通过血清糖化血红蛋白评估妊娠期糖尿病患者产后血糖异常：一项全国性数据分析
Evaluation of postpartum dysglycemia by serum glycosylated hemoglobin in patients with gestational diabetes mellitus: a national data analysis.
作者信息
Cohen Nadav, Toledano Yoel, Shafir May, Lavie Ofer, Zilberlicht Ariel
机构信息
Department of Obstetrics and Gynecology, Rappaport Faculty of Medicine, Lady Davis Carmel Medical Center, Technion University, 7 Michal Street, 34361, Haifa, Israel.
Division of Maternal Fetal Medicine, Helen Schneider Hospital for Women, Rabin Medical Center, Petah Tikva, Israel.
出版信息
Arch Gynecol Obstet. 2024 Dec;310(6):3029-3035. doi: 10.1007/s00404-024-07845-z. Epub 2024 Nov 28.
PURPOSE
To assess the postpartum sensitivity and accuracy of serum HbA1c levels, compared to the gold standard of 75-g Oral Glucose Tolerance Test (OGTT), for diagnosis of dysglycemia in patients with a history of gestational diabetes mellitus (GDM).
METHODS
A nationwide retrospective analysis of individuals with a history of GDM and with records of both postpartum 2 h-OGTT and serum HbA1c measured anytime between delivery until 12 months post-delivery. Results were stratified into 3 different intervals: 0-3 months, 3-12 months, and > 12 months after delivery, according to the timing of both OGTT and HbA1c performance.
RESULTS
Between January 1st, 2015, until December 31st, 2021, a total of 55,119 individuals were screened, and 9,118 were diagnosed with GDM. Overall, 677 of the 9,118 individuals with GDM had laboratory results of both serum HbA1c levels and 2 h 75-gm-OGTT values after delivery. The overall Pearson correlation coefficient between HbA1c and 2 h-OGTT was 0.21 (P < 0.0001). However, when the OGTT results were stratified into 2 h-glucose values ≥ 200 mg/dL, a ROC curve yielded an Area Under the Curve (AUC) of 91.4% [95% CI: 83.9%-98.9%], with HbA1c levels of 5.7% yielding 80.0% sensitivity and 80.8% specificity (95% CI: 44.39-97.48%).
CONCLUSIONS
In patients with a recent diagnosis of GDM, serum HbA1c may be used as an auxiliary tool for postpartum diagnosis of dysglycemia.
目的
与75克口服葡萄糖耐量试验（OGTT）这一诊断妊娠期糖尿病（GDM）患者血糖异常的金标准相比，评估产后血清糖化血红蛋白（HbA1c）水平诊断血糖异常的敏感性和准确性。
方法
对有GDM病史且有产后2小时OGTT和分娩至产后12个月期间任何时间测定的血清HbA1c记录的个体进行全国性回顾性分析。根据OGTT和HbA1c检测时间，将结果分为3个不同时间段：产后0 - 3个月、3 - 12个月和>12个月。
结果
2015年1月1日至2021年12月31日期间，共筛查55119人，其中9118人被诊断为GDM。总体而言，9118例GDM患者中有677例在产后有血清HbA1c水平和2小时75克OGTT值的实验室结果。HbA1c与2小时OGTT之间的总体Pearson相关系数为0.21（P < 0.0001）。然而，当将OGTT结果分层为2小时血糖值≥200mg/dL时，ROC曲线的曲线下面积（AUC）为91.4%[95%CI：83.9% - 98.9%]，HbA1c水平为5.7%时，敏感性为80.0%，特异性为80.8%（95%CI：44.39 - 97.48%）。
结论
对于近期诊断为GDM的患者，血清HbA1c可作为产后血糖异常诊断的辅助工具。
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