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目的探讨妊娠糖尿病(gestational diabetes mellitus,GDM)孕妇口服50g葡萄糖筛查(GCT)和75g葡萄糖耐量试验(OGTT)的特点,分析血糖水平对GDM的诊断和治疗的价值。方法回顾性分析广东省妇幼保健院2008年186例妊娠期糖尿病患者的临床资料和GCT及OGTT的结果。结果50g GCT以7.8 mmol/L为界值,GDM的漏诊率约(7/186)3.76%,GCT平均血糖为(9.66±1.49)mmol/L;75g OGTT平均空腹血糖为(5.01±0.84)mmol/L,1h血糖为(11.15±1.71)mmol/L,2 h血糖为(9.79±1.61)mmol/L,3h血糖为(6.93±1.94)mmol/L;其中血糖值2项异常有113例,3项异常有53例,4项异常有20例;OGTT血糖2项异常与3项、4项异常的GCT均有统计学意义;75g OGTT不检测3 h血糖,将漏诊46例GDM,约24.7%;需饮食合并胰岛素治疗患者空腹及餐后2h血糖明显高于仅需饮食治疗患者。结论GCT以7.8mmol/L为界值漏诊率不高,应较适合本地区临床使用;GCT血糖值与OGTT异常程度有关;孕妇75g OGTT诊断可考虑降低空腹血糖标准,不宜省略OGTT3h血糖的检测;对空腹及餐后2h血糖水平较高的GDM患者应注意治疗方案的选择。
Objective To investigate the characteristics of 50g glucose screening (GCT) and 75g glucose tolerance test (OGTT) in pregnant women with gestational diabetes mellitus (GDM), and to analyze the value of blood glucose in the diagnosis and treatment of GDM. Methods The clinical data, GCT and OGTT of 186 cases of gestational diabetes mellitus in Guangdong MCH hospital in 2008 were analyzed retrospectively. Results The rate of missed diagnosis in GDM was 3.76% (7/186), the average glucose level in GCT was (9.66 ± 1.49) mmol / L for 50g GCT and (5.01 ± 0.84) mmol / L for 75g OGTT (11.15 ± 1.71) mmol / L for 1 h, (9.79 ± 1.61) mmol / L for 2 h and (6.93 ± 1.94) mmol / L for 3 h, 113 of which were abnormal in 2 of blood glucose, 3 abnormalities in 53 cases, 4 abnormalities in 20 cases; 2 abnormal OGTT blood glucose and 3, 4 abnormal GCT were statistically significant; 75g OGTT does not detect 3 h blood glucose, will miss 46 cases of GDM, about 24.7 %; Need dietary insulin therapy in patients with fasting and 2h postprandial blood glucose was significantly higher than those who need only diet therapy. Conclusions The rate of misdiagnosis of GCT with 7.8mmol / L cutoff is not high enough to be suitable for clinical use in this area. The blood glucose level of GCT is related to the abnormality of OGTT. Pregnancy 75g OGTT diagnosis can reduce fasting blood glucose level, On fasting and 2h postprandial blood glucose levels higher GDM patients should pay attention to the choice of treatment options.