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目的:探究糖化血红蛋白(HbAlc)对妊娠期糖尿病(GDM)患者治疗及新生儿出生体重的预测价值。方法:对188例GDM患者的临床治疗资料进行回顾性分析,采用受试者工作特性(ROC)曲线与Logistic回归分析法,分析HbAlc对GDM患者治疗及新生儿出生体重的预测效果。结果:使用胰岛素治疗的GDM患者与不需要使用胰岛素患者的HbAlc水平值分别为(5.78±0.58)%与(5.42±0.37)%,差异具有统计学意义(P<0.01),大于胎龄儿组与非大于胎龄组的HbAlc对比、巨大儿组与非巨大儿组的HbAlc对比,差异均具有统计学意义(P均<0.01);孕周≥28周后,HbAlc与新生儿体重呈线性相关(P均<0.01),经Logistic回归分析后,HbAlc与GDM患者使用胰岛素、大于胎龄儿、巨大儿等因素,具有明显相关性(P均<0.01);经ROC曲线分析后,HbAlc预测GDM需要胰岛素治疗的最高敏感性与特异性分别为82.3%与82.1%,预测大于胎龄儿的最高敏感性与特异性分别为83.5%与62.9%,预测测巨大儿的最高敏感性与特异性分别为62.5%与96.4%。结论:糖化血红蛋白对妊娠期糖尿病患者使用胰岛素治疗、发生大于胎龄儿与发生巨大儿等均具有预测价值。
Objective: To investigate the predictive value of glycosylated hemoglobin (HbAlc) in the treatment of gestational diabetes mellitus (GDM) and the birth weight of neonates. Methods: The clinical data of 188 patients with GDM were retrospectively analyzed. The predicted effect of HbAlc on the treatment of GDM and the birth weight of newborns were analyzed by ROC curves and Logistic regression analysis. Results: The levels of HbA1c in insulin-treated and non-insulin-treated patients were (5.78 ± 0.58)% and (5.42 ± 0.37)%, respectively, with statistical significance (P <0.01) Compared with HbAlc in non-large gestational age group, the difference of HbAlc in macrosomia group and non-macrosomia group was statistically significant (all P <0.01), but there was a linear correlation between HbA1c and neonatal body weight (P <0.01). After Logistic regression analysis, HbA1c and GDM patients had significantly higher levels of insulin than those with gestational age and giant macrosomia (all P <0.01). After ROC curve analysis, HbA1c predicted GDM The highest sensitivity and specificity for insulin therapy were 82.3% and 82.1%, respectively, and the highest sensitivity and specificity for predicting over-gestational age children were 83.5% and 62.9% respectively. The highest sensitivity and specificity for predicting macrosomia 62.5% and 96.4% respectively. CONCLUSION: HbA1c has predictive value for the treatment of gestational diabetes mellitus with insulin therapy, with more than gestational age children and with huge children.