[1]何宇辉*,王宝娣,蒋玲,等.糖化血红蛋白联合血细胞比容在早期筛查妊娠期糖尿病中的价值[J].中国计划生育和妇产科,2020,(9):63-67.
　HE Yuhui*,WANG Baodi,JIANG Ling,et al.The value of HbA1c combined with haematocrit for early screening of gestational diabetes mellitus[J].Chinese Journal of Family Planning & Gynecotokology,2020,(9):63-67.
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糖化血红蛋白联合血细胞比容在早期筛查妊娠期糖尿病中的价值
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《中国计划生育和妇产科》[ISSN:1674-4020/CN:51-1708/R]

卷:
期数:
2020年9期
页码:
63-67
栏目:
论著与临床
出版日期:
2020-09-25

文章信息/Info

Title:
The value of HbA1c combined with haematocrit for early screening of gestational diabetes mellitus
作者:
何宇辉1*; 王宝娣1; 蒋玲1; 陈华2; 王莹3
1.224200江苏盐城，南通大学附属东台医院妇产科；2.224000江苏盐城，东台市妇幼保健院妇产科；
Author(s):
HE Yuhui1*; WANG Baodi1; JIANG Ling1; CHEN Hua2; WANG Ying3
1.Department of Obstetrics and Gynecology,Dongtai Hospital Affiliated of Nantong University,Yancheng Jiangsu 224200;2.Department of Obstetrics and Gynecology,Dongtai Maternal and Child Health Hospital,Yancheng Jiangsu 224000;3.Department of Obstetrics and
关键词:
妊娠期糖尿病; 早期筛查; 糖化血红蛋白; 血细胞比容
Keywords:
gestational diabetes mellitus;  early screening;  glycosylated hemoglobin;  hematocrit
分类号:
R 714256
摘要:
目的评估糖化血红蛋白（haemoglobin A1c，HbA1c）与血细胞比容（haematocrit，HCT）联合用于妊娠12~16周筛查妊娠期糖尿病（gestational diabetes mellitus ，GDM）的价值。方法选择2016年1月至2019年1月在南通大学附属东台医院行孕12~16周的产前筛查孕妇120例，所有研究对象在孕12~16周接受HbA1c和HCT的常规血液检查，并在孕24~28周接受75 g口服葡萄糖耐量试验。采用ROC曲线评估HbA1c在联合或不联合HCT的情况下的诊断效能。结果共21名孕妇在孕24~28周诊断为GDM。 12~16周的HbA1c截断值<455 ％时，对诊断GDM具有足够的敏感度（848 ％），但特异度较低（178 ％），而HbA1c截断值≥525 ％时，表现出足够的特异度（742 ％）,但敏感度低（375 ％）。12~16周HbA1c诊断GDM的ROC下面积为0578（95 ％ CI:0520712，P=0041）。 当HbA1c与HCT（>388 ％）联合用于筛查GDM时，ROC下面积为0725（95 ％ CI:05160785，P= 003）。结合HCT（>388 ％），使用HbA1c≥525 ％的截断值诊断GDM的特异度为699 ％，敏感度为682 ％，PPV为606 ％，NPV为826 ％。此时约登指数最高为0381。结论HbA1c作为GDM的筛查手段是否会使孕妇受益仍有待确定。但联合HbA1c与HCT可能是早期筛查GDM的有效工具。
Abstract:
Objective To evaluate the value of haemoglobin A1c (HbA1c) combined with haematocrit (HCT) for screening gestational diabetes mellitus (GDM) at 12~16 weeks of pregnancy.MethodsSelected 120 pregnant women from 12 to 16 weeks of pregnancy receiving prenatal screening at Dongtai Hospital Affiliated to Nantong University from January 2016 to January 2019. All women underwent routine blood tests for HbA1c and HCT at 12~16 weeks of pregnancy, and received a 75 g oral glucose tolerance test at 24~28 weeks of pregnancy. ROC curve was used to evaluate the diagnostic efficacy of HbA1c with or without HCT.ResultsA total of 21 pregnant women were diagnosed with GDM between 24 and 28 weeks of gestation. When the cutoff value of HbA1c was less than 455 % at 12 to 16 weeks, it had sufficient sensitivity (848 %) for diagnosis of GDM, but the specificity was low (178 %). When the cutoff value of HbA1c was ≥525 %,it showed sufficient specificity (742 %) but low sensitivity (375 %).The area under ROC for HbA1c diagnosis of GDM at 12~16 weeks was 0578 (95 % CI:0520712,P=0041). When HbA1c was used in combination with HCT (>388 %) to screen for GDM, the area under ROC was 0725 (95 % CI:05160785,P=003). Combined with HCT (>388 %), the specificity of diagnosis of GDM using a cutoff value of HbA1c ≥525 % was 699 %, sensitivity was 682 %,PPV was 606 %, and NPV was 826 %. At this time, the Jordan index was 0381.ConclusionWhether HbA1c as a screening tool for GDM will benefit pregnant women remains to be determined. However, combining HbA1c with HCT may be an effective tool for early screening of GDM.

参考文献/References:

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备注/Memo

备注/Memo:
江苏省卫生计生委2017年医学科研课题（项目编号：Z 201718）
更新日期/Last Update: 2020-09-25