Gestational diabetes in a high-risk population: using the fasting plasma glucose to simplify the diagnostic algorithm
Gestational diabetes in a high-risk population: using the fasting plasma glucose to simplify the diagnostic algorithm
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DOI：
10.1016/j.ejogrb.2004.07.034
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发表时间：
2005-05-01
影响因子：
2.6
通讯作者：
Koster, G
中科院分区：
文献类型：
--
作者：
Agarwal, MM;Dhatt, GS;Koster, G
目的：评价空腹血糖(FPG)在妊娠期糖尿病(MM)高危人群筛查中的价值。研究设计：在为期8个月的时间里，1685名孕妇接受了一步75g口服葡萄糖耐量试验(OGTT)，作为普遍筛查计划的一部分。结果：333例(19.8%)GDM患者符合WHO标准。空腹血糖ROC曲线下面积为0.639(95%可信区间为1.6~0.674)。这反映了患有和不患有妊娠期糖尿病的女性的空腹血糖直方图重叠的程度。当空腹血糖阈值为4.7mmo1/L时，最低可接受灵敏度为78.1%，相应的不可接受特异度为32.2%。508名妇女(31%)低于这一门槛，其阴性预测值为85.6%。特异性可接受的高阈值空腹血糖的敏感性较差，阳性预测值较低。结论：尽管在任何阈值下的高假阳性率足够敏感，但空腹血糖不适合用于GDM的筛查。FPG有可能避免近三分之一的繁琐的OGTT，但代价是错过了五分之一患有轻度GDM的孕妇。(C)2004爱思唯尔爱尔兰有限公司。保留所有权利。
Objective: To evaluate the value of fasting plasma glucose (FPG) in screening a high-risk population for gestational diabetes mellitus (MM).Study design: During an 8-month period, 1685 pregnant women underwent the one-step 75 g oral glucose tolerance test (OGTT) as a part of a universal screening progam. The receiver operating characteristic (ROC) curve was used to analyze the performance of the FPG.Results: 333 (19.8%) women had GDM (WHO criteria). The area under the ROC curve of FPG to detect GDM was 0.639 (95% CI (1.60 - 0.674). which reflected the degree of the FPG histogram overlap in women with and without GDM. A FPG threshold of 4.7 mmol/l reachcd the minimally acceptable sensitivity of 78.1% with a corresponding unacceptable specificity of 32.2%. 508 (31%) women were below this threshold, at a negative predictive value of 85.6%. The FPG at higher thresholds with acceptable specificity had poor sensitivity and positive predictive value to be useful.Conclusion: Though the high false positive rate at any FPG threshold with adequate sensitivity makes the FPG an inappropriate test for GDM screening. the FPG has the potential to avoid nearly one-third of the cumbersome OGTTs at the expense of missing one-fifth of pregnant women with milder GDM. (c) 2004 Elsevier Ireland Ltd. All rights reserved.