中华围产医学杂志
中華圍產醫學雜誌
중화위산의학잡지
CHINESE JOURNAL OF PERINATAL MEDICINE
2014年
8期
516-520
,共5页
唐琼秀%肖梅%张娜%管平%王玲%张翠玉%扈菊英
唐瓊秀%肖梅%張娜%管平%王玲%張翠玉%扈菊英
당경수%초매%장나%관평%왕령%장취옥%호국영
糖尿病,妊娠%妊娠中期%妊娠末期%血糖%葡糖耐量试验
糖尿病,妊娠%妊娠中期%妊娠末期%血糖%葡糖耐量試驗
당뇨병,임신%임신중기%임신말기%혈당%포당내량시험
Diabetes,gestational%Pregnancy trimester,second%Pregnancy trimesters,third%Blood glucose%Glucose tolerance test
目的 探讨妊娠中晚期空腹血浆葡萄糖(fasting plasma glucose,FPG) ＜4.4 mmol/L可暂不行75g 口服葡萄糖耐量试验(oral glucose tolerance test,OGTT)的可行性. 方法 2012年2月1日至2013年8月31日,于湖北省妇幼保健院进行产前检查且排除孕前糖尿病,共18 851例孕妇妊娠24～28周行75 g OGTT.FPG、75 g OGTT服糖后1和2h的血糖界值分别为5.1、10.0和8.5 mmol/L,任一点血糖达到或高于界值即诊断为妊娠期糖尿病(gestational diabetes mellitus,GDM).采用受试者工作特性(receiver operating characteristic,ROC)曲线分析FPG＜5.1 mmol/L预测GDM的价值;采用x2检验比较各年龄组、不同FPG水平孕妇及有无GDM高危因素者GDM检出率的差异. 结果 GDM总的检出率为9.11％ (1 718/18 851).孕妇＜25岁时,GDM检出率为4.77％(137/2 875),明显低于25～、30～和≥35岁的孕妇[分别为7.76％ (803/10 350)、12.43％(552/4 440)和19.06％(226/1 186),x2值分别为30.53、120.24和210.66,P值均＜0.01].FPG为4.4 mmol/L时预测GDM的敏感性为55％,特异性为68％,约登指数为0.23,ROC曲线下面积为0.61(95％CI:0.59～0.63,P＜0.01);FPG为4.5 mmol/L时预测GDM的敏感性为40％,特异性为80％,约登指数为0.20,ROC曲线下面积为0.61 (95％CI:0.59～0.63,P＜0.01).与FPG为4.5 mmol/L相比,FPG界值为4.4 mmol/L时,预测GDM的敏感性较高,漏诊率较低.FPG＜4.4 mmol/L时GDM的检出率为3.45％(384/11 121),明显低于FPG≥4.4但＜5.1 mmol/L组和≥5.1 mmol/L组[分别为8.06％(561/6 957)和100.00％(773/773),x2值分别为183.66和7 672.08,P值均＜0.01].FPG＜4.4 mmol/L或FPG≥4.4但＜5.1 mmol/L时,具有GDM高危因素的孕妇GDM检出率分别为5.09％ (118/2 318)和10.75％(184/1 712),均高于没有高危因素者[分别为3.02％(266/8 803)和7.19％(377/5 245),x2值分别为23.56和22.06,P值均＜0.01]. 结论 医疗资源相对缺乏地区,妊娠中晚期FPG＜4.4 mmol/L且无GDM高危因素者可暂不行OGTT.
目的 探討妊娠中晚期空腹血漿葡萄糖(fasting plasma glucose,FPG) ＜4.4 mmol/L可暫不行75g 口服葡萄糖耐量試驗(oral glucose tolerance test,OGTT)的可行性. 方法 2012年2月1日至2013年8月31日,于湖北省婦幼保健院進行產前檢查且排除孕前糖尿病,共18 851例孕婦妊娠24～28週行75 g OGTT.FPG、75 g OGTT服糖後1和2h的血糖界值分彆為5.1、10.0和8.5 mmol/L,任一點血糖達到或高于界值即診斷為妊娠期糖尿病(gestational diabetes mellitus,GDM).採用受試者工作特性(receiver operating characteristic,ROC)麯線分析FPG＜5.1 mmol/L預測GDM的價值;採用x2檢驗比較各年齡組、不同FPG水平孕婦及有無GDM高危因素者GDM檢齣率的差異. 結果 GDM總的檢齣率為9.11％ (1 718/18 851).孕婦＜25歲時,GDM檢齣率為4.77％(137/2 875),明顯低于25～、30～和≥35歲的孕婦[分彆為7.76％ (803/10 350)、12.43％(552/4 440)和19.06％(226/1 186),x2值分彆為30.53、120.24和210.66,P值均＜0.01].FPG為4.4 mmol/L時預測GDM的敏感性為55％,特異性為68％,約登指數為0.23,ROC麯線下麵積為0.61(95％CI:0.59～0.63,P＜0.01);FPG為4.5 mmol/L時預測GDM的敏感性為40％,特異性為80％,約登指數為0.20,ROC麯線下麵積為0.61 (95％CI:0.59～0.63,P＜0.01).與FPG為4.5 mmol/L相比,FPG界值為4.4 mmol/L時,預測GDM的敏感性較高,漏診率較低.FPG＜4.4 mmol/L時GDM的檢齣率為3.45％(384/11 121),明顯低于FPG≥4.4但＜5.1 mmol/L組和≥5.1 mmol/L組[分彆為8.06％(561/6 957)和100.00％(773/773),x2值分彆為183.66和7 672.08,P值均＜0.01].FPG＜4.4 mmol/L或FPG≥4.4但＜5.1 mmol/L時,具有GDM高危因素的孕婦GDM檢齣率分彆為5.09％ (118/2 318)和10.75％(184/1 712),均高于沒有高危因素者[分彆為3.02％(266/8 803)和7.19％(377/5 245),x2值分彆為23.56和22.06,P值均＜0.01]. 結論 醫療資源相對缺乏地區,妊娠中晚期FPG＜4.4 mmol/L且無GDM高危因素者可暫不行OGTT.
목적 탐토임신중만기공복혈장포도당(fasting plasma glucose,FPG) ＜4.4 mmol/L가잠불행75g 구복포도당내량시험(oral glucose tolerance test,OGTT)적가행성. 방법 2012년2월1일지2013년8월31일,우호북성부유보건원진행산전검사차배제잉전당뇨병,공18 851례잉부임신24～28주행75 g OGTT.FPG、75 g OGTT복당후1화2h적혈당계치분별위5.1、10.0화8.5 mmol/L,임일점혈당체도혹고우계치즉진단위임신기당뇨병(gestational diabetes mellitus,GDM).채용수시자공작특성(receiver operating characteristic,ROC)곡선분석FPG＜5.1 mmol/L예측GDM적개치;채용x2검험비교각년령조、불동FPG수평잉부급유무GDM고위인소자GDM검출솔적차이. 결과 GDM총적검출솔위9.11％ (1 718/18 851).잉부＜25세시,GDM검출솔위4.77％(137/2 875),명현저우25～、30～화≥35세적잉부[분별위7.76％ (803/10 350)、12.43％(552/4 440)화19.06％(226/1 186),x2치분별위30.53、120.24화210.66,P치균＜0.01].FPG위4.4 mmol/L시예측GDM적민감성위55％,특이성위68％,약등지수위0.23,ROC곡선하면적위0.61(95％CI:0.59～0.63,P＜0.01);FPG위4.5 mmol/L시예측GDM적민감성위40％,특이성위80％,약등지수위0.20,ROC곡선하면적위0.61 (95％CI:0.59～0.63,P＜0.01).여FPG위4.5 mmol/L상비,FPG계치위4.4 mmol/L시,예측GDM적민감성교고,루진솔교저.FPG＜4.4 mmol/L시GDM적검출솔위3.45％(384/11 121),명현저우FPG≥4.4단＜5.1 mmol/L조화≥5.1 mmol/L조[분별위8.06％(561/6 957)화100.00％(773/773),x2치분별위183.66화7 672.08,P치균＜0.01].FPG＜4.4 mmol/L혹FPG≥4.4단＜5.1 mmol/L시,구유GDM고위인소적잉부GDM검출솔분별위5.09％ (118/2 318)화10.75％(184/1 712),균고우몰유고위인소자[분별위3.02％(266/8 803)화7.19％(377/5 245),x2치분별위23.56화22.06,P치균＜0.01]. 결론 의료자원상대결핍지구,임신중만기FPG＜4.4 mmol/L차무GDM고위인소자가잠불행OGTT.
Objective To explore the feasibility of excluding oral 75 g glucose tolerance test (OGTT)in pregnant women with fasting plasma glucose (FPG) ＜4.4 mmol/L in middle and late trimester.Methods From February 1,2012 to August 31,2013,18 851 pregnant women without pre-gestational diabetes mellitus who received 75 g OGTT in Maternal and Child Health Hospital of Hubei Province,China,at 24-28 weeks of gestation were enrolled.The criteria for gestational diabetes mellitus (GDM) were FPG ＞5.1 mmol/L and/or 1 h plasma glucose ＞10.0 mmol/L and/or 2 h plasma glucose ＞8.5 mmol/L in OGTT.The values of FPG in predicting GDM were analyzed with receiver operating characteristic (ROC) curve.The differences of detection rates for GDM among women of different ages,women with different FPG levels,and those with or without risk factors of GDM were compared by x2 test and Fisher's exact test.Results The overall detection rate of GDM was 9.11％(1 718/18 851).The detection rate of GDM was lower in women aged ＜ 25 years than women aged 25-,30-and ≥ 35 years [4.77％ (137/2 875) vs 7.76％ (803/10 350),12.43％ (552/4 440)and 19.06％ (226/1 186),respectively,x2=30.53,120.24 and 210.66,all P＜0.01].The sensitivity and specificity were 55％ and 68％,respectively,when the cutoff value of FPG was 4.4 mmol/L,and the Youden index was 0.23 and the area under the ROC curve was 0.61 (95％CI:0.59-0.63,P＜0.01).The sensitivity and specificity were 40％ and 80％,respectively,when the cutoff value was 4.5 mmol/L,and the Youden index was 0.20 and the area under the ROC curve was 0.61 (95％CI:0.59-0.63,P＜0.01).The missed diagnosis rate was lower when the cutoff point of FPG was defined as 4.4 mmol/L.The detection rate for GDM was 3.45％ (384/11 121) in women with FPG ＜4.4 mmol/L,significantly lower than in those with FPG ≥ 4.4 but ＜5.1 mmol/L and ≥ 5.1 mmol/L [8.06％ (561/6 957) and 100.00％ (773/773),x2=183.66 and 7 672.08,all P＜0.01].When FPG was ＜4.4 mmol/L or ≥ 4.4 but ＜5.1 mmol/L,the detection rate for GDM was significantly higher in women with GDM risk factors than in those without [5.09％ (118/2 318) and 10.75％ (184/1 712) vs 3.02％ (266/8 803) and 7.19％ (377/5 245),x2=23.56 and 22.06,P＜0.01].Conclusion OGTT may not be included in GDM screening in the pregnant women with FPG＜4.4 mmol/L and without GDM risk factors in the areas lack of medical resources.
