基于糖化血红蛋白、糖化白蛋白和空腹血糖的妊娠期糖尿病预测模型的研究

Predictive model of gestational diabetes mellitus based on glycated hemoglobin, glycated albumin and fasting blood glucose

  • 摘要:
      目的  观察基于糖化血红蛋白(HbA1c)、糖化白蛋白(GA)和空腹血糖(FBG)的妊娠期糖尿病(GDM)预测模型的应用效果。
      方法  选取产前检测以及分娩的孕妇3 132例,其中GDM组2 070例,非GDM组(血糖正常)1 062例。分析孕早、晚期2组HbA1c、GA、FBG水平; 采用logistic回归分析构建GDM预测模型; 应用受试者工作特征(ROC)曲线,计算曲线下面积(AUC)以评价模型效果。
      结果  孕早期GDM组GA、FBG水平高于非GDM组,差异有统计学意义(P<0.05), 2组HbA1c比较,差异无统计学意义(P>0.05); 孕晚期GDM组HbA1c、GA和FBG水平均高于非GDM组,差异有统计学意义(P<0.05)。预测模型显示,孕早期GA、FBG为GDM发生的影响因素,孕晚期HbA1c、GA、FBG均为GDM发生的影响因素; 孕早期GA的AUC高于HbA1c, 而孕晚期刚好相反,联合预测的AUC均高于单独指标检测。
      结论  GDM预测模型具有较好的效果。HbA1c、GA、FBG在孕早、晚期对GDM的预测效果不同,应根据孕期不同阶段联合使用各指标,以为GDM的临床诊断和治疗提供参考依据。

     

    Abstract:
      Objective  To observe the effect of predictive model of gestational diabetes mellitus (GDM) based on glycated hemoglobin (HbA1c), glycated albumin (GA) and fasting blood glucose (FBG).
      Methods  A total of 3 132 pregnant women who underwent prenatal testing and delivery were selected, and divided into GDM group (n=2 070) and non-GDM group (n=1 062, normal blood glucose). The levels of HbA1c, GA and FBG in the two groups were analyzed in the early and last pregnancy. The GDM prediction model was established by logistic regressive analysis. Receiver operating characteristic (ROC) curve was used to calculate area under the curve (AUC) to evaluate the effect of the model.
      Results  The levels of GA and FBG in the GDM group in the early pregnancy were significantly higher than those in the non-GDM group (P<0.05); there was no significant difference in HbA1c between the two groups (P>0.05). The levels of HbA1c, GA and FBG in the GDM group in the late pregnancy were significantly higher than those in the non-GDM group (P<0.05). The predictive model showed that the GA and FBG in the early pregnancy were the influencing factors for GDM, while the HbA1c, GA and FBG were all influencing factors for GDM in the late pregnancy. The AUC of GA in early pregnancy was higher than that of HbA1c, while it was opposite in late pregnancy. The AUC of combined prediction was higher than that of single indicator detection.
      Conclusion  GDM prediction model has a good effect. The predictive effects of HbA1c, GA and FBG on GDM are different in the early and late stages of pregnancy, these indicators should be used in combination according to different stages of pregnancy in order to provide reference for the diagnosis and treatment of clinical GDM.

     

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