1小时50克葡萄糖筛查对高危人群妊娠期糖尿病的诊断预测价值。

The predictive value of the 1-h 50-g glucose screen for diagnosing gestational diabetes mellitus in a high-risk population.

作者信息

Lanni Susan, Barrett Diane

机构信息

Department of OB/GYN, Division of Maternal-Fetal Medicine, Medical College of Virginia/Virginia Commonwealth University, Richmond, VA 23298, USA.

出版信息

J Matern Fetal Neonatal Med. 2004 Jun;15(6):375-9. doi: 10.1080/14767050410001724308.

DOI:10.1080/14767050410001724308

PMID:15280108

Abstract

OBJECTIVE

To determine a value, for a gestational diabetes mellitus (GDM) screening test, above which the glucose tolerance test is obviated.

METHODS

A database search of patients delivered at the Medical College of Virginia Hospital (MCV) between April 1991 and April 2002 was undertaken. Subjects were screened using standard methodology: blood glucose level 1 h after a 50-g oral glucose load (1OGT). Subjects with values meeting/exceeding 140 mg/dl underwent 3-h 100-g oral glucose tolerance tests (3OGTT). GDM was diagnosed using criteria of the National Diabetes Data Group (NDDG), with Carpenter-Coustan (CC) criteria for comparison. Receiver-operator characteristic (ROC) curves were generated; areas under the curve (AUC) were calculated.

RESULTS

1OGT results were available for 16898 subjects; 2770 (16.4%) had values meeting/exceeding 140 mg/dl. The NDDG and CC criteria were applied to 1972 subjects with both 1OGT and 3OGTT results available: 419 (21%) and 614 (31%) subjects had GDM, respectively. Positive predictive values for results > or =180 mg/dl and values at 20 mg/dl increments up to 260 mg/dl were: 36, 47, 55, 57 and 63% (NDDG) and 45, 54, 62, 61 and 66% (CC). AUC for NDDG=0.68; AUC for CC=0.64.

CONCLUSIONS

GDM cannot be diagnosed with the 1OGT; predictive values are low. A cut-off of 200 mg/dl predicts only 47-54% of GDM cases correctly, and may lead to over-diagnosis. It is inappropriate for GDM to be diagnosed based on the 1OGT.

摘要

目的

确定一个妊娠期糖尿病（GDM）筛查试验的值，高于该值则无需进行葡萄糖耐量试验。

方法

对1991年4月至2002年4月在弗吉尼亚医学院医院（MCV）分娩的患者进行数据库检索。采用标准方法对受试者进行筛查：口服50克葡萄糖后1小时的血糖水平（1小时口服葡萄糖耐量试验，1OGT）。血糖值达到或超过140毫克/分升的受试者接受3小时100克口服葡萄糖耐量试验（3OGTT）。采用美国国家糖尿病数据组（NDDG）的标准诊断GDM，并与卡彭特-库斯坦（CC）标准进行比较。生成受试者工作特征（ROC）曲线；计算曲线下面积（AUC）。

结果

有16898名受试者的1OGT结果可用；2770名（16.4%）受试者的值达到或超过140毫克/分升。将NDDG和CC标准应用于1972名同时有1OGT和3OGTT结果的受试者：分别有419名（21%）和614名（31%）受试者患有GDM。血糖值≥180毫克/分升以及以20毫克/分升递增直至260毫克/分升时的阳性预测值分别为：36%、47%、55%、57%和63%（NDDG）以及45%、54%、62%、61%和66%（CC）。NDDG的AUC = 0.68；CC的AUC = 0.64。