Wu Lian-fang, Liu Dong-yan, Huang Xing-hua, Zu Xiu-song, Yang Min, Liu Wei-jing, Heng Zong-hua, Chi Xin-zuo, Jia Xiao-fang, Hu Min-hua
Department of Bostetrics, Beijing Obstetrics and Gynecology Hospital, The Capital University of Medical Sciences, Beijing 100006, China.
Zhonghua Fu Chan Ke Za Zhi. 2003 Mar;38(3):132-5.
To investigate the feasibility of using random blood glucose to screen gestational diabetes mellitus (GDM).
The random blood glucose was determined in 1 038 pregnant women between 24 and 32 gestational weeks. Then 50 gram glucose challenge test (50 g GCT) was performed followed immediately. Finally, 75 gram oral glucose tolerance test (75 g OGTT) was done without dietary control for 3 days. If two values of four were abnormal, GDM was diagnosed. Impaired glucose tolerance (IGT) was diagnosed if only one value was abnormal or the 2nd hour value ranged from 120 to 164 mg/dl.
(1) The determination of the three steps was completed in 948 cases. Among them, 42 cases (4.4%) were GDM, 372 cases (39.2%) were IGT and other 534 cases were normal. (2) In the normal group, the random blood glucose were different in fasting and postprandial times. No difference was found among blood glucose values determined of 50 g GCT at different times except that the value of 50 g GCT 1 hour postprandial was higher than the value at other times. There was no significant association between random blood glucose and 50 g GCT. (3) The sensitivity and specificity were 50.0% and 67.7%, when IGT was diagnosed using the cut point of 6.4 mmol/L (115 mg/dl) of random blood glucose, which was similar with 51.1% of sensitivity and 71.2% of specificity when using >or= 7.8 mmoL/L (140 mg/dl) as the cut point of 50 g GCT. If 6.4 mmol/L (115 mg/dl) was used as the cut point in GDM group the sensitivity would be 80.0%, which was much higher than that of IGT group and the specificity was 61.2%. In this study, if the value of >or= 8.3 mmoL/L (150 mg/dl) was used as the cut-point of 50 g GCT to screen the GDM, the sensitivity decreased only 2.0% while the specificity increased more than 10.0%.
(1) The determination of random blood glucose to screen GDM couldn't replace the 50 g GCT, but it can be used as a complemental method and can be used repeatedly at any gestational age and convenience the pregnant women and the doctors. (2) The value of 8.3 mmol/L (150 mg/dl) was used as the cut-point of 50 g GCT, the specificity would be increased and the requirement for OGTT would be lowered markedly, which would reduce economic and psychological stress.
探讨采用随机血糖筛查妊娠期糖尿病（GDM）的可行性。
对1038例孕24至32周的孕妇测定随机血糖，随后立即进行50克葡萄糖耐量试验（50g GCT），最后进行75克口服葡萄糖耐量试验（75g OGTT），试验前3天不进行饮食控制。若四项值中有两项异常，则诊断为GDM；若只有一项值异常或第2小时值在120至164mg/dl之间，则诊断为糖耐量受损（IGT）。
（1）948例完成了三步测定。其中，42例（4.4%）为GDM，372例（39.2%）为IGT，其余534例正常。（2）正常组中，空腹及餐后随机血糖不同。50g GCT不同时间测定的血糖值之间无差异，仅餐后1小时的50g GCT值高于其他时间的值。随机血糖与50g GCT之间无显著关联。（3）以随机血糖切点6.4mmol/L（115mg/dl）诊断IGT时，敏感性和特异性分别为50.0%和67.7%，与以50g GCT切点≥7.8mmol/L（140mg/dl）时的敏感性51.1%和特异性71.2%相似。在GDM组中，若以6.4mmol/L（115mg/dl）为切点，敏感性为80.0%，远高于IGT组，特异性为61.2%。本研究中，若以≥8.3mmol/L（150mg/dl）为50g GCT的切点筛查GDM，敏感性仅降低2.0%，而特异性增加超过10.0%。
（1）测定随机血糖筛查GDM不能替代50g GCT，但可作为一种补充方法，可在任何孕周重复进行，方便孕妇和医生。（2）以8.3mmol/L（150mg/dl）为50g GCT的切点，可提高特异性，显著降低OGTT的要求，从而减轻经济和心理压力。
