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目的分析按照国际糖尿病与妊娠研究组(IADPSG)诊断标准新增加的妊娠期糖尿病(GDM)患者的妊娠结局,探讨IADPSG诊断标准在我国临床应用价值。方法选择2011年1月1日至2011年6月30日于复旦大学附属妇产科医院门诊定期产检、孕24-28w行50g糖筛查试验(GCT)阳性,进一步行75g口服葡萄糖耐量试验(OGTT),按照美国国家糖尿病数据组(NDDG)诊断标准诊断为非GDM或糖耐量受损(GIGT)的产妇332例的病历资料进行回顾性分析。按是否符合IADPSG诊断标准分为new-GDM组和non-GDM组,比较两组患者的妊娠结局。结果根据IADPSG标准新诊断出的new-GDM患者共44名,其在孕24-28w行糖筛查时的血糖筛查值明显高于non-GDM组孕妇(new-GDM组:9.0±0.9 mmol/L,non-GDM组:8.5±0.6mmol/L,P=0.002)。比较两组孕妇的妊娠结局,妊高症、胎盘早剥、剖宫产率、产后出血、胎儿窘迫、早产、新生儿低血糖的发生率无统计学意义(P>0.05)。两组的巨大儿发生率(new-GDM组:20.5%[9/44],non-GDM组:8.3%[24/288],P=0.026)和新生儿出生体重(new-GDM组:3555.6±507.8g,non-GDM组:3357.2±461.5g,P=0.009)均显著升高,且有显著统计学差异。结论本研究显示采用IADPSG诊断标准可诊断出更多的GDM患者,这些患者若未进行血糖控制,其围产期并发症,尤其是巨大儿的发生率明显增加,提示IADPSG标准作为我国GDM诊断标准具有一定的临床意义。
Objective To analyze the pregnancy outcome of newly diagnosed gestational diabetes mellitus (GDM) patients according to the diagnostic criteria of International Diabetes and Pregnancy Study Group (IADPSG) and to explore the clinical value of IADPSG diagnostic criteria in China. METHODS: From January 1, 2011 to June 30, 2011, regular gynecological examination was conducted at the Obstetrics and Gynecology Hospital of Fudan University. A 50g sugar screening test (GCT) was performed 24-28 weeks pregnant. The oral glucose tolerance test (75g oral glucose tolerance test OGTT) were retrospectively analyzed in 332 cases of maternal women who were diagnosed with non-GDM or impaired glucose tolerance (GIGT) according to the National Diabetes Data Group (NDDG) diagnostic criteria. The patients were divided into new-GDM group and non-GDM group according to the diagnostic criteria of IADPSG. The pregnancy outcome was compared between the two groups. Results A total of 44 new-GDM patients diagnosed according to the IADPSG standard had a significantly higher blood glucose screening score at 24-28 weeks of gestation than non-GDM pregnant women (9.0 ± 0.9 mmol / L, non-GDM group: 8.5 ± 0.6 mmol / L, P = 0.002). The incidence of pregnancy-induced hypertension, placental abruption, cesarean section rate, postpartum hemorrhage, fetal distress, premature birth and neonatal hypoglycemia were not statistically significant (P> 0.05). The prevalence of macrosomia (20.5% [9/44] in new-GDM group, 8.3% [24/288] in non-GDM group, P = 0.026) and newborn birth weight (new-GDM group: 3555.6 ± 507.8g, non-GDM group: 3357.2 ± 461.5g, P = 0.009) were significantly increased, and there was a statistically significant difference. Conclusions This study shows that more patients with GDM can be diagnosed using the IADPSG diagnostic criteria. The absence of glycemic control in these patients significantly increases the incidence of perinatal complications, especially macrosomia, suggesting that the IADPSG standard serves as a diagnostic criteria for GDM in China Has some clinical significance.