基于国际糖尿病与妊娠研究组标准的墨西哥青少年妊娠糖尿病筛查中空腹血糖的敏感性：一项基于回顾性数据分析的诊断准确性研究
Sensitivity of fasting glucose for gestational diabetes mellitus screening in Mexican adolescents based on International Association of Diabetes and Pregnancy Study Groups criteria: a diagnostic accuracy study based on retrospective data analysis.
作者信息
Reyes-Muñoz Enrique, Sandoval-Osuna Norma Lidia, Reyes-Mayoral Christian, Ortega-González Carlos, Martínez-Cruz Nayeli, Ramírez-Torres María Aurora, Arce-Sánchez Lidia, Lira-Plascencia Josefina, Estrada-Gutiérrez Guadalupe, Montoya-Estrada Araceli
机构信息
Department of Gynecological and Perinatal Endocrinology, Instituto Nacional de Perinatología Isidro Espinosa de los Reyes, Mexico City, Mexico.
Division of Obstetrics and Gynecology, Instituto Nacional de Perinatología Isidro Espinosa de los Reyes, Mexico City, Mexico.
出版信息
BMJ Open. 2018 Apr 13;8(4):e021617. doi: 10.1136/bmjopen-2018-021617.
OBJECTIVE
To evaluate fasting plasma glucose (FPG) as a screening test for gestational diabetes mellitus (GDM) among Mexican adolescents using International Association of Diabetes and Pregnancy Study Groups criteria.
DESIGN
Retrospective cohort study.
SETTING
Level-three medical institution in Mexico City.
PARTICIPANTS
The study population comprised 1061 adolescent women aged 12-19 years with singleton pregnancies, who underwent a 75 g oral glucose tolerance test (OGTT) between 11 and 35 weeks of gestation.
PRIMARY AND SECONDARY OUTCOME MEASURES
The sensitivity (Sn), specificity (Sp), positive and negative predictive values (PPV and NPV, respectively), and positive and negative likelihood ratios LR (+) and LR (-), respectively) with 95% CIs for selected FPG cut-off values were compared. Secondary measures were perinatal outcomes in women with and without GDM.
RESULTS
GDM was present in 71 women (6.7%, 95% CI 5.3% to 8.4%). The performances of FPG at thresholds of ≥80 (4.5 mmol/L), 85 (4.7 mmol/L) and 90 mg/dL (5.0 mmol/L) were as follow (95% CI): Sn: 97% (89% to 99%), 94% (86% to 97%) and 91% (82% to 95%); Sp: 50% (47% to 53%), 79% (76% to 81%) and 97% (95% to 97%); PPV: 12% (9% to 15%), 23% (18% to 28%) and 64% (54% to 73%); NPV: 99% (98.5% to 99.9%) for all three cut-offs; LR (+): 1.9 (1.8 to 2.1), 4.3 (3.8 to 5.0) and 26.7 (18.8 to 37.1) and LR (-): 0.06 (0.02 to 0.23), 0.07 (0.03 to 0.19) and 0.09 (0.04 to 0.19), respectively. No significant differences in perinatal outcomes were found between adolescents with and without GDM.
CONCLUSIONS
An FPG cut-off of ≥90 mg/dL (5.0 mmol/L) is ideal for GDM screening in Mexican adolescent women. An FPG threshold of 90 mg/dL would miss 6 (8.5%) women with GDM, pick up 34 (3.4%) women without GDM and avoid 962 (90.7%) OGTTs.
目的
采用国际糖尿病与妊娠研究组的标准，评估空腹血糖（FPG）作为墨西哥青少年妊娠糖尿病（GDM）筛查试验的效果。
设计
回顾性队列研究。
地点
墨西哥城的三级医疗机构。
参与者
研究人群包括1061名年龄在12至19岁的单胎妊娠青春期女性，她们在妊娠11至35周期间接受了75克口服葡萄糖耐量试验（OGTT）。
主要和次要结局指标
比较选定FPG临界值的敏感度（Sn）、特异度（Sp）、阳性和阴性预测值（分别为PPV和NPV）以及阳性和阴性似然比（分别为LR(+)和LR(-)）及其95%置信区间。次要指标是患有和未患有GDM的女性的围产期结局。
结果
71名女性患有GDM（6.7%，95%置信区间5.3%至8.4%）。FPG在≥80（4.5毫摩尔/升）、85（4.7毫摩尔/升）和90毫克/分升（5.0毫摩尔/升）阈值时的表现如下（95%置信区间）：Sn：97%（89%至99%）、94%（86%至97%）和91%（82%至95%）；Sp：50%（47%至53%）、79%（76%至81%）和97%（95%至97%）；PPV：12%（9%至15%）、23%（18%至28%）和64%（54%至73%）；所有三个临界值的NPV均为99%（98.5%至99.9%）；LR(+)：1.9（1.8至2.1）、4.3（3.8至5.0）和26.7（18.8至37.1），LR(-)：分别为0.06（0.02至0.23）、0.07（0.03至0.19）和0.09（0.04至0.19）。患有和未患有GDM的青少年之间在围产期结局方面未发现显著差异。
结论
FPG临界值≥90毫克/分升（5.0毫摩尔/升）是墨西哥青春期女性GDM筛查的理想选择。FPG阈值为90毫克/分升会漏诊6名（8.5%）患有GDM的女性，误诊34名（3.4%）未患有GDM的女性，并可避免962例（90.7%）OGTT检查。
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