Objective To assess the screening and diagnosing values of glycesylated hemoglobin (HbA1c) for gestational diabetes mellitus(GDM)with determining HbA lc levels of pregnant women.Methods On the basis of 50 g Glucose Challenge Test(GCT) and 75g oral glucose tolerance test(OGTT), 305 pregnant women were distrbuted into four groups 87 normal pregnancy group, 76 normal glucose tolerance pregnancy group, 88 GDM, 54 IGT. Estimating HbAIc levels of the second trimester and late pregnancy in four preg-nancy Group. With HbA1c≥6.1% for the cut-off point, GDM will be divided into GDM 1 group (HbA1c ≥6.1% ) and GDM 2 group ( HbA1c <6.1% ).Results Pregnant women with C, DM in the second trimester and the late pregnancy, their HbA1c levels were higher than other groups, the difference was significant, p <0.01. Along with pregnancy weeks development, HbA1c level gradually increased, during the late pregnancy,HbA1c level is 5.87% ± 0.43%.HbA1c levels of other pregnancy group is gradually increased with the development of pregnancy. The area under recerver operating characteristic curve of HbA1c in the second trimester pregnancy was 0.760 (95% CI 0.663-0.858), the cut-off value was 5.25%, the sensitivity and specificity were 82.9% and 67.3% respectively, the diagnostic accuracy was 76.0%. The area under ROC in late pregnancy was 0.785 (95% CI 0.709-0.861), the cut-off value was 5.65%, the sensitivity and specificity were 78.8% and 71.6% respectively, diagnostic accuracy is 75.6%. When the boundary value of HbA1c was 6.1% in the late pregnancy, sensitivity for GDM was 31.0% and specificity was 97.5%.In GDM group 1, GCT, fasting blood glucose, 1 hour glucose were higher than GDM group 2, the difference was statistically significant.Conclusion The HbA1c is the middle accuracy test for the screening diagnosis of GDM and have a certain value. But the elevated HbA1c indicates the higher glucose levels, so HbA1c may contribute to the choosing and monitoring of clinical treatment in GDM.%目的 通过测定妊娠中期和妊娠晚期孕妇糖化血红蛋白水平,探讨其在妊娠糖尿病筛选诊断中的价值.方法 通过1 h葡萄糖筛查及75 g葡萄糖耐量试验将305例孕妇分为正常妊娠组87例、糖耐量正常妊娠组76例、妊娠糖尿病组88例及妊娠糖耐量受损组54例,测定各妊娠组妊娠中期及妊娠晚期的糖化血红蛋白含量,应用ROC曲线对HbA1c进行诊断性能评价.以HbA1c ≥6.1%为界,将妊娠糖尿病组分为HbA1c≥6.1%的妊娠糖尿病1组及HbA1c＜6.1%的妊娠糖尿病2组,并对两组进行分析.结果 妊娠中期及妊娠晚期的妊娠糖尿病组孕妇,其糖化血红蛋白水平均高于其它组,差异有统计学意义,P＜0.01,随着妊娠的发展,妊娠糖尿病组孕妇HbA1c水平逐渐升高,妊娠后期HbA1c水平为(5.87±0.43)%;其它各妊娠组HbA1c水平也是随着妊娠的发展逐渐升高.妊娠糖尿病1组的1小时糖筛查、空腹血糖、1小时血溏均高于妊娠糖尿病2组,差异有统计学意义.妊娠中期HbA1c诊断GDM的ROC曲线面积为0.760(95%的可信限为0.663～0.858),诊断分界值为5.25%,在此值下的诊断灵敏度与特异度分别为82.9%和67.3%,诊断准确率为76.0%.而妊娠晚期AUC HbA1c面积为0.785(95%的可信限为0.709～0.861),分界值为5.65%,在此值下的诊断灵敏度与特异度分别为71.6%和78.8%,诊断准确率为75.6%.而以HbA1c 6.1%作为分界值时,GDM妊娠晚期诊断灵敏度为31.0%,诊断特异性为97.5%.结论 ROC曲线分析表明HbA1c对妊娠糖尿病的筛选诊断有一定的价值,由于随着妊娠的发展,HbA1c水平逐渐升高,因此可动态观察妊娠妇女的HbA1c水平,尤其对HbA1c明显升高的GDM患者,有助于临床治疗的选择及疗效的监测,对估计GDM的预后及治疗监测有一定的作用.
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