糖尿病与妊娠

　　【摘要】目的 探讨中晚孕期非妊娠期糖尿病(GDM)孕妇血清糖化白蛋白(GA)的正常参考值范围及其筛查GDM的临床意义。 方法 选取24~28周孕妇189名，其中,GDM(GDM组)患者63例，正常对照者(NC组)126名。测定GA、FPG等相关指标，分析孕中晚期GA正常参考值水平，同时应用受试者工作特征曲线(ROC)得出筛查GDM最佳切点及其敏感性、特异性。 结果 (1)NC组孕中晚期GA的正常参考值范围为11.1%~15.3%;(2)若GA为15.2%、FPG为4.35 mmol/L，诊断GDM的敏感性分别为98.4%、82.5%，特异性分别为96.8%、66.7%。(3)孕24~28周FPG≥4.35 mmol/L或GA≥15.2%者，需行75 g OGTT，这将有助于减少43.8%的孕妇行75 g OGTT。 结论 孕24~28周同时检测FPG及GA，可提高GDM筛查的准确性及敏感性。若FPG≥4.35 mmol/L或GA≥15.2%的孕妇需行75 g OGTT，则建议将11.1%~15.3%作为妊娠中期GA的正常参考值范围。

　　【关键词】糖尿病，妊娠;糖化血清白蛋白;空腹血糖;妊娠中晚期;切点

　　【Abstract】 Objective To explore the normal range of serum glycated albumin(GA)during the second and third trimester in pregnant women without gestational diabetes mellitus(GDM),and to evaluate the value of serum GA for diagnosing GDM. Methods A total of 189 pregnant womenwere recruited from Jun 2013 to Jan 2014,including 63 with GDM (GDM group), and 126 without GDM (NC group). The levels of GA were measured at 24~28weeks to determine the normal range for second and third trimester of pregnancy. ROC curve analysis was used to evaluatecut-off pointof the best GA and fasting plasma glucose(FPG)for screening GDM. Results (1)The normal range of GA during second and third trimester was 11.1%~15.3%. (2) When the cut point of GA was 15.2%, the sensitivity and specificity to diagnose GDM were 98.4% and 96.8% respectively. When the cut point of FPG reached 4.35 mmol/L, the sensitivity and specificity were 82.5% and 66.7% respectively. (3) 75 g oral glucose tolerance test(OGTT)is recommended to confirm GDM if FPG ≥ 4.35 mmol/L or GA≥15.2% at 24~28 weeks. This will reduce the approximately 43.8% of the official 75 g OGTT. Conclusion FPG≥4.35mmol/L or GA≥15.2% could provide a pointer for subsequent GDM diagnosis using the 75g OGTT. The present study recommended GA 11.1%~15.3% as the normal range for second and third trimester pregnant women.

　　【Key words】Gestational diabetes mellitus;Serum albumin;Fasting blood glucose; Second and third trimester ;Cut-off point