【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(duì)妊娠期糖尿病(gestational diabetes mellitus,GDM)的預(yù)測(cè)價(jià)值。方法隨機(jī)抽取2014年12月至2015年4月在諸城市婦幼保健院定期進(jìn)行孕期檢查的孕婦542例,全部研究對(duì)象于妊娠早期(孕8~12周)空腹采取靜脈血測(cè)定FPG水平,測(cè)量孕婦身高、體重,計(jì)算并記錄體重指數(shù)(BMI)。于妊娠24~28周時(shí)行75g葡萄糖耐量試驗(yàn)(oral glucose tolerance test,OGTT)進(jìn)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(duì)象分為GDM組(n=108例)和對(duì)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(yù)測(cè)GDM的價(jià)值。應(yīng)用spss17.0統(tǒng)計(jì)學(xué)軟件系統(tǒng)進(jìn)行數(shù)據(jù)處理,P0.05為有統(tǒng)計(jì)學(xué)差異。結(jié)果(1)GDM組孕婦妊娠早期FPG水平較對(duì)照組明顯升高,兩組比較有明顯統(tǒng)計(jì)學(xué)差異(P0.05)。GDM組和對(duì)照組的孕婦分娩孕周、新生兒體重,經(jīng)統(tǒng)計(jì)學(xué)分析均有統(tǒng)計(jì)學(xué)差異(P0.05)。(2)GDM組和對(duì)照組的妊娠早期BMI和年齡,經(jīng)統(tǒng)計(jì)學(xué)分析均有統(tǒng)計(jì)學(xué)差異(P0.05);FPG監(jiān)測(cè)孕周和OGTT監(jiān)測(cè)孕周,經(jīng)統(tǒng)計(jì)學(xué)分析均無(wú)統(tǒng)計(jì)學(xué)差異(P0.05)。(3)GDM組妊娠早期和OGTT時(shí)FPG值均高于正常組,差異具有統(tǒng)計(jì)學(xué)意義(P0.05)。正常組在妊娠早期FPG值和OGTT時(shí)FPG值相比較,差異有統(tǒng)計(jì)學(xué)意義(P0.05);GDM組在妊娠早期FPG值和OGTT時(shí)FPG值相比較,差異無(wú)統(tǒng)計(jì)學(xué)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(duì)528例研究對(duì)象妊娠早期FPG檢測(cè)的血糖值用ROC曲線進(jìn)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(yù)測(cè)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(yáng)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(duì)照組,兩組比較差異有統(tǒng)計(jì)學(xué)意義。(2)不同妊娠時(shí)期FPG有預(yù)測(cè)GDM價(jià)值的界值可能不同,篩查時(shí)期越早,有意義的界值可能越高。(3)妊娠早期FPG水平監(jiān)測(cè)對(duì)GDM發(fā)病有一定預(yù)測(cè)價(jià)值,把妊娠早期FPG值5.07mmol/L作為一個(gè)GDM的預(yù)測(cè)值,具有一定的臨床應(yīng)用價(jià)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(xué)位授予單位】：青島大學(xué)
【學(xué)位級(jí)別】：碩士
【學(xué)位授予年份】：2017
【分類號(hào)】：R714.256

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