糖化血紅蛋白測(cè)定在妊娠期糖尿病篩查中的應(yīng)用與評(píng)價(jià)

DOC格式論文，方便您的復(fù)制修改刪減DOC格式論文，方便您的復(fù)制修改刪減糖化血紅蛋白測(cè)定在妊娠期糖尿病篩查中的應(yīng)用與評(píng)價(jià)（作者: 單: 郵: ）作者：龐玲霞，王友沛，葛海峰，龔永生，鄭美琴（HbAlc）的測(cè)定在妊娠期糖尿?。℅DM）318例、妊691050g葡萄糖篩選實(shí)驗(yàn)）和c測(cè)定。并通過(guò)ROCFPG，OGCTHbAlcGDM篩查中的應(yīng)用價(jià)值。Pc在M82.997.894.1HbAlcGDMROC曲線下面積（AUC%）83.5%、91.8%和90.6%。OGCT7.8mmol/L68.6%、96.5%；HbAlc的診斷界點(diǎn)6.0%對(duì)應(yīng)的敏感性、特異性為82.997.8%。結(jié)論：通過(guò)ROCGDM篩查中FPGGDM篩查診斷的指標(biāo)?！娟P(guān)鍵詞】糖化血紅蛋白；妊娠期糖尿??；篩查；ROC曲線Abstract:Objective:Toinvestigatethecontributionandvalueofglycosylatedhemoglobin（HbAlc）testinthescreeningofgestationaldiabetesmellitus.Methods:Thefastingbloodsugar，oralglucosescreenandHbA1cweremeasuredin318ofnormalgestationwomengroup，60ofimpairedglucosetolerancegroupand105ofgestationaldiabetesmellitusgroup.TheevaluationofsignificanceofFPG，OGCTandHbAlcinGDMScreeningwereevaluatedusingthereceiver-operatingcharacteristic(ROC)curves.Results:ThelevelsofFPG，OGCTandHbAlcweresignificantlyhigherthanthoseinnormalgestationgroupandimpairedglucosetolerancegroup(P0.05).ThepositiverateofHbAlcinnormalgestationwomengroup，impairedglucosetolerancegroupandgestationaldiabetesmellitusgroupwereandrespectively.Thepositiverateofgestationaldiabetesmellitusgroupwasobviouslyhigherthanthoseinnormalgestationgroupandimpairedglucosetolerancegroup(P0.05).Thesensitivity，specificity，dependabilityandpredictingpositivelyofHbAlctestinscreeninggestationaldiabetesmellituswere82.9%，97.8%，94.1%，andTheareaunderthecurve(AUC)ofFPG，OGCTandHbAlcwas83.5%，91.8%and0.6%，respectively.forGDMandwiththeoptimalcut-offvalueof7.8mmol/L，OCGTshowedadiagnosticsensitivityof68.6%andspectificityof96.5%；andtheoptimalcut-offvalueof6.0%，HbAlcshowedadiagnosticsensitivityof82.9%andspectificityof97.8%. Conculsion: HbAlc can be served as an index forgestationaldiabetesmellitusscreeninganddiagnoses.Keywords:glycosylatedhemoglobin；gestationaldiabetesmellitus；screen；ROCcurves妊娠期糖尿?。╣estationaldiabetesmel-litus，GDM）是婦女2%～8%FPGGDM漏診而延誤治療，具有很大危害[1]50g葡萄糖（oralglucosechallengetest，OGCT）作篩查妊娠糖尿病試驗(yàn)，且需在此試驗(yàn)上進(jìn)一步進(jìn)行葡萄糖耐量試驗(yàn)（oralglucose75gtolerancetest，OGTT[2]）[3]，操作繁瑣，受多種因素影響，給病人帶來(lái)痛苦和不便。目前，糖化血紅蛋白（glycosylated作為糖尿病篩查、診斷、血HbAlc在妊娠糖尿病篩查中的價(jià)值。對(duì)象和方法對(duì)象2003120088492例，包括正常妊娠組318例，年齡22～43（30.3±4.3）歲，孕周周，其中9669（26.8±1.8）1810520～42（30.9±5.4）歲，孕周（26.5±5.3）周，其中經(jīng)產(chǎn)婦32例。該研究經(jīng)醫(yī)院倫理委員會(huì)批準(zhǔn)。方法血糖檢測(cè)：晨空腹采靜脈血測(cè)定FPG，同時(shí)進(jìn)行50g葡萄糖篩選實(shí)驗(yàn)，于服葡萄糖1hSYNCHRONLX20HbA1c2TOSOHHLC723G7高HbA1cGDM在未接受治療前抽血。診斷標(biāo)準(zhǔn)G≥1mmol/L為陽(yáng)性，T≥8mmol/L為陽(yáng)性，HbAlc6.0%為陽(yáng)性。統(tǒng)計(jì)學(xué)處理方法qSPSS軟件建立C曲線，計(jì)算曲線下面積。結(jié)果FPG，OGCT，HbAlcGDMFPG，OGCT，HbAlcGIGT，見(jiàn)表。FPG，OGCT，HbAlcGDMGIGTP，見(jiàn)表。各指標(biāo)的敏感性、特異性、可靠性及陽(yáng)性預(yù)示值HbAlcGDM。ROC曲線分析ROC越大，曲線越凸越接近左上角，表明其診斷價(jià)值HbAlcGDMROC（AUC%）83.590.6OGCT7.8mmol/L68.6%、96.5%；HbAlc6.0%82.9HbAlcFPG；其OGCTHbAlcAUC(POGCT，。討論妊娠期特別是孕晚期的孕婦處于一種致糖尿病狀態(tài)，此時(shí)機(jī)體GDM2GDM國(guó)際學(xué)術(shù)會(huì)議建議對(duì)所有GDMGDM篩查方法是空腹血糖和糖篩查實(shí)驗(yàn)。孕期僅依靠常規(guī)G檢查容易造成M漏診GDM國(guó)際委員會(huì)推薦的篩查措施是24～28OGCTGDM[1上逐漸推廣使用c對(duì)M]血糖反映瞬時(shí)血糖值之不足，又可避免過(guò)程復(fù)雜且重復(fù)性差的OGCT。HbAlcHbAlc的測(cè)定可反映測(cè)定前6～10周內(nèi)的平均血糖水平，是判定糖尿病長(zhǎng)期HbAlc[5]。Rohlfing[6-7]認(rèn)為，HbAlc的診斷篩查中的效能評(píng)價(jià)包括敏感性和特異性還不甚清楚。本組資料表明FPG，OGCT，HbAlc69GDM中，F(xiàn)PG4240.0%FPGGDM60.0%（63/105）的病人漏診，這HbAlc71.4%（45/63）患者被重新HbAlcGDM等[8]HbAlc僅僅是一個(gè)補(bǔ)充診斷，認(rèn)為OGCT才適合篩查。我們的研究發(fā)現(xiàn)，HbAlc82.9%)(Rahlenbeck[9-10]ROC曲線可觀察到，HbAlcAUCFPGHbAlc的診斷界點(diǎn)對(duì)應(yīng)的敏感性明顯高于OGCT，進(jìn)一步提示HbAlc診斷GDMHbAlcHbAlc的測(cè)定很可能GDM的篩查方法?！緟⒖嘉墨I(xiàn)】曾衛(wèi)民,李文凱,吳意.較[J].,2003,13(14):69-71.謝幸,.[M].6版.:人民衛(wèi)生出版社,2004:160.RohlfingCL,LittleRR,WiedmeyerHM.UseofGH(HbAlc)inscreeningforundiagnoseddiabetesintheUSpopulation[J].DiabetesCare,2000,23(2):187-191.KilpatrickES,RigbyAS,AtkinSL,etal.Variabilityintherela-tionshipbetweenmeanplasmaglucoseandHbAlc:implica-tionsfortheassessmentofglycemiccontrol[J].ClinChemMay,2007,53(5):897-901.馬勇,覃艷玲.[J].,2004,12(6):87-91.GuerinA,NisenbaumR,JoelGR.Uesofmaternalglycosylatedhemoglobinconcentrationtoestimatetheriskofcongeni-talanomaliesintheoffspringofwomenwithpre-pregnancydiabetesCare,2007,30:(7)1920-1925.

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