Rust O, Bofill J A, Carroll S C, Cowan B D, Martin R W, Morrison J C
Department of Obstetrics and Gynecology, University of Mississippi Medical Center, Jackson 39216-4505, USA.
J Perinatol. 1998 Jan-Feb;18(1):49-54.
The objective of this study was to compare 2-hour postprandial glucose measurements with the standard 1-hour, 50 gm glucola screen as a predictor of gestational diabetes.
In this prospective study, 448 patients were screened for gestational diabetes mellitus after 20 weeks' gestation. Each patient was instructed to ingest a meal containing at least 100 gm of carbohydrate, and 2 hours later a plasma glucose level was obtained. Shortly after, each patient was given 50 gm glucola followed by a 1-hour glucose measurement. If either screen showed a result of 140 mg/dl or more, a formal 3-hour glucose tolerance test was done. Data were analyzed with use of the receiver operating characteristic curve.
Of the 448 patients screened, 39 (8.7%) had a screening result of 140 mg/dl or greater and 16 (3.6%) of these had gestational diabetes mellitus. The receiver operating characteristic curve showed that the 1-hour glucose screen was more predictive of gestational diabetes than the postmeal assessment. The area under the receiver operating characteristic curve (plus or minus the SEM) for the 1-hour glucose test was 0.746 +/- 0.086 (p < 0.005) whereas the 2-hour postprandial test produced an area of 0.524 +/- 0.097 (p = NS). The range of optimal 1-hour glucola discriminatory values was 182 to 190 mg/dl. Thus the critical cutoff value of the 1-hour glucola test that minimizes false-positive results and maximizes true-positive screening for gestational diabetes is 182 mg/dl or greater.
The 1-hour glucola test is a reliable screening test for gestational diabetes mellitus whereas the 2-hour post-prandial test is not.
本研究的目的是比较餐后2小时血糖测量值与标准的1小时50克葡萄糖耐量筛查作为妊娠期糖尿病预测指标的情况。
在这项前瞻性研究中，对448例妊娠20周后的孕妇进行了妊娠期糖尿病筛查。每位患者被要求摄入至少含100克碳水化合物的一餐，2小时后测定血浆葡萄糖水平。此后不久，每位患者口服50克葡萄糖，随后进行1小时血糖测量。如果任何一项筛查结果显示为140mg/dl或更高，则进行正式的3小时葡萄糖耐量试验。使用受试者操作特征曲线对数据进行分析。
在接受筛查的448例患者中，39例（8.7%）筛查结果为140mg/dl或更高，其中16例（3.6%）患有妊娠期糖尿病。受试者操作特征曲线显示，1小时血糖筛查比餐后评估更能预测妊娠期糖尿病。1小时血糖试验的受试者操作特征曲线下面积（±标准误）为0.746±0.086（p<0.005），而餐后2小时试验的面积为0.524±0.097（p=无统计学意义）。1小时葡萄糖耐量试验的最佳鉴别值范围为182至190mg/dl。因此，将妊娠期糖尿病假阳性结果降至最低并使真阳性筛查最大化的1小时葡萄糖耐量试验的临界截断值为182mg/dl或更高。
1小时葡萄糖耐量试验是妊娠期糖尿病的可靠筛查试验，而餐后2小时试验则不是。
