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目的探讨妊娠糖尿病(GDM)患者糖化血红蛋白(HbA1c)测定的临床意义。方法测定279例妊娠糖尿病(GDM)孕妇、101例糖耐量低减(GIGT)孕妇和309例糖耐量正常(NGT)孕妇的空腹血糖(FPG)和50g糖筛查(GCT)的水平,其中50gGCT结果异常者且未达到诊断GDM的标准,再进行75g葡萄糖耐量试验(OGTT),同时对所有研究对象均进行HbA1c的测定并根据其的水平高低分组进行并发症的统计。结果(1)GDM组HbA1c、FPG、50g糖筛查结果与NGT组比较均明显增高,差异有统计学意义(P<0.01);(2)HbA1c的阳性率在GDM组为37.3%,虽然单用该指标来筛查诊断的敏感性偏低,但结合FPG可减少单用FPG来诊断的漏诊率。而且GDM患者的并发症随HbA1c的增高而增多。结论HbA1c在GDM的筛查、诊断及其预后评估中具有重要意义。
Objective To investigate the clinical significance of determination of HbA1c in patients with gestational diabetes mellitus (GDM). Methods Fasting plasma glucose (FPG) and 50g glucose screening (GCT) were measured in 279 pregnant women with gestational diabetes mellitus (GDM), 101 pregnant women with impaired glucose tolerance (GIGT) and 309 pregnant women with normal glucose tolerance (NGT) Results were abnormal and did not meet the criteria for the diagnosis of GDM, and then 75g glucose tolerance test (OGTT), while all subjects were measured HbA1c and according to the level of sub-group complication statistics. Results (1) The results of screening HbA1c, FPG and 50g sugar in GDM group were significantly higher than those in NGT group (P <0.01). (2) The positive rate of HbA1c in GDM group was 37.3% The sensitivity of screening for this indicator is low, but binding to FPG reduces the rate of misdiagnosis diagnosed with FPG alone. And the complication of GDM patients increased with the increase of HbA1c. Conclusion HbA1c plays an important role in the screening, diagnosis and prognosis evaluation of GDM.