【摘要】：目的探討妊娠早期(孕8~12周)空腹血糖(fasting plasma glucose,FPG)水平對妊娠期糖尿病(gestational diabetes mellitus,GDM)的預測價值。方法隨機抽取2014年12月至2015年4月在諸城市婦幼保健院定期進行孕期檢查的孕婦542例,全部研究對象于妊娠早期(孕8~12周)空腹采取靜脈血測定FPG水平,測量孕婦身高、體重,計算并記錄體重指數(shù)(BMI)。于妊娠24~28周時行75g葡萄糖耐量試驗(oral glucose tolerance test,OGTT)進行妊娠期糖尿病(GDM)診斷,最終入組者528例。按照OGTT結(jié)果將研究對象分為GDM組(n=108例)和對照組(n=420例),追蹤孕婦直至分娩,記錄孕婦分娩孕周及新生兒體重。比較兩組孕婦(1)妊娠早期(孕8~12周)FPG水平、分娩孕周、新生兒體重的差異;(2)一般資料差異;(3)妊娠早期不同F(xiàn)PG水平妊娠期糖尿病的檢出率的差異;(4)采用受試者工作特征(ROC)曲線分析FPG水平預測GDM的價值。應用spss17.0統(tǒng)計學軟件系統(tǒng)進行數(shù)據(jù)處理,P0.05為有統(tǒng)計學差異。結(jié)果(1)GDM組孕婦妊娠早期FPG水平較對照組明顯升高,兩組比較有明顯統(tǒng)計學差異(P0.05)。GDM組和對照組的孕婦分娩孕周、新生兒體重,經(jīng)統(tǒng)計學分析均有統(tǒng)計學差異(P0.05)。(2)GDM組和對照組的妊娠早期BMI和年齡,經(jīng)統(tǒng)計學分析均有統(tǒng)計學差異(P0.05);FPG監(jiān)測孕周和OGTT監(jiān)測孕周,經(jīng)統(tǒng)計學分析均無統(tǒng)計學差異(P0.05)。(3)GDM組妊娠早期和OGTT時FPG值均高于正常組,差異具有統(tǒng)計學意義(P0.05)。正常組在妊娠早期FPG值和OGTT時FPG值相比較,差異有統(tǒng)計學意義(P0.05);GDM組在妊娠早期FPG值和OGTT時FPG值相比較,差異無統(tǒng)計學意義(P0.05)。(4)隨妊娠早期FPG水平的逐漸升高,GDM的發(fā)病率逐漸增加。(5)對528例研究對象妊娠早期FPG檢測的血糖值用ROC曲線進行分析,表明ROC曲線下面積為0.725(95%CI為0.685~0.763),孕早期FPG水平預測GDM的最佳診斷界值在5.07mmol/L,此界值診斷GDM的靈敏度為66.67%,特異度為71.98%。選取不同界值,將獲得不同的GDM篩查的靈敏度和特異度,隨著妊娠早期FPG值的逐漸上升,OGTT陽性率明顯增加,而篩查GDM的靈敏度逐漸下降,特異度逐漸上升。結(jié)論(1)GDM組妊娠早期FPG值顯著高于對照組,兩組比較差異有統(tǒng)計學意義。(2)不同妊娠時期FPG有預測GDM價值的界值可能不同,篩查時期越早,有意義的界值可能越高。(3)妊娠早期FPG水平監(jiān)測對GDM發(fā)病有一定預測價值,把妊娠早期FPG值5.07mmol/L作為一個GDM的預測值,具有一定的臨床應用價值。
[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.
【學位授予單位】：青島大學
【學位級別】：碩士
【學位授予年份】：2017
【分類號】：R714.256

【參考文獻】

相關期刊論文 前10條

1 車榮華;黃亞絹;;妊娠6～24周空腹血糖預測妊娠期糖尿病的意義[J];上海交通大學學報(醫(yī)學版);2013年04期

2 車榮華;黃亞絹;;妊娠期糖尿病空腹血糖篩查的意義及其對妊娠結(jié)局的影響[J];國際婦產(chǎn)科學雜志;2012年04期

3 陳利春;陳冠軍;葉俊良;黃大雁;劉治春;孫玉秀;汪凌云;陳莉;魯云霞;;妊娠期糖尿病患者脂肪細胞因子與炎癥的相關性分析[J];安徽醫(yī)科大學學報;2012年07期

4 劉陶;房臻;楊冬;劉晴;;炎性及脂肪細胞因子與妊娠期糖尿病發(fā)病的相關性及在產(chǎn)褥期的變化[J];中華婦產(chǎn)科雜志;2012年06期

5 魏玉梅;楊慧霞;;妊娠期糖尿病不同診斷標準適宜性的比較[J];中華婦產(chǎn)科雜志;2011年08期

6 楊慧霞;;重視妊娠期糖尿病國際新標準的臨床應用[J];國際婦產(chǎn)科學雜志;2011年03期

7 劉陶;劉晴;楊冬;房臻;;早孕期血清脂聯(lián)素、瘦素、腫瘤壞死因子α、C反應蛋白水平與胰島素抵抗的相關性[J];中華醫(yī)學雜志;2011年15期

8 趙丹青;楊慧霞;魏玉梅;董燕;;妊娠早期空腹血漿血糖與妊娠期糖尿病診斷的相關性[J];中華圍產(chǎn)醫(yī)學雜志;2011年04期

9 吳春鳳;楊慧霞;;早孕期空腹血漿血糖與妊娠期糖代謝異常的相關性[J];中華圍產(chǎn)醫(yī)學雜志;2011年03期

10 耿迎春;王茜;李軼林;陳旭;徐榮春;張靜;;血清瘦素、血鐵蛋白濃度的研究對妊娠期糖尿病早期篩查的價值[J];齊齊哈爾醫(yī)學院學報;2010年24期

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