糖化血红蛋白及糖化白蛋白在高龄孕妇妊娠期糖尿病中的应用价值

doi:10.3969/j.issn.1673-8640.2018.04.008

摘要/Abstract

摘要：

目的探讨糖化血红蛋白（HbA_1c）和糖化白蛋白（GA）在高龄孕妇妊娠期糖尿病（GDM）筛查中的价值。方法选取妊娠时年龄≥35周岁的孕妇1 201名,其中血糖正常者（对照组）626名,GDM患者575例。分别采用己糖激酶法检测血糖、高效液相色谱法检测HbA_1c,酶法检测GA。将GDM患者按葡萄糖耐量试验（OGTT）3个值（空腹血糖、1 h血糖、2 h血糖）的异常个数分别分组,其中1个值异常者330例、2个值异常者170例、3个值异常者75例,分别比较各组的HbA_1c和GA水平。各项目之间的相关性采用Pearson相关分析。采用受试者工作特征（ROC）曲线及Logistic回归分析评价HbA_1c、GA诊断GDM的价值。结果与对照组比较,GDM组HbA_1c和GA水平均明显升高（P<0.01）。在GDM患者中,OGTT 3个值异常者HbA_1c水平明显高于2个值异常者和1个值异常者（P<0.01）,OGTT 3个值异常者和2个值异常者的GA水平明显高于1个值异常者（P<0.01）。相关性分析显示,HbA_1c、GA与空腹血糖呈明显正相关（r值分别为0.309、0.141,P<0.01）,HbA_1c与GA呈正相关（r=0.206,P<0.01）。ROC曲线分析显示,HbA_1c和GA联合检测诊断GDM的曲线下面积[95%可信区间（CI）]为0.851（0.821~0.881）,明显优于单项检测。结论 HbA_1c和GA联合检测对辅助诊断高龄孕妇GDM有重要价值。

关键词: 糖化血红蛋白, 糖化白蛋白, 高龄孕妇, 妊娠期糖尿病

Abstract:

Objective To investigate the roles of glycated hemoglobin A_1c（HbA_1c） and glycated albumin（GA） in screening gestational diabetes mellitus（GDM） among elderly pregnant women. Methods A total of 1 201 pregnant women ≥35 years old,including 626 cases of normal blood glucose（control group） and 575 cases of GDM,were enrolled. Blood glucose was determined by hexokinase method,HbA_1c was determined by high performance liquid chromatography,and GA was determined by enzymatic method. Patients with GDM were classified into 3 groups according to the results of oral glucose tolerance test（OGTT）（fasting blood glucose,1 h blood glucose and 2 h blood glucose）. Among them,there were 330 cases with 1 abnormal value,170 cases with 2 abnormal values and 75 cases with 3 abnormal values. The levels of HbA_1c and GA among these groups were compared. The correlation was analyzed by Pearson correlation analysis. The roles of HbA_1c and GA for the diagnosis of GDM were evaluated by receiver operating characteristic（ROC） curve and Logistic regression analysis. Results Compared with control group,the levels of HbA_1c and GA in GDM group were increased（P<0.01）. In patients with GDM,the HbA_1c level with 3 abnormal values was higher than those with 2 abnormal values and 1 abnormal value（P<0.01）. The GA levels with 3 abnormal values and 2 abnormal values were higher than that with 1 abnormal value（P<0.01）. The correlation analysis showed that HbA_1c and GA were positively correlated with fasting blood glucose（r=0.309 and 0.141,P<0.01）,and HbA_1c and GA were positively correlated（r=0.206,P<0.01）. ROC curve showed that the area under curve [95% confidence interval（CI）] of HbA_1c and GA combined determination was 0.851（0.821-0.881）,which was better than those of single determinations. Conclusions The combined determination of HbA_1c and GA plays a role in the diagnosis of GDM among elderly pregnant women.

Key words: Glycated hemoglobin A_1c, Glycated albumin, Elderly pregnant woman, Gestational diabetes mellitus

中图分类号:

R446.1

金玥雯, 岳朝艳, 应春妹. 糖化血红蛋白及糖化白蛋白在高龄孕妇妊娠期糖尿病中的应用价值[J]. 检验医学, 2018, 33(4): 312-315.

JIN Yuewen, YUE Chaoyan, YING Chunmei. Roles of glycated hemoglobin A_1c and glycated albumin in screening gestational diabetes mellitus among elderly pregnant women[J]. Laboratory Medicine, 2018, 33(4): 312-315.

图/表 3

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组别	例数	OGTT			HbA_1c（%）	GA（%）
组别	例数	空腹血糖（mmol/L）	1 h血糖（mmol/L）	2 h血糖（mmol/L）	HbA_1c（%）	GA（%）
对照组	626	4.34±0.33	7.45±1.31	6.54±1.01	4.60±0.39	12.62±0.92
GDM组	575	4.90±0.73^*	10.00±1.60^*	8.82±1.66^*	5.12±0.43^*	13.08±1.66^*

组别	例数	OGTT			HbA_1c（%）	GA（%）
组别	例数	空腹血糖（mmol/L）	1 h血糖（mmol/L）	2 h血糖（mmol/L）	HbA_1c（%）	GA（%）
对照组	626	4.34±0.33	7.45±1.31	6.54±1.01	4.60±0.39	12.62±0.92
GDM组	575	4.90±0.73^*	10.00±1.60^*	8.82±1.66^*	5.12±0.43^*	13.08±1.66^*

OGTT异常值个数	例数	HbA_1c	GA
1	330	5.03±0.38	13.00±1.51
2	170	5.11±0.43	13.24±1.79^*
3	75	5.44±4.63^*#	13.13±1.82^*

OGTT异常值个数	例数	HbA_1c	GA
1	330	5.03±0.38	13.00±1.51
2	170	5.11±0.43	13.24±1.79^*
3	75	5.44±4.63^*#	13.13±1.82^*