孕晚期糖化血红蛋白对妊娠结局的预测价值临床研究

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1、目录中文摘要···································································································1英文摘要····································································································3研究论文孕晚期糖化血红蛋白对妊娠结局的预测价值临床研究前言·····················································

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4、·····································································17综述糖化血红蛋白、糖化白蛋白对妊娠期糖尿病的诊断价值············24致谢··········································································································34个人简历····································································

5、·······························35孕晚期糖化血红蛋白对妊娠结局的预测价值临床研究摘要目的：妊娠期糖尿病(gestationaldiabetesmellitusGDM)是因为妊娠期内分泌系统发生改变而特发的一种合并症，它是指糖代谢正常女性，孕期出现的糖代谢异常。GDM可导致巨大儿、胎儿窘迫、新生儿低血糖、新生儿窒息、产后出血等不良结局，同时也会增加孕妇及其子代患糖尿病的概率。根据中华人民共和国卫生行业标准2011年《妊娠期糖尿病诊断标准》，我国于24-28周进行妊娠期糖尿病筛查，诊断标准是测定空腹血糖(fastingplasmaglucose，FPG

6、)，然后口服75g葡萄糖，分别测定服糖后1小时、2小时的血糖，三次血糖界值分别为5.1-10.0-8.5mmol/L。任何一项血糖大于或等于上述标准即诊断为GDM。但是，由于OGTT操作较繁琐，需禁食，多次采血，耗时2个小时，其结果受检查前摄入糖类、脂肪的多少、应激、服糖后恶心、呕吐等多种因素影响，孕妇依从性差，甚至某些孕妇会因OGTT诱发或加重恶心及呕吐反应而无法完成。同时，在目前诊疗水平下，存在基层医院管理不完善、产检不到位、部分孕妇孕期保健意识淡薄的现象，孕期未行或拒行OGTT，直至孕足月或临产后来院就诊，孕期血糖水平不明确，为诊疗工作带来诸多不便。糖化血红蛋白(HbA1c

7、)反映近2-3月的血糖平均水平，其检测操作便捷、结果稳定、不需要禁食，可随时抽血检验。因此本研究以孕晚期HbA1c5.5%为截断点，探讨孕晚期糖化血红蛋白对妊娠结局的预测价值，以指导临床医生对孕妇分层管理，并依据病情及时临床干预，改善母婴结局。方法：采用回顾性研究的方法，选取2017年5月至2017年11月在沧州市人民医院产科分娩且孕期未行OGTT孕妇400例，其入院后均行HbA1c测定，其中200例HbA1c≥5.5%孕妇为病例组，另200例HbA1c＜5.5%孕妇为对照组，以