我们真的能在孕期诊断出糖尿病吗？
Can we really diagnose diabetes during pregnancy?
作者信息
Burlingame Janet M, Bartholomew Lisa, Brink-Wong Teresa, Sampaga Sheila, Dye Timothy
出版信息
J Perinat Med. 2015 May;43(3):277-82. doi: 10.1515/jpm-2014-0162.
OBJECTIVE
To identify the accuracy of diagnosing postpartum diabetes and glucose intolerance using antepartum glycosylated hemoglobin (HbA1c) and fasting glucose values.
STUDY DESIGN
A retrospective Hawaiian cohort of women with gestational diabetes during 2004-2011 were evaluated. Antepartum HbA1c and postpartum 75-g glucose tolerance tests were obtained.
RESULTS
An antepartum HbA1c value of ≥6.5% had a 45.7% sensitivity, a 96% specificity and a 40% positive predictive value (PPV) for predicting postpartum diabetes. An antepartum HbA1c value of ≥6.5% had a 6.6% sensitivity, a 94.2% specificity and a 27% PPV for predicting postpartum impaired glucose tolerance. An antepartum HbA1c value of ≥6.5% had a 10.3% sensitivity, a 95.7% specificity and a 33.3% PPV for predicting postpartum impaired fasting glucoses.
CONCLUSION
We could not demonstrate a clinically useful PPV for diagnosing postpartum diabetes or glucose intolerance using an antepartum elevated HbA1c value of ≥6.5% or a fasting glucose level of ≥90 mg/dL.
目的
通过产前糖化血红蛋白（HbA1c）和空腹血糖值来确定产后糖尿病和糖耐量异常的诊断准确性。
研究设计
对2004年至2011年期间患有妊娠期糖尿病的夏威夷女性回顾性队列进行评估。获取产前HbA1c和产后75克葡萄糖耐量试验结果。
结果
产前HbA1c值≥6.5%对预测产后糖尿病的敏感性为45.7%，特异性为96%，阳性预测值（PPV）为40%。产前HbA1c值≥6.5%对预测产后糖耐量异常的敏感性为6.6%，特异性为94.2%，PPV为27%。产前HbA1c值≥6.5%对预测产后空腹血糖受损的敏感性为10.3%，特异性为95.7%，PPV为33.3%。
结论
我们无法证明使用产前HbA1c值≥6.5%或空腹血糖水平≥90毫克/分升来诊断产后糖尿病或糖耐量异常具有临床有用的PPV。
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