孕早期血红蛋白与体质指数比值联合空腹血糖在妊娠糖尿病诊断中的价值

韦松晓; 麦莹莹; 欧炎萍; 黄茵; 莫隆静

doi:10.13201/j.issn.1004-2806.2024.08.006

孕早期血红蛋白与体质指数比值联合空腹血糖在妊娠糖尿病诊断中的价值

- 1.
  梧州医学高等专科学校直属附属医院(广西梧州，543002)
- 2.
  梧州市红十字会医院检验科
- 3.
  梧州市红十字会医院产科
基金项目:
广西高校中青年教师科研基础能力提升项目课题(No：2023KY2018)

详细信息

通讯作者: 韦松晓，E-mail：359306968@qq.com

中图分类号: R587.1

收稿日期: 2024-01-19

刊出日期: 2024-08-01

Value of ratio of hemoglobin to body mass index combined with fasting blood glucose in diagnosis of gestational diabetes mellitus in early pregnancy

- 1.
  Wuzhou Medical College Directly Affiliated Hospital, Wuzhou, 543002, China
- 2.
  Department of Clinical Laboratorial Examination, Wuzhou Red Cross Hospital
- 3.
  Department of Obstetrical, Wuzhou Red Cross Hospital

More Information

Corresponding author: WEI Songxiao, E-mail: 359306968@qq.com

Received Date: 19 January 2024

Publish Date: 01 August 2024

摘要

摘要: 目的探讨妊娠早期血红蛋白(Hb)与体质指数(BMI)比值和空腹血糖(GLU)在妊娠糖尿病预测中的价值，构建孕早期妊娠妇女妊娠期糖尿病(gestational diabetes mellitus，GDM)风险预测模型。方法选取2021年4月—2023年4月于医院产科产检并分娩的1 113例单胎孕妇为研究对象，收集一般临床资料及孕早期Hb、GLU等结果。根据口服葡萄糖耐量试验(OGTT)结果分为GDM组(341例)和妊娠期血糖正常对照组(772例)，比较两组人群临床代谢特征，采用二元logistic回归分析筛选指标并建立预测模型。采用受试者工作特性(ROC)曲线分析各项指标及诊断模型预测GDM模型的效能。结果 GDM组在孕早期体重、GLU、Hb、血压、经产率、高龄产妇比例及高BMI比例上均高于对照组，而Hb/BMI比值则低于对照组，差异均有统计学意义(P < 0.001)。ROC曲线分析结果显示，单项指标GLU、联合指标(Hb/BMI比值+GLU)鉴别诊断GDM价值较高，ROC曲线下面积(AUC)为0.720、0.737，灵敏度为55.1%和67.7%，特异度为21.6%和29.3%。预测模型诊断GDM发生风险的AUC为0.769，最佳临界值为0.31，灵敏度为68.6%，特异度为73.6%。结论妊娠早期Hb与BMI比值和GLU水平与GDM的发生有一定关系，联合可预测GDM的发生可能性。
- 血红蛋白与体质指数比值 /
- 妊娠糖尿病 /
- 空腹血糖 /
- ROC曲线 /
- 预测模型
Abstract: Objective To investigate the value of the ratio of hemoglobin to body mass index and fasting blood glucose in the prediction of gestational diabetes mellitus(GDM) in the first trimester, and build a GDM risk prediction model for pregnant women in the first trimester.Methods From April 2021 to April 2023, 1 113 single pregnant women who were given birth in the obstetric department of our hospital were selected as the study objects. General clinical data and the results of hemoglobin and fasting blood glucose in early pregnancy were collected. OGTT test results were divided into GDM group and control group. Clinical metabolic characteristics of the two groups were compared, and binary logistic regression was used to analyze the screening indicators and establish the prediction model. Receiver operating characteristic(ROC) curve was used to analyze the performance of each index and the diagnostic model to predict the GDM model.Results In the GDM group, the weight, fasting blood glucose, hemoglobin, blood pressure, postpartum rate, proportion of old women and high BMI in early pregnancy were higher than those in the normal blood glucose group, while the Hb/BMI ratio was lower than that in the normal group, with statistical significance(P < 0.001). ROC curve analysis results showed that single index fasting blood glucose and combined index(Hb/BMI + blood glucose) had higher value in differential diagnosis of GDM (area under the curve [AUC] was 0.720, 0.737, sensitivity was 55.1% and 67.7%, specificity was 21.6% and 29.3%). The predictive model had an AUC of 0.769, the optimal critical value was 0.31, the sensitivity was 68.6%, and the specificity was 73.6%.Conclusion The ratio of hemoglobin to body mass index and fasting blood glucose level in early pregnancy may have a certain relationship with the occurrence of GDM, and the combination can predict the occurrence of GDM.
- Hb/BMI ratio /
- gestational diabetes mellitus /
- fasting blood glucose /
- ROC curve /
- prediction model

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图 1 各单项指标及Hb/BMI与GLU联合指标对GDM的鉴别诊断价值

下载: 全尺寸图片幻灯片

图 2 诊断模型Y鉴别诊断GDM的ROC曲线(训练集)

下载: 全尺寸图片幻灯片

表 1 对照组和GDM组孕妇的基本临床资料比较

变量	总人数(n=1 113)	对照组(n=772)	GDM组(n=341)	t/χ²	P
Hb/(g/L)	122.68±11.03	121.70±10.83	124.91±11.19	t=-4.520	< 0.001
GLU/(mmol/L)	4.57±0.54	4.44±0.39	4.87±0.68	t=-10.734	< 0.001
Hb/BMI	5.65±0.88	5.76±0.86	5.42±0.87	t=6.113	< 0.001
身高/cm	157.57±4.75	157.78±4.75	157.08±4.72	t=2.279	0.023
孕早期体重/kg	54.91±8.89	53.52±8.12	58.07±9.73	t=-7.559	< 0.001
BP/mmHg^a	106.82±11.69	104.97±10.74	111.01±12.65	t=-7.683	< 0.001
舒张压/mmHg	71.06±8.54	70.13±8.01	73.16±9.30	t=-5.222	< 0.001
孕次/次	2.32±1.41	2.33±1.34	2.28±1.55	t=0.461	0.645
产次/例(%)				χ²=4.978	0.026
0	493(44.29)	359(46.50)	134(39.30)
≥1	620(55.71)	413(53.50)	207(60.70)
BMI/例(%)				χ²=68.114	< 0.001
< 24 kg/m²	838(75.29)	636(82.38)	202(59.24)
≥24 kg/m²	275(24.71)	136(17.62)	139(40.76)
年龄/例(%)				χ²=28.192	< 0.001
< 35岁	793(71.25)	587(76.04)	206(60.41)
≥35岁	320(28.75)	185(23.96)	135(39.59)
注：^a1 mmHg=0.133 kPa。

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表 2 各单项指标及Hb/BMI与GLU联合指标鉴别GDM的诊断价值

指标	AUC(95%CI)	最佳截断值	灵敏度	特异度	Youden指数
年龄/岁	0.632(0.597~0.667)	31.5	0.666	0.455	0.211
GLU/(mmol/L)	0.720(0.686~0.754)	4.7	0.551	0.216	0.335
孕早期体重/kg	0.651(0.616~0.686)	54.6	0.630	0.391	0.239
BMI/(kg/m²)	0.678(0.643~0.712)	21.5	0.713	0.426	0.287
Hb/(g/L)	0.588(0.551~0.621)	122.5	0.622	0.472	0.150
Hb/BMI	0.612(0.760~0.648)	5.4	0.496	0.324	0.172
收缩压/mmHg	0.644(0.608~0.679)	109.5	0.531	0.311	0.220
舒张压/mmHg	0.589(0.553~0.626)	76.5	0.355	0.212	0.143
Hb/BMI+GLU	0.737(0.704~0.770)	0.3	0.677	0.293	0.384

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表 3 妊娠早期影响孕妇患GDM风险的单因素logistic回归分析结果

变量	β	SE	Wald χ²	P	OR(95%CI)
年龄≥35岁	0.82	0.16	5.01	< 0.001	2.27(1.65~3.13)
BMI≤24 kg/m²	-1.08	0.17	-6.28	< 0.001	0.34(0.24~0.47)
Hb	0.03	0.01	4.35	< 0.001	1.03(1.02~1.05)
GLU	1.66	0.19	8.69	< 0.001	5.28(3.63~7.68)
身高	-0.04	0.02	-2.23	0.026	0.96(0.93~0.99)
收缩压	0.05	0.01	6.74	< 0.001	1.05(1.03~1.06)
舒张压	0.05	0.01	4.85	< 0.001	1.05(1.03~1.07)
Hb/BMI	-0.40	0.09	-4.41	< 0.001	0.67(0.56~0.80)
体重	0.05	0.01	5.99	< 0.001	1.06(1.04~1.07)

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表 4 训练样本多因素二元logistic回归分析结果

变量	β	SE	Wald χ²	P	OR(95%CI)
Hb/BMI	-0.39	0.12	9.89	0.002	0.68(0.53~0.86)
BP	0.03	0.01	9.51	0.002	1.03(1.01~1.04)
GLU	1.41	0.19	53.55	< 0.001	4.10(2.80~5.96)
Hb	0.04	0.01	19.39	< 0.001	1.04(1.02~1.06)
年龄≥35岁	0.56	0.19	9.00	0.003	1.75(1.21~2.52)
常量	-12.82	1.54	69.51	< 0.001	0.001

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