丁琥+付锦艳

[摘要] 目的 探讨糖化血清蛋白（GSP）及糖化血红蛋白（HbA1c）早期筛查妊娠期糖尿病（GDM）的诊断效果。 方法 选取2015年1月～2016年6月在南京医科大学附属无锡妇幼保健院行产前检查的140例GDM孕妇作为GDM组，同时收集140例正常孕妇作为正常组，分析两组孕妇的血糖、HbA1c及GSP水平分布的差异，计算HbA1c和GSP早期筛查GDM的诊断效果（灵敏度、特异度及准确度）。 结果 GDM组的血糖、HbA1c及GSP水平明显高于正常组（P < 0.05）；GDM组HbA1c及GSP异常率明显高于正常组（P < 0.05）；HbA1c联合GSP筛查GDM具有较高的灵敏度、特异度及准确度，分别为91.4%、95.7%及93.6%。 结论 HbA1c、GSP在正常、GDM孕妇中分布有明显差异，可以作为早期筛查GDM的重要指标，两者联合检测则更具有意义。

[关键词] 妊娠期糖尿病；糖化血红蛋白；糖化血清蛋白；诊断效果

[中图分类号] R714.256 [文献标识码] A [文章编号] 1673-7210（2017）01（b）-0179-03

Diagnostic effect study of glycosylated hemoglobin and glycosylated serum protein for early screening of gestational diabetes mellitus

DING Hu FU Jinyan

Department of Obstetrical， Wuxi Maternal and Child Health Hospital Affiliated to Nanjing Medical University， Jiangsu Province， Wuxi 214000， China

[Abstract] Objective To explore the diagnostic effect of glycosylated serum protein （GSP） and glycosylated hemoglobin （HbA1c） for early screening of gestational diabetes mellitus （GDM）. Methods 140 cases of pregnant women with GDM were collected as GDM group， and 140 cases of normal pregnant women were collected as normal group through prenatal examination in Wuxi Maternal and Child Health Hospital Affiliated to Nanjing Medical University from January 2015 to June 2016. The differences of levels of blood sugar， HbA1c and GSP were compared between the two groups， and the diagnostic effects （sensitivity， specificity and accuracy） of HbA1c and GSP respectively for early screening of GDM were calculated. Results The levels of blood sugar， HbA1c and GSP in the GDM group were higher than those in the normal group （P < 0.05）. The abnormality rates of HbA1c and GSP in the GDM group were higher than those in the the normal group （P < 0.05）. HbA1c combination with GSP for early screening of GDM had a higher sensitivity， specificity and accuracy， wich was 91.4%， 95.7% and 93.6% respectively. Conclusion There is obviously different about HbA1c and GSP between normal group and GDM group of pregnant women. The two indexes can be considered as important indexes for early screening of GDM. It is more important if the two indexes can be associated together.

[Key words] Gestational diabetes mellitus； Glycosylated hemoglobin； Glycosylated serum protein； Diagnostic effect

妊娠期糖尿病（gestational diabetes mellitus，GDM）是指妊娠前糖代謝正常或潜在糖耐量减退，而在妊娠期间出现了糖代谢异常的疾病，是一种妊娠期的高危因素[1]，对孕产妇妊娠结局产生重要影响，妊娠期血糖过高可导致15%～30%的孕妇出现流产现象[2]。目前，主要采用空腹血糖和口服糖耐量试验诊断GDM，但前者检出率较低，易出现漏诊，而后者操作较为复杂，影响测定结果的因素较多，结果可能不准确，而且重复性也不好[3]。GDM多被发现于妊娠中晚期，已经对妊娠期妇女和胎儿产生较大的影响[4-5]，若能早期筛查GDM并且采取必要干预措施，对改善妊娠结局具有重要的意义。因此，本研究采用较为常用的糖化血红蛋白（glycosylated hemoglobin，HbA1c）和糖化血清蛋白（glycosylated serum protein，GSP）指标来早期筛查GDM，分析这些指标在不同群组中的分布差异，探讨早期筛查诊断GDM的效果，现将结果报道如下：

1 对象与方法

1.1 对象

选取2015年1月～2016年6月在南京医科大学附属无锡妇幼保健院行产前检查确诊为GDM的单胎孕妇140例作为GDM组，年龄21～35岁，平均（28.43±4.15）岁，平均孕龄（25.50±2.36）周。……