胞计数、白细胞计数与年龄、孕前BMI等临床指标相联合,可简便、经济、有效地早期预测GDM的发生风险。

Objective:To investigate how to use simple,economical and effective methods to predict the high-risk groups of GDM early.Methods:A retrospective nested case-control study was conducted to collect clinical datas of 2841 pregnant women with cards between 8 and 15 weeks of gestation.287 pregnant women were diagnosed GDM.287 pregnant women with normal OGTT test were selected as the normal group.Maternal characteristics and laboratory indicators,such as FPG,HbA1 c,RBC,Hb,WBC,PLT,SF,ALT,AST,GGT,TG and TC were compared between the two groups.Logistic regression analysis and ROC curve were used in the analysis.Results:Multivariate logistic regression analysis revealed that age≥35 years old,pre-pregnancy overweight or obesity,gravidity≥3,parity≥1,FPG,RBC,WBC were independent risk factors for GDM(P<0.05).The regression equation model was established according to the table of regression coefficients of variables.The area under the curive was 0.805,the threshold value was 0.56,the sensitivity was 66.8%,and the specificity was 79.0%.The test of Hosmer-Lemeshow was P=0.802.Conclusions:Combining fasting plasma glucose,red and white blood cell cout with clinical indicators such as age and pre-pregnancy body mass index at 8~15 weeks of gestation can predict the risk of GDM easily,economically and effectively.