糖化血红蛋白水平在韩国人群妊娠期糖尿病诊断中的应用价值
The Usefulness of the Glycosylated Hemoglobin Level for the Diagnosis of Gestational Diabetes Mellitus in the Korean Population.
作者信息
Ryu Ah Jeong, Moon Hyuk Jin, Na Joo Ok, Kim Yeo Joo, Kim Sang Jin, Mo Sang Il, Byun Jeong Ran
机构信息
Department of Internal Medicine, Soonchunhyang University Cheonan Hospital, Soonchunhyang University College of Medicine, Cheonan, Korea.
Department of Internal Medicine, Dong Gunsan Hospital, Gunsan, Korea.
出版信息
Diabetes Metab J. 2015 Dec;39(6):507-11. doi: 10.4093/dmj.2015.39.6.507. Epub 2015 Nov 23.
BACKGROUND
An oral glucose tolerance test (OGTT) is the current method used for screening and diagnosis of gestational diabetes mellitus (GDM). OGTT is a relatively complicated procedure and is expensive. Thus, new strategies that do not require fasting or more than a single blood draw may improve the diagnosis of GDM and increase the rate of GDM testing. We investigated the utility of monitoring glycosylated hemoglobin (HbA1c) levels for the diagnosis of GDM.
METHODS
The data from 992 pregnant women with estimated gestational ages ranging from 24 to 28 weeks were retrospectively reviewed. There were 367 women with plasma glucose levels ≥140 mg/dL 1 hour after a 50-g OGTT. GDM was diagnosed according to the Carpenter-Coustan criteria for a 3-hour 100 g OGTT. A HbA1c assessment was performed at the same time.
RESULTS
We enrolled 343 women in this study, and there were 109 women with GDM. The area under the curve the receiver operating characteristic curve for HbA1c detection of GDM was 0.852 (95% confidence interval, 0.808 to 0.897). A HbA1c cutoff value ≥5.35% had maximal points on the Youden index (0.581). The sensitivity was 87.2% and the specificity was 70.9% for diagnosing GDM. A threshold value ≥5.35% indicated that 163 patients had GDM and that 68 (41.7%) were false positive. The positive predictive value was 58.3% at this threshold value.
CONCLUSION
Despite substantial progress in methodology, HbA1c values cannot replace OGTT for the diagnosis of GDM.
背景
口服葡萄糖耐量试验（OGTT）是目前用于筛查和诊断妊娠期糖尿病（GDM）的方法。OGTT是一个相对复杂的程序且费用高昂。因此，无需空腹或只需单次采血的新策略可能会改善GDM的诊断并提高GDM检测率。我们研究了监测糖化血红蛋白（HbA1c）水平用于诊断GDM的效用。
方法
回顾性分析了992例估计孕周在24至28周的孕妇的数据。其中367例孕妇在50克OGTT后1小时血浆葡萄糖水平≥140mg/dL。根据Carpenter-Coustan标准对100克3小时OGTT进行GDM诊断。同时进行HbA1c评估。
结果
本研究纳入343例女性，其中109例患有GDM。HbA1c检测GDM的受试者操作特征曲线下面积为0.852（95%置信区间，0.808至0.897）。HbA1c临界值≥5.35%时约登指数达到最大值（0.581）。诊断GDM的敏感性为87.2%，特异性为70.9%。阈值≥5.35%表明163例患者患有GDM，其中68例（41.7%）为假阳性。此阈值下的阳性预测值为58.3%。
结论
尽管在方法学上取得了重大进展，但HbA1c值不能替代OGTT用于诊断GDM。
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