妊娠期糖尿病患者糖化血红蛋白和糖化白蛋白水平与新生儿体重的相关性

doi:10.3969/j.issn.1673-8640.2017.03.002

摘要/Abstract

摘要：

目的探讨孕晚期糖化血红蛋白（HbA_1c）和糖化白蛋白（GA）水平与妊娠期糖尿病（GDM）孕妇新生儿出生体重的相关性。方法选取孕晚期同时检测HbA_1c和GA,并有产前检测和分娩记录的孕妇322例,其中正常对照组80名、GDM组242例（分娩巨大儿25例、非巨大儿217例）。采用高效液相色谱法检测HbA_1c,采用酶法检测GA。采用Pearson相关分析评价HbA_1c、GA与GDM组新生儿出生体重的关系,采用受试者工作特征（ROC）曲线确定HbA_1c预测巨大儿的最佳临界值。结果 GDM组HbA_1c和GA水平及新生儿出生体重均明显高于正常对照组（P<0.05）。GDM组新生儿出生体重与HbA_1c呈正相关（r=0.212,P=0.001）,与GA无相关性（r=0.038,P=0.555）。根据GDM组HbA_1c水平将其分为高HbA_1c组（132例,HbA_1c>5.29%）和低HbA_1c组（110例,HbA_1c≤5.29%）。高HbA_1c组的巨大儿发生率（14.39%）明显高于低HbA_1c组（5.45%,P<0.05）。HbA_1c预测巨大儿的最佳临界值为5.25%,敏感性为76.0%,特异性为47.9%,ROC曲线下面积为0.642。结论 GDM患者HbA_1c水平与新生儿出生体重相关,HbA_1c水平越高,分娩出巨大儿的概率越高。孕妇HbA_1c可作为早期筛查巨大儿的指标。

关键词: 糖化血红蛋白, 糖化白蛋白, 妊娠期糖尿病, 新生儿, 体重

Abstract:

Objective To investigate the correlation of neonate birth weight with glycated hemoglobin A_1c（HbA_1c） and glycated albumin （GA） levels in patients with gestational diabetes mellitus（GDM）during the 3rd trimester pregnancy. Methods Totally,322 pregnant women registered for prenatal examination and delivery were enrolled. Their HbA_1c and GA levels were determined during the 3rd trimester pregnancy. They were classified into healthy control group（80 cases） and GDM group （242 cases,including 25 cases of macrosomia and 217 cases of non-macrosomia）. High-performance liquid chromatography was used to determine HbA_1c,and enzymatic method was used to determine GA. Pearson analysis was used to analyze the correlation of neonate birth weight with HbA_1c and GA,and receiver operating characteristic（ROC）curve was used to determine the optimal cut-off value of HbA_1c for the prediction of macrosomia. Results HbA_1c and GA levels in GDM group were higher than those in healthy control group（P<0.05）. HbA_1c level in GDM group and neonate birth weight were in positive correlation （r=0.212,P=0.001）,while there was no correlation with GA level （r=0.038,P=0.555）. According to HbA_1c level in GDM group,GDM group were subclassified into high HbA_1c group （132 cases,HbA_1c>5.29%） and low HbA_1c group （110 cases,HbA_1c≤5.29%）．The rate of macrosomia in high HbA_1c group （14.39%） was higher than that in low HbA_1c group（5.45%,P<0.05）. The optimal cut-off value of HbA_1c for the prediction of macrosomia was 5.25%,the sensitivity was 76.0%,the specificity was 47.9%,and the area under ROC curve was 0.642. Conclusions HbA_1c level is correlated with neonate birth weight in GDM group. Higher HbA_1c level is,higher the rate of macrosomia is. HbA_1c levels of pregnant women can become a parameter for the early screening of macrosomia.

Key words: Glycated hemoglobin A1c, Glycated albumin, Gestational diabetes mellitus, Neonates, Weight

中图分类号:

R446.1

张淳义, 倪颖华, 季鑫, 应春妹. 妊娠期糖尿病患者糖化血红蛋白和糖化白蛋白水平与新生儿体重的相关性[J]. 检验医学, 2017, 32(3): 165-168.

ZHANG Chunyi, NI Yinghua, JI Xin, YING Chunmei. Correlation of neonate birth weight with glycated hemoglobin A_1c and glycated albumin levels in patients with gestational diabetes mellitus[J]. Laboratory Medicine, 2017, 32(3): 165-168.

图/表 3

参考文献 20

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组别	例数	HbA_1c（%）	GA（%）	新生儿出生体重（g）
正常对照组	80	5.08（4.65~5.51）	12.17（10.43~13.91）	2 720.6（1 868.4~3 572.9）
GDM组	242	5.29（4.86~5.72）	12.91（11.09~14.73）	3 353.3（2 772.1~3 934.6）
P值		0.001	0.001	0.000

组别	例数	HbA_1c（%）	GA（%）	新生儿出生体重（g）
正常对照组	80	5.08（4.65~5.51）	12.17（10.43~13.91）	2 720.6（1 868.4~3 572.9）
GDM组	242	5.29（4.86~5.72）	12.91（11.09~14.73）	3 353.3（2 772.1~3 934.6）
P值		0.001	0.001	0.000

组别	例数	非巨大儿	巨大儿
低HbA_1c组	110	104（94.55）	6（5.45）
高HbA_1c组	132	113（85.61）	19（14.39）^*
合计	242	217（89.67）	25（10.33）

组别	例数	非巨大儿	巨大儿
低HbA_1c组	110	104（94.55）	6（5.45）
高HbA_1c组	132	113（85.61）	19（14.39）^*
合计	242	217（89.67）	25（10.33）