糖化血红蛋白测定在妊娠期糖尿病筛查中的应用与评价

目的：探讨糖化血红蛋白（HbAlc）的测定在妊娠期糖尿病（GDM）筛查中的作用和意义。方法：正常妊娠组318例、妊娠期糖耐量异常组69例及妊娠期糖尿病组105例分别进行空腹血糖（FPG）、50 g葡萄糖筛选实验（OGCT）和HbAlc测定。并通过ROC曲线评价FPG,OGCT和HbAlc在GDM筛查中的应用价值。结果：妊娠期糖尿病组FPG,OGCT,HbAlc水平均高于正常妊娠组（P〈0.05）,HbAlc在GDM筛查中敏感性、特异性、可靠性和阳性预示值分别为82.9%、97.8%、94.1%和92.6%;FPG,OGCT和HbAlc诊断GDMROC曲线下面积（AUC%）分别为83.5%、91.8%和90.6%。OGCT的诊断界点7.8 mmol/L对应的敏感性和特异性为68.6%、96.5%;HbAlc的诊断界点6.0%对应的敏感性、特异性为82.9%、97.8%。结论：通过ROC曲线评价,HbAlc在GDM筛查中的诊断效率明显高于FPG,可作为临床GDM筛查诊断的指标。

Application and evaluation of significance of glycosylated hemoglobin test in gestational diabetes mellitus screening

Objective：To investigate the contribution and value of glycosylated hemoglobin（HbAlc）test in the screening of gestational diabetes mellitus.Methods：The fasting blood sugar,oral glucose screen and HbA1c were measured in 318 of normal gestation women group,60 of impaired glucose tolerance group and 105 of gestational diabetes mellitus group.The evaluation of significance of FPG,OGCT and HbAlc in GDM Screening were evaluated using the receiver-operating characteristic（ROC） curves.Results：The levels of FPG,OGCT and HbAlc in GDM Screening were evaluated using the receiver-operating characteristic （ROC） curves. Results： The levels of FPG, OGCT and HbA1c were significantly higher than those in normal gestation group and impaired glucose tolerance group （P〈O.05）. The positive rate of HbAlc in normal gestation women group, impaired glucose tolerance group and gestational diabetes mellitus group were 2.2%, 43.5% and 82.9%, respectively. The positive rate of gestational diabetes mellitus group was obviously higher than those in normal gestation group and impaired glucose tolerance group （P〈O.O5）.The sensitivity, specificity, dependability and predicting positively of HbAlc test in screening gestational diabetes mellitus were 82.9%, 97.8%, 94.1%, and 92.6%,respectively. The area under the curve （AUC） of FPG, OCT and HbAlc was 83.5%,91.8%and 0.6%, respectively, for GDM diagnosis, and with the optimal cut-off value of 7.8 mmol/L, OCGT showed a diagnostic sensitivity of 68.6% and speetificity of 96.5% ; and the optimal cut-off value of 6.0%, HbAlc showed a diagnostic sensitivity of 82.9% and spectificity of 97,8%. Conculsion： HbAlc can be served as an index for gestational diabetes mellitus screening and diagnoses.