妊娠早期空腹血糖水平对妊娠期糖尿病预测价值

发布时间：2018-09-04 16:02

【摘要】：目的探讨妊娠早期(孕8~12周)空腹血糖(fasting plasma glucose,FPG)水平对妊娠期糖尿病(gestational diabetes mellitus,GDM)的预测价值。方法随机抽取2014年12月至2015年4月在诸城市妇幼保健院定期进行孕期检查的孕妇542例,全部研究对象于妊娠早期(孕8~12周)空腹采取静脉血测定FPG水平,测量孕妇身高、体重,计算并记录体重指数(BMI)。于妊娠24~28周时行75g葡萄糖耐量试验(oral glucose tolerance test,OGTT)进行妊娠期糖尿病(GDM)诊断,最终入组者528例。按照OGTT结果将研究对象分为GDM组(n=108例)和对照组(n=420例),追踪孕妇直至分娩,记录孕妇分娩孕周及新生儿体重。比较两组孕妇(1)妊娠早期(孕8~12周)FPG水平、分娩孕周、新生儿体重的差异;(2)一般资料差异;(3)妊娠早期不同FPG水平妊娠期糖尿病的检出率的差异;(4)采用受试者工作特征(ROC)曲线分析FPG水平预测GDM的价值。应用spss17.0统计学软件系统进行数据处理,P0.05为有统计学差异。结果(1)GDM组孕妇妊娠早期FPG水平较对照组明显升高,两组比较有明显统计学差异(P0.05)。GDM组和对照组的孕妇分娩孕周、新生儿体重,经统计学分析均有统计学差异(P0.05)。(2)GDM组和对照组的妊娠早期BMI和年龄,经统计学分析均有统计学差异(P0.05);FPG监测孕周和OGTT监测孕周,经统计学分析均无统计学差异(P0.05)。(3)GDM组妊娠早期和OGTT时FPG值均高于正常组,差异具有统计学意义(P0.05)。正常组在妊娠早期FPG值和OGTT时FPG值相比较,差异有统计学意义(P0.05);GDM组在妊娠早期FPG值和OGTT时FPG值相比较,差异无统计学意义(P0.05)。(4)随妊娠早期FPG水平的逐渐升高,GDM的发病率逐渐增加。(5)对528例研究对象妊娠早期FPG检测的血糖值用ROC曲线进行分析,表明ROC曲线下面积为0.725(95%CI为0.685~0.763),孕早期FPG水平预测GDM的最佳诊断界值在5.07mmol/L,此界值诊断GDM的灵敏度为66.67%,特异度为71.98%。选取不同界值,将获得不同的GDM筛查的灵敏度和特异度,随着妊娠早期FPG值的逐渐上升,OGTT阳性率明显增加,而筛查GDM的灵敏度逐渐下降,特异度逐渐上升。结论(1)GDM组妊娠早期FPG值显著高于对照组,两组比较差异有统计学意义。(2)不同妊娠时期FPG有预测GDM价值的界值可能不同,筛查时期越早,有意义的界值可能越高。(3)妊娠早期FPG水平监测对GDM发病有一定预测价值,把妊娠早期FPG值5.07mmol/L作为一个GDM的预测值,具有一定的临床应用价值。
[Abstract]:Objective To investigate the predictive value of fasting plasma glucose (FPG) level in early pregnancy (8-12 weeks gestation) for gestational diabetes mellitus (GDM). During 8-12 weeks of gestation, fasting blood was taken to measure the level of FPG, the height and weight of pregnant women were measured, and body mass index (BMI) was calculated and recorded. Comparing the two groups of pregnant women (1) FPG levels in early pregnancy (8-12 weeks of gestation), gestational weeks of delivery, and neonatal weight differences; (2) general data differences; (3) differences in the detection rate of gestational diabetes mellitus at different levels of FPG in early pregnancy; (4) employing subjects The value of predicting GDM by FPG level was analyzed by ROC curve. The data were processed by SPSS 17.0 statistical software system, and the difference was statistically significant (P 0.05). There were significant differences in BMI and age between GDM group and control group (P 0.05). (2) There were significant differences in BMI and age between GDM group and control group (P 0.05). FPG monitoring gestational weeks and OGTT monitoring gestational weeks had no significant difference (P 0.05). (3) FPG values of GDM group in early pregnancy and OGTT were higher than those of normal group, the difference was significant. There was no significant difference in FPG value between GDM group and OGTT group (P 0.05). (4) With the increase of FPG level in early pregnancy, the incidence of GDM increased gradually. (5) 528 pregnant subjects were pregnant. The ROC curve was used to analyze the blood glucose values of early FPG detection. The results showed that the area under the ROC curve was 0.725 (95% CI 0.685-0.763), and the best diagnostic threshold for predicting GDM was 5.07 mmol/L. The sensitivity and specificity of this threshold were 66.67% and 71.98% respectively. With the increase of FPG value in early pregnancy, the positive rate of OGTT increased significantly, while the sensitivity and specificity of GDM screening decreased gradually. Conclusion (1) FPG value in early pregnancy of GDM group was significantly higher than that of control group, the difference was statistically significant. (2) The threshold value of FPG in predicting GDM at different gestational stages may be different, and the earlier the screening period, the higher the specificity. (3) Monitoring of FPG level in early pregnancy has certain predictive value for GDM. Taking the FPG value of 5.07 mmol/L in early pregnancy as a predictive value of GDM has certain clinical application value.
【学位授予单位】：青岛大学
【学位级别】：硕士
【学位授予年份】：2017
【分类号】：R714.256

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