| 张雪琼,任卫红,万思然,等.妊娠 8~14周血清糖化血红蛋白联合空腹血浆葡萄糖、胰岛素抵抗指数预测妊娠糖尿病的临床价值[J].安徽医药,2021,25(10):2032-2035. |
| 妊娠 8~14周血清糖化血红蛋白联合空腹血浆葡萄糖、胰岛素抵抗指数预测妊娠糖尿病的临床价值 |
| Clinical value of serum HbAlc combined with FPG and HOMA-IR in predicting gestational diabetes mellitus from 8 to 14 weeks |
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| DOI：10.3969/j.issn.1009-6469.2021.10.028 |
| 中文关键词: 糖尿病，妊娠 糖化血红蛋白 血糖 胰岛素抵抗指数 妊娠初期 |
| 英文关键词: Diabetes, gestational HbAlc Blood glucose HOMA-IR Pregnancy trimester,first |
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| 中文摘要: |
| 目的探析孕 8~14周血清糖化血红蛋白( HbA1c)联合空腹血浆葡萄糖( FPG)以及胰岛素抵抗指数( HOMA-IR)对妊娠糖尿病( GDM)的预测价值。方法回顾性分析 2016年 1月至 2018年 6月在雅安市人民医院进行常规性孕前检查的孕妇 5 124名，收集其基本资料及孕 8~14周的血清中 HbA1c、FPG及 HOMA-IR。按其孕 24~28周空腹葡萄糖耐受试验( OGTT)筛查结果分为 GDM组和非 GDM组。比较组间基本资料以及 HbA1c、FPG、HOMA-IR差异。采用多因素 logistic回归分析 GDM的相关因素，并建立联合诊断模型。绘制受试者工作特征曲线( ROC)，Hanley-McNeil方法比较曲线下面积。分析 HbA1c联合 FPG、HOMA-IR对 GDM的预测价值。结果 5 124名孕妇中，合并 GDM的孕妇有 526名( 10.26%)糖代谢正常孕妇 4 598名(89.74%)。 GDM组孕妇血清中的 HbA1c(5.47±0.37)%、FPG(5.18±0.32)mmol/L及 HOMA-IR(3.32±0.8，4)均高于正常孕妇清中的 HbA1c(5.01±0.14)%、FPG(5.02±0.39)mmol/L及 HOMA-IR(2.17±0.26)。 logistic多因素回归分析显示 HbA1c(OR=1.390， 95%CI:1.046~1.846)、 FPG(OR=1.323，95%CI:1.020~1.717)、和 HOMA-IR(OR=1.831，95%CI:1.104~3.036)是 GDM发生的独立危险因素( P<0.05)。通过回归模型中的概率预测值 P来拟合联合检测的 ROC曲线，与各指标单独检测的结果进行比较，发现预测模型检测的曲线下面积( 0.871)高于单独检测( P<0.05)。结论血清 HbA1c联合 FPG、HOMA-IR对妊娠糖尿病早期诊断的灵敏度较好，有良好的预测价值。 |
| 英文摘要: |
| Objective To investigate the predictive value of serum glycosylated hemoglobin (HbA1c) combined with fasting plasmaglucose (FPG) and insulin resistance index (HOMA-IR) for gestational diabetes mellitus (GDM) at 8 to 14 weeks of gestation.Methods Five thousand one hundred and twenty-four pregnant women who underwent routine pre-pregnancy examinations in Ya'an People'sHospital from January to February 2018 were retrospectively analyzed, the basic data, serum HbA1c, FPG and (HOMA-IR from 8 to 14 weeks of gestation were collected. All subjects underwent OGTT screening at 24-28 weeks of gestation and were divided into GDM and non-GDM groups according to the GDM diagnostic method. The basic data between groups and the differences of HbA1c, FPG andHOMA-IR were compared. Multivariate logistic regression was used to analyze the relevant factors of GDM and establish a joint diagnosis model. The predictive value of HbA1c combined with FPG and HOMA-IR for GDM was analyzed, and receiver operating characteristic curve (ROC) and the Hanley-McNeil method was used to compare the area under the curve.Results Of the 5124 pregnant women, 526 were pregnant with GDM, accounting for 10.26%, and 4598 were pregnant with normal glucose metabolism, accounting for89.74%. The serum levels of HbA1c (5.47±0.37)%, FPG (5.18±0.32) mmol/L and HOMA-IR (3.32±0.84) in GDM group were higherthan those in normal pregnant women [HbA1c (5.01±0.14)%, FPG (5.02±0.39) mmol/L and HOMA-IR (2.17±0.26)]. Logistic multivariate regression analysis showed HbA1c (OR=1.390, 95%CI: 1.046-1.846), FPG (OR=1.323, 95%CI: 1.020-1.717), HOMA-IR (OR= 1.831, 95%CI: 1.104-3.036) were an independent risk factors for GDM (P<0.05). The ROC curve of the joint detection was fitted by theprobability prediction value p in the prediction model, and the results of the separate detection of each index were compared. The combination module displayed a higher AUC (0.871) compared with individual detection and has good predictive value (P<0.05).Conclu? sion Serum HbA1c combined with FPG and HOMA-IR has good sensitivity and specificity for early diagnosis of gestational diabetes, and has good predictive value. |
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