妊娠糖尿病診斷的評(píng)價(jià)33課件

妊娠糖尿病診斷的評(píng)價(jià)SimonWeitzman,MD,MPH翻譯：斯曉燕妊娠糖尿病診斷的評(píng)價(jià)SimonWeitzman,MD,M1妊娠糖尿病診斷標(biāo)準(zhǔn)的評(píng)價(jià)診斷方法和標(biāo)準(zhǔn)篩檢測(cè)率母親和胎兒結(jié)局妊娠糖尿病診斷標(biāo)準(zhǔn)的評(píng)價(jià)診斷方法和標(biāo)準(zhǔn)2妊娠糖尿病診斷標(biāo)準(zhǔn)的評(píng)價(jià)診斷方法和標(biāo)準(zhǔn)篩檢測(cè)率母親和胎兒結(jié)局妊娠糖尿病診斷標(biāo)準(zhǔn)的評(píng)價(jià)診斷方法和標(biāo)準(zhǔn)3妊娠糖尿病的診斷方法1小時(shí)葡萄糖負(fù)荷試驗(yàn)（GCT）口服糖耐量試驗(yàn)（OGTT）世界衛(wèi)生組織（WHO）全國糖尿病資料組（NDDG）Coustan修正方案妊娠糖尿病的診斷方法1小時(shí)葡萄糖負(fù)荷試驗(yàn)（GCT）4妊娠糖尿病的診斷方法診斷標(biāo)準(zhǔn)(mg/dL)空腹血糖1小時(shí)2小時(shí)3小時(shí)WHO（75g）140200NDDG(100g)105195165145Coustan(100g)95180155140妊娠糖尿病的診斷方法診斷標(biāo)準(zhǔn)(mg/dL)空腹血糖1小時(shí)2小5妊娠糖尿病診斷標(biāo)準(zhǔn)的評(píng)價(jià)診斷方法和標(biāo)準(zhǔn)篩檢測(cè)率母親和胎兒結(jié)局妊娠糖尿病診斷標(biāo)準(zhǔn)的評(píng)價(jià)診斷方法和標(biāo)準(zhǔn)6妊娠糖尿病的篩選策略方法一步法二步法妊娠糖尿病的篩選策略方法750g葡萄糖負(fù)荷試驗(yàn)（>=186mgdL）敏感性38.2%特異性93.3%陽性預(yù)測(cè)值78.6%陰性預(yù)測(cè)值70.0%50g葡萄糖負(fù)荷試驗(yàn)（>=186mgdL）敏感性38.2%850g葡萄糖負(fù)荷試驗(yàn)（>=186mgdL）敏感性38.2%特異性93.3%陽性預(yù)測(cè)值19.5%陰性預(yù)測(cè)值97.2%50g葡萄糖負(fù)荷試驗(yàn)（>=186mgdL）敏感性38.2%9妊娠糖尿病的篩選策略人群群體篩檢高危人群篩檢妊娠糖尿病的篩選策略人群10群體篩檢VS高危篩檢群體篩檢57.4%的人同意篩檢27.7%糖負(fù)荷試驗(yàn)陽性的人口服糖耐量試驗(yàn)異常未參加的人有更多的危險(xiǎn)因素高危篩檢可能漏診40％的妊娠糖尿病群體篩檢VS高危篩檢群體篩檢11內(nèi)蓋夫地區(qū)的群體篩查70％的猶太婦女和57％的貝多因婦女同意篩查49％的婦女進(jìn)行葡萄糖負(fù)荷試驗(yàn)只有10％的婦女參加口服糖耐量試驗(yàn)總共未參加的婦女：40％內(nèi)蓋夫地區(qū)的群體篩查70％的猶太婦女和57％的貝多因婦女同意12妊娠糖尿病診斷標(biāo)準(zhǔn)的評(píng)價(jià)診斷方法和標(biāo)準(zhǔn)篩檢測(cè)率母親和胎兒結(jié)局妊娠糖尿病診斷標(biāo)準(zhǔn)的評(píng)價(jià)診斷方法和標(biāo)準(zhǔn)13妊娠糖尿病對(duì)兒童糖尿病發(fā)展的影響動(dòng)物中高糖血癥將影響β細(xì)胞的功能宮內(nèi)營養(yǎng)剝奪和母體高糖血癥增加今后患糖尿病的危險(xiǎn)妊娠糖尿病對(duì)兒童糖尿病發(fā)展的影響動(dòng)物中高糖血癥將影響β細(xì)胞的14母親和胎兒的后果特點(diǎn)OGTT正常妊娠糖尿病大于胎齡兒(%)3438胎齡（周）3939.2住院天數(shù)3.73.9母親和胎兒的后果特點(diǎn)OGTT正常妊娠糖尿病大于胎齡兒(%)315根據(jù)危險(xiǎn)因素，妊娠糖尿病婦女圍產(chǎn)期特點(diǎn)特點(diǎn)危險(xiǎn)因素比值比（95％可信區(qū)間）有無剖宮產(chǎn)（％）38351.6(0.7~3.7)巨大兒（％）33172.4(0.9~6.7)肩難產(chǎn)（％）7130.5(0.1~2.1)胰島素治療30281.1(0.4~2.7)根據(jù)危險(xiǎn)因素，妊娠糖尿病婦女圍產(chǎn)期特點(diǎn)特點(diǎn)危險(xiǎn)因素比值比（916妊娠糖尿病診斷的評(píng)價(jià)33課件17妊娠糖尿病診斷的評(píng)價(jià)33課件18有妊娠糖尿病史婦女此后發(fā)生糖尿病的相關(guān)因素的對(duì)數(shù)回歸分析因素比值比95％可信區(qū)間診斷時(shí)空腹血糖6.941.83~26.24產(chǎn)后OGTT0～120分血糖AUC3.151.08~9.23診斷OGTT0～60分胰島素AUC5.261.13~22.50有妊娠糖尿病史婦女此后發(fā)生糖尿病的相關(guān)因素的對(duì)數(shù)回歸分析因素19隨訪妊娠糖尿病史和健康對(duì)照組婦女的糖耐量情況隨訪狀態(tài)妊娠糖尿?。╪＝139）對(duì)照（n＝27）正常OGTT64.7(90)88.9(24)糖耐量受損20.1(28)11.1(3)2型糖尿病10.8(15)--1型糖尿病4.3(6)--隨訪妊娠糖尿病史和健康對(duì)照組婦女的糖耐量情況隨訪狀態(tài)妊娠糖尿20總結(jié)（1）J.Nerup說1型糖尿病是遺傳學(xué)家的惡夢(mèng)，同樣，妊娠糖尿病是流行病學(xué)家的惡夢(mèng)。對(duì)它的定義，最佳診斷方法，診斷標(biāo)準(zhǔn)，確定篩檢人群都一直存有爭(zhēng)論。總結(jié)（1）J.Nerup說1型糖尿病是遺傳學(xué)家的惡夢(mèng)，同樣21總結(jié)（2）盡管如此，對(duì)這些情況的處理已經(jīng)有了很大改進(jìn)。除了巨大兒，妊娠糖尿病母親胎兒的圍產(chǎn)期結(jié)局已經(jīng)和非糖尿病母親的相似了?？偨Y(jié)（2）盡管如此，對(duì)這些情況的處理已經(jīng)有了很大改進(jìn)。除了巨22總結(jié)（3）有更多的證據(jù)表明，有妊娠糖尿病史的婦女得糖尿病(尤其是2型糖尿病)的危險(xiǎn)性增加在肥胖的妊娠糖尿病婦女中，即使是在產(chǎn)后數(shù)年，胰島素抵抗仍然存在。總結(jié)（3）有更多的證據(jù)表明，有妊娠糖尿病史的婦女得糖尿病(尤23-x*u$qZnWkShPdMaJ7F4C1z)w&t!pYmUjRgOcL9I6E3B+y(v%r#oXlTiQeNbK8G5D2A-x*t$qZnVkShPdMaI7F4C0z)w&s!pXmUjRfOcL9H6E2B+y(u%r#oWlTiQeNbJ8G5D1A-x*t$qYnVkSgPdMaI7F3C0z)v&s!pXmUiRfOcK9H6E2B+x(u%rZoWlThQeMbJ8G4D1A-w*t!qYnVjSgPdLaI6F3C0y)v&s#pXmUiRfNcK9H5E2B+x(u$rZoWkThQeMbJ7G4D1z-w*t!qYmVjSgOdLaI6F3B0y)v%s#pXlUiQfNcK8H5E2A+x*u$rZnWkThPeMbJ7G4C1z-w&t!qYmVjRgOdL9I6F3B0y(v%s#oXlUiQfNbK8H5D2A+x*u$qZnWkShPeMaJ7F4C1z)w&t!pYmUjRgOcL9I6E3B+y(v%r#oXlTiQfNbK8G5D2A-x*u$qZnVkShPdMaJ7F4C0z)w&s!pYmUjRfOcL9H6E3B+y(u%r#oWlTiQeNbJ8G5D1A-x*t$qYnVkSgPdMaI7F4C0z)v&s!pXmUjRfOcK9H6E2B+y(u%rZoWlThQeNbJ8G4D1A-w*t$qYnVjSgPdLaI7F3C0y)v&s#pXmUiRfNcK9H5E2B+x(u%rZoWkThQeMbJ8G4D1z-w*t!qYnVjSgOdLaI6F3C0y)v%s#pXlUiRfNcK8H5E2A+x(u$rZnWkThPeMbJ7G4C1z-w&t!qYmVjRgOdL9I6F3B0y)v%s#oXlUiQfNcK8H5D2A+x*u$rZnWkShPeMaJ7G4C1z)w&t!pYmVjRgOcL9I6E3B0y(v%r#oXlTiQfNbK8G5D2A-x*u$qZnWkShPdMaJ7F4C1z)w&s!pYmUjRgOcL9H6E3B+y(v%r#oWlTiQeNbK8G5D1A-x*t$qZnVkSgPdMaI7F4C0z)v&s!pXmUjRfOcL9H6E2B+y(u%r#oWlThQeNbJ8G5D1A-w*t$qYnVkSgPdLaI7F3C0z)v&s#pXmUiRfOcK9H5E2B+x(u%rZoWkThQeMbJ8G4D1z-w*t!qYnVjSgPdLaI6F3C0y)v&s#pXlUiRfNcK9H5E2A+x(u$rZoWkThPeMbJ7G4D1z-w&t!qYmVjSgOdL9I6F3B0y)v%s#oXlUiQfNcK8H5E2A+x*u$rZnWkThPeMaJ7G4C1z-w&t!pYmVjRgOdL9I6E3B0y(v%s#oXlTiQfNbK8H5D2A-x*u$qZnWkShPdMaF3B0y)v%s#pXlUiQfNcK8H5E2A+x*u$rZnWkThPeMaJ7G4C1z-w&t!pYmVjRgOdL9I6E3B0y(v%s#oXlTiQfNbK8H5D2A-x*u$qZnWkShPeMaJ7F4C1z)w&t!pYmUjRgOcL9I6E3B+y(v%r#oXlTiQeNbK8G5D2A-x*t$qZnVkShPdMaI7F4C0z)w&s!pXmUjRfOcL9H6E2B+y(u%r#oWlTiQeNbJ8G5D1A-x*t$qYnVkSgPdMaI7F3C0z)v&s!pXmUiRfOcK9H6E2B+x(u%rZoWlThQeMbJ8G4D1A-w*t!qYnVjSgPdLaI7F3C0y)v&s#pXmUiRfNcK9H5E2B+x(u$rZoWkThQeMbJ7G4D1z-w*t!qYmVjSgOdLaI6F3B0y)v%s#pXlUiQfNcK8H5E2A+x(u$rZnWkThPeMbJ7G4C1z-w&t!qYmVjRgOdL9I6F3B0y(v%s#oXlUiQfNbK8H5D2A+x*u$qZnWkShPeMaJ7F4C1z)w&t!pYmUjRgOcL9I6E3B0y(v%r#oXlTiQfNbK8G5D2A-x*u$qZnVkShPdMaJ7F4C0z)w&s!pYmUjRfOcL9H6E3B+y(u%r#oWlTiQeNbJ8G5D1A-x*t$qZnVOcL9I6E3B0y(v%r#oXlTiQfNbK8G5D2A-x*u$qZnVkShPdMaJ7F4C0z)w&s!pYmUjRfOcL9H6E3B+y(u%r#oWlTiQeNbK8G5D1A-x*t$qZnVkSgPdMaI7F4C0z)v&s!pXmUjRfOcK9H6E2B+y(u%rZoWlThQeNbJ8G4D1A-w*t$qYnVjSgPdLaI7F3C0z)v&s#pXmUiRfOcK9H5E2B+x(u%rZoWkThQeMbJ8G4D1z-w*t!qYnVjSgOdLaI6F3C0y)v%s#pXlUiRfNcK8H5E2A+x(u$rZoWkThPe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