糖尿病,妊娠%血红蛋白A,糖基化%血糖
糖尿病,妊娠%血紅蛋白A,糖基化%血糖
당뇨병,임신%혈홍단백A,당기화%혈당
Diabetes,gestational%Hemoglobin A,glycosylated%Blood glucose
目的 探讨糖化血红蛋白(glyeosylated hemoglobin,HbAlc)在妊娠期糖尿病(gestational diabetes mellitus,GDM)病情程度评价、胰岛素使用及新生儿出生体重预测方面的指导价值. 方法 收集2005年1月1日至2011年8月31日于北京大学第一医院分娩的GDM孕妇中测定HbAlc者1074例的资料,75 g口服葡萄糖耐量试验(oral glucose tolerance test,OGTT)空腹、1和2h血糖诊断界值分别为5.1、10.0及8.5 mmol/L,3点中任何1点血糖达到或者超过界值即诊断为GDM.采用Pearson相关分析探讨HbAlc与OGTT空腹、1和2h血糖水平之间的关系；采用受试者工作特性(receiver operating characteristic,ROC)曲线及Logistic回归分析HbAlc预测GDM孕妇需要使用胰岛素治疗及新生儿出生体重的效力. 结果 1074例GDM孕妇平均年龄为(31.8±4.0)岁,均于妊娠中、晚期行OGTT,平均孕周为(27.6±3.4)周,其中,空腹、1和2h平均血糖分别为(5.2±0.7)、(10.9±1.4)及(9.4±1.5) mmol/L.初次检测HbAlc的孕周为(31.8±4.3)周,HbAlc为(5.57±0.48)％.(1)HbAlc与OGTT血糖水平的关系:726例孕妇在OGTT后1个月内进行了HbAlc检测,HbAlc为(5.54±0.47)％.1点血糖异常者159例,HbAlc为(5.34±0.41)％,低于2点血糖异常者[293例,HbAlc为(5.47±0.41)％](t=3.025,P＜0.01)；2点血糖异常者HbAlc低于3点血糖异常者[228例,HbAlc为(5.71±0.46)％](t=6.399,P＜0.01).(2)HbAlc与需要胰岛素治疗的相关性:使用胰岛素治疗的299例孕妇HbAlc为(5.78±0.58)％,显著高于不需要胰岛素治疗者[775例,HbAlc为(5.42±0.37)％](t=9.431,P＜0.01).HbAlc水平预测GDM需要胰岛素治疗的ROC曲线下面积为0.713,当HbAlc为5.67％时,预测GDM需要胰岛素治疗的敏感性与特异性分别为57.8％及75.5％.两因素Logistic回归分析示OR＝6.847,95％CI:4.588～10.218,P＜0.01.(3)妊娠晚期HbAlc与新生儿出生体重的关系:大于胎龄儿组(290例,344次)HbAlc为(5.75±0.52)％,高于非大于胎龄儿组[763例,814次,HbAlc为(5.54±0.42)％](t=6.845,P＜0.01).HbAlc预测大于胎龄儿的ROC曲线下面积为0.626.当HbAlc为5.75％时,预测大于胎龄儿的敏感性与特异性分别为44.8％及73.8％.两因素Logistic回归分析示OR=2.187,95％CI:2.097～3.783,P＜0.01.巨大儿组(93例,117次)HbAlc为(5.88±0.53)％,高于非巨大儿组[960例,1041次,HbAlc为(5.57±0.45)％](t＝5.990,P＜0.01).HbAlc预测巨大儿的ROC曲线下面积为0.675.当HbAlc为5.85％时,预测巨大儿的敏感性与特异性分别为50.4％及79.8％.两因素Logistic回归分析示OR＝3.299,95％CI:2.237～4.865,P＜0.01.结论 诊断GDM时HbAlc水平与GDM的病情程度相关,对胰岛素的使用有预测价值.妊娠晚期HbAlc水平对大于胎龄儿及巨大儿的发生有预测价值.
目的 探討糖化血紅蛋白(glyeosylated hemoglobin,HbAlc)在妊娠期糖尿病(gestational diabetes mellitus,GDM)病情程度評價、胰島素使用及新生兒齣生體重預測方麵的指導價值. 方法 收集2005年1月1日至2011年8月31日于北京大學第一醫院分娩的GDM孕婦中測定HbAlc者1074例的資料,75 g口服葡萄糖耐量試驗(oral glucose tolerance test,OGTT)空腹、1和2h血糖診斷界值分彆為5.1、10.0及8.5 mmol/L,3點中任何1點血糖達到或者超過界值即診斷為GDM.採用Pearson相關分析探討HbAlc與OGTT空腹、1和2h血糖水平之間的關繫；採用受試者工作特性(receiver operating characteristic,ROC)麯線及Logistic迴歸分析HbAlc預測GDM孕婦需要使用胰島素治療及新生兒齣生體重的效力. 結果 1074例GDM孕婦平均年齡為(31.8±4.0)歲,均于妊娠中、晚期行OGTT,平均孕週為(27.6±3.4)週,其中,空腹、1和2h平均血糖分彆為(5.2±0.7)、(10.9±1.4)及(9.4±1.5) mmol/L.初次檢測HbAlc的孕週為(31.8±4.3)週,HbAlc為(5.57±0.48)％.(1)HbAlc與OGTT血糖水平的關繫:726例孕婦在OGTT後1箇月內進行瞭HbAlc檢測,HbAlc為(5.54±0.47)％.1點血糖異常者159例,HbAlc為(5.34±0.41)％,低于2點血糖異常者[293例,HbAlc為(5.47±0.41)％](t=3.025,P＜0.01)；2點血糖異常者HbAlc低于3點血糖異常者[228例,HbAlc為(5.71±0.46)％](t=6.399,P＜0.01).(2)HbAlc與需要胰島素治療的相關性:使用胰島素治療的299例孕婦HbAlc為(5.78±0.58)％,顯著高于不需要胰島素治療者[775例,HbAlc為(5.42±0.37)％](t=9.431,P＜0.01).HbAlc水平預測GDM需要胰島素治療的ROC麯線下麵積為0.713,噹HbAlc為5.67％時,預測GDM需要胰島素治療的敏感性與特異性分彆為57.8％及75.5％.兩因素Logistic迴歸分析示OR＝6.847,95％CI:4.588～10.218,P＜0.01.(3)妊娠晚期HbAlc與新生兒齣生體重的關繫:大于胎齡兒組(290例,344次)HbAlc為(5.75±0.52)％,高于非大于胎齡兒組[763例,814次,HbAlc為(5.54±0.42)％](t=6.845,P＜0.01).HbAlc預測大于胎齡兒的ROC麯線下麵積為0.626.噹HbAlc為5.75％時,預測大于胎齡兒的敏感性與特異性分彆為44.8％及73.8％.兩因素Logistic迴歸分析示OR=2.187,95％CI:2.097～3.783,P＜0.01.巨大兒組(93例,117次)HbAlc為(5.88±0.53)％,高于非巨大兒組[960例,1041次,HbAlc為(5.57±0.45)％](t＝5.990,P＜0.01).HbAlc預測巨大兒的ROC麯線下麵積為0.675.噹HbAlc為5.85％時,預測巨大兒的敏感性與特異性分彆為50.4％及79.8％.兩因素Logistic迴歸分析示OR＝3.299,95％CI:2.237～4.865,P＜0.01.結論 診斷GDM時HbAlc水平與GDM的病情程度相關,對胰島素的使用有預測價值.妊娠晚期HbAlc水平對大于胎齡兒及巨大兒的髮生有預測價值.
목적 탐토당화혈홍단백(glyeosylated hemoglobin,HbAlc)재임신기당뇨병(gestational diabetes mellitus,GDM)병정정도평개、이도소사용급신생인출생체중예측방면적지도개치. 방법 수집2005년1월1일지2011년8월31일우북경대학제일의원분면적GDM잉부중측정HbAlc자1074례적자료,75 g구복포도당내량시험(oral glucose tolerance test,OGTT)공복、1화2h혈당진단계치분별위5.1、10.0급8.5 mmol/L,3점중임하1점혈당체도혹자초과계치즉진단위GDM.채용Pearson상관분석탐토HbAlc여OGTT공복、1화2h혈당수평지간적관계；채용수시자공작특성(receiver operating characteristic,ROC)곡선급Logistic회귀분석HbAlc예측GDM잉부수요사용이도소치료급신생인출생체중적효력. 결과 1074례GDM잉부평균년령위(31.8±4.0)세,균우임신중、만기행OGTT,평균잉주위(27.6±3.4)주,기중,공복、1화2h평균혈당분별위(5.2±0.7)、(10.9±1.4)급(9.4±1.5) mmol/L.초차검측HbAlc적잉주위(31.8±4.3)주,HbAlc위(5.57±0.48)％.(1)HbAlc여OGTT혈당수평적관계:726례잉부재OGTT후1개월내진행료HbAlc검측,HbAlc위(5.54±0.47)％.1점혈당이상자159례,HbAlc위(5.34±0.41)％,저우2점혈당이상자[293례,HbAlc위(5.47±0.41)％](t=3.025,P＜0.01)；2점혈당이상자HbAlc저우3점혈당이상자[228례,HbAlc위(5.71±0.46)％](t=6.399,P＜0.01).(2)HbAlc여수요이도소치료적상관성:사용이도소치료적299례잉부HbAlc위(5.78±0.58)％,현저고우불수요이도소치료자[775례,HbAlc위(5.42±0.37)％](t=9.431,P＜0.01).HbAlc수평예측GDM수요이도소치료적ROC곡선하면적위0.713,당HbAlc위5.67％시,예측GDM수요이도소치료적민감성여특이성분별위57.8％급75.5％.량인소Logistic회귀분석시OR＝6.847,95％CI:4.588～10.218,P＜0.01.(3)임신만기HbAlc여신생인출생체중적관계:대우태령인조(290례,344차)HbAlc위(5.75±0.52)％,고우비대우태령인조[763례,814차,HbAlc위(5.54±0.42)％](t=6.845,P＜0.01).HbAlc예측대우태령인적ROC곡선하면적위0.626.당HbAlc위5.75％시,예측대우태령인적민감성여특이성분별위44.8％급73.8％.량인소Logistic회귀분석시OR=2.187,95％CI:2.097～3.783,P＜0.01.거대인조(93례,117차)HbAlc위(5.88±0.53)％,고우비거대인조[960례,1041차,HbAlc위(5.57±0.45)％](t＝5.990,P＜0.01).HbAlc예측거대인적ROC곡선하면적위0.675.당HbAlc위5.85％시,예측거대인적민감성여특이성분별위50.4％급79.8％.량인소Logistic회귀분석시OR＝3.299,95％CI:2.237～4.865,P＜0.01.결론 진단GDM시HbAlc수평여GDM적병정정도상관,대이도소적사용유예측개치.임신만기HbAlc수평대대우태령인급거대인적발생유예측개치.
Objective To evaluate the value of glycosylated hemoglobin (HbAlc) level in glucose monitoring,insulin therapy and neonatal birth weight prognosis in gestational diabetes mellitus (GDM) patients.Methods Data of 1074 women who were diagnosed as GDM and delivered at Peking University First Hospital between January 1,2005 and August 31,2011 were collected and retrospective analysis was conducted.The relationship of HbAlc level with plasma glucose level of oral glucose tolerance test (OGTT),insulin administration and neonatal birth weight were investigated with Pearson correlation analysis,Logistic regression analysis or receiver operating characteristic (ROC) curve.Results OGTT was done on 1074 women with (31.8± 4.0) years old during the second and third trimester and diagnosed GDM at (27.6 ± 3.4) weeks of gestational age.Among them,glucose level of fasting and 1 and 2 hours after OGTT were (5.2 ± 0.7),(10.9± 1.4) and (9.4±1.5) mmol/L.The levels of HbAlcwere (5.57±0.48)％ at the fist time of HbAlc testing at (31.8±4.3) weeks of gestational age.(1)The average value of HbAlc in 726 women determined at one month after OGTT was (5.54±0.47)％,and increased from (5.34±0.41)％ in women with one abnormal item in OGTT to (5.47±0.41)％ and (5.71±0.46)％ in women with two or three abnormal items inOGTT (t=3.025 and 6.399,all P＜0.01).(2) HbAlc level in women received insulin therapy was higher than those who did not [(5.78±0.58) ％ vs (5.42±0.37) ％,t=9.431,P＜0.01].The sensitivity and specificity were 57.8％ and 75.5％ respectively in predicting insulin requirement in women with GDM at the cut-off value of 5.67％ for HbAlc (Logistics analysis:OR＝6.847,95％CI:4.588-10.218,P＜0.01).(3) Maternal HbAlc levelat the third trimester was higher in large for gestational age(LGA) group than that in non-LGA group [(5.75±0.52)％ vs (5.54±0.42)％,t=6.845,P＜0.01].The sensitivity and specificity were 44.8％ and 73.8％ respectively in predicting LGA at the cut-off value of 5.75％ for HbAlc (Logistics analysis:OR=2.187,95％CI:2.097-3.783,P＜0.01).(4) Maternal HbAlc level at the third trimester was higher in macrosomia group than that in non-macrosomia group [(5.88±0.53)％ vs (5.57±0.45)％,t=5.990,P＜0.01].The sensitivity and specificity were 50.4％ and 79.8％ respectively in predicting macrosomia at the cut-off value of 5.85％ for HbAlc (Logistics analysis:OR=3.299,95％CI:2.237-4.865,P＜0.01).Conclusions HbAlc level at the time of GDM diagnosis could imply the severity of disease and might predict insulin requirement.While maternal HbAlc level at the third trimester may predict the occurrence of LGA and macrosomia.
