摘要
目的探讨孕晚期外周血纤维蛋白原(FIB)、糖化血红蛋白(HbA1c)对妊娠期糖尿病(GDM)不良妊娠结局的预测价值。方法选取安徽省宁国市人民医院2022年1月至2023年12月收治的112例GDM患者为研究对象,根据患者妊娠结局不同分为妊娠结局正常组与不良组,记录2组患者临床资料、产妇及胎儿不良妊娠结局、FIB、HbA1c水平,经Logistics回归分析GDM不良妊娠结局的危险因素,采用Spearman相关法分析FIB、HbA1c水平与不良妊娠结局的关系,绘制受试者工作特征(ROC)曲线分析孕晚期GDM患者FIB、HbA1c水平对不良妊娠结局的预测价值。结果GDM患者不良妊娠结局者共34例,发生率为30.36%;2组患者年龄、产次、孕次、分娩方式、糖尿病家族史、分娩时出血量、产前体质量指数差异均无统计学意义(P>0.05);不良组FIB、HbA1c水平高于正常组(P<0.05);FIB、HbA1c水平与GDM患者不良妊娠结局呈正相关性(r=0.387,0.481,P均<0.05);HbA1c≥5.5%组与HbA1c<5.5%组相比,胎膜早破发生率更高(P<0.05);FIB≥4.2 g/L组与FIB<4.2 g/L组相比,早产儿发生率更高(P>0.05);FIB≥4.2 g/L+HbA1c≥5.5%组与FIB≥4.2 g/L+HbA1c<5.5%组相比,胎膜早破发生率更高(P>0.05);FIB、HbA1c是影响GDM患者不良妊娠结局的危险因素(OR=3.142,22.512,P均<0.05);FIB、HbA1c最佳截断值分别为4.82 g/L,5.76%,两者联合检测曲线下面积(AUC)为0.846(95%CI:0.747~0.944)优于单独检测[0.742(95%CI:0.637~0.848),0.802(95%CI:0.704~0.900)]。结论孕晚期外周血FIB、HbA1c是影响GDM患者不良妊娠结局的危险因素,两者联合检测对GDM不良妊娠结局有较高的预测价值。
Objective To evaluate the predictive value of peripheral blood fibrinogen(FIB)and glycated haemoglobin(HbA1c)in late pregnancy for adverse pregnancy outcomes in gestational diabetes mellitus(GDM).Methods 112 GDM women admitted to our hospital from January 2022 to December 2023 were included,and categorized into normal outcome group and poor outcome group according to different pregnancy outcomes.Clinical data,adverse maternal and fetal outcomes,FIB and HbA1c levels were recorded in all subjects.Logistics regression was applied to analyze the risk factors for adverse pregnancy outcomes in GDM,Spearman correlation method was used to testify the correlation of FIB and HbA1c levels with adverse pregnancy outcomes in GDM,and receiver operating characteristic curve(ROC)was used to evaluate the impact of FIB and HbA1c in late pregnancy for adverse pregnancy outcomes.Results Adverse pregnancy outcomes occurred in 34 GDM patients,with an incidence of 30.36%.No statistical difference was reported in age,number of live births,number of pregnancies,mode of delivery,family history of diabetes mellitus,hemorrhage during delivery,and prenatal body mass index between two groups(P>0.05),while poor outcome group detected higher FIB and HbA1c levels compared to normal outcome group(P<0.05).FIB and HbA1c levels were positively correlated with adverse pregnancy outcomes in GDM patients(r=0.387,0.481,P<0.05).Compared with the HbA1c<5.5%group,the HbA1c≥5.5%group had a higher incidence of premature rupture of membranes(P<0.05);the FIB≥4.2 g/L group had a higher incidence of premature infants than the FIB<4.2 g/L group.higher(P>0.05);compared with the FIB≥4.2g/L+HbA1c<5.5%group,the incidence of premature rupture of membranes was higher in the FIB≥4.2g/L+HbA1c≥5.5%group(P>0.05).FIB and HbA1c were risk factors for adverse pregnancy outcomes in GDM patients(OR=3.142,22.512,P<0.05).A cutoff value of 4.82 g/L and 5.76%for FIB and HbA1c resulted in an area under the curve of 0.846(95%CI:0.747~0.944),which was larger than the separate test of FIB0.742[0.742(95%CI:0.637~0.848)]and HbA1c[0.802(95%CI:0.704~0.900)].Conclusion Peripheral blood FIB and HbA1c in late pregnancy are risk factors for adverse pregnancy outcomes in patients with GDM,and the combined testing has a high predictive value for adverse pregnancy outcomes in GDM.
作者
田继芳
陈望
徐敏
邵琴
TIAN Jifang;CHEN Wang;XU Min;SHAO Qin(Department of Laboratory Medicine,Ningguo People's Hospital,Ningguo,Anhui 242300,China;Department of Obstetrics and Gynecology,Ningguo People's Hospital,Ningguo,Anhui 242300,China)
出处
《转化医学杂志》
2024年第9期1444-1448,共5页
Translational Medicine Journal
