妊娠糖尿病诊断的评价2课件

妊娠糖尿病诊断的评价SimonWeitzman,MD,MPH翻译：斯晓燕妊娠糖尿病诊断的评价SimonWeitzman,MD,M1妊娠糖尿病诊断标准的评价诊断方法和标准筛检测率母亲和胎儿结局妊娠糖尿病诊断标准的评价诊断方法和标准2妊娠糖尿病诊断标准的评价诊断方法和标准筛检测率母亲和胎儿结局妊娠糖尿病诊断标准的评价诊断方法和标准3妊娠糖尿病的诊断方法1小时葡萄糖负荷试验（GCT）口服糖耐量试验（OGTT）世界卫生组织（WHO）全国糖尿病资料组（NDDG）Coustan修正方案妊娠糖尿病的诊断方法1小时葡萄糖负荷试验（GCT）4妊娠糖尿病的诊断方法诊断标准(mg/dL)空腹血糖1小时2小时3小时WHO（75g）140200NDDG(100g)105195165145Coustan(100g)95180155140妊娠糖尿病的诊断方法诊断标准(mg/dL)空腹血糖1小时2小5妊娠糖尿病诊断标准的评价诊断方法和标准筛检测率母亲和胎儿结局妊娠糖尿病诊断标准的评价诊断方法和标准6妊娠糖尿病的筛选策略方法一步法二步法妊娠糖尿病的筛选策略方法750g葡萄糖负荷试验（>=186mgdL）敏感性38.2%特异性93.3%阳性预测值78.6%阴性预测值70.0%50g葡萄糖负荷试验（>=186mgdL）敏感性38.2%850g葡萄糖负荷试验（>=186mgdL）敏感性38.2%特异性93.3%阳性预测值19.5%阴性预测值97.2%50g葡萄糖负荷试验（>=186mgdL）敏感性38.2%9妊娠糖尿病的筛选策略人群群体筛检高危人群筛检妊娠糖尿病的筛选策略人群10群体筛检VS高危筛检群体筛检57.4%的人同意筛检27.7%糖负荷试验阳性的人口服糖耐量试验异常未参加的人有更多的危险因素高危筛检可能漏诊40％的妊娠糖尿病群体筛检VS高危筛检群体筛检11内盖夫地区的群体筛查70％的犹太妇女和57％的贝多因妇女同意筛查49％的妇女进行葡萄糖负荷试验只有10％的妇女参加口服糖耐量试验总共未参加的妇女：40％内盖夫地区的群体筛查70％的犹太妇女和57％的贝多因妇女同意12妊娠糖尿病诊断标准的评价诊断方法和标准筛检测率母亲和胎儿结局妊娠糖尿病诊断标准的评价诊断方法和标准13妊娠糖尿病对儿童糖尿病发展的影响动物中高糖血症将影响β细胞的功能宫内营养剥夺和母体高糖血症增加今后患糖尿病的危险妊娠糖尿病对儿童糖尿病发展的影响动物中高糖血症将影响β细胞的14母亲和胎儿的后果特点OGTT正常妊娠糖尿病大于胎龄儿(%)3438胎龄（周）3939.2住院天数3.73.9母亲和胎儿的后果特点OGTT正常妊娠糖尿病大于胎龄儿(%)315根据危险因素，妊娠糖尿病妇女围产期特点特点危险因素比值比（95％可信区间）有无剖宫产（％）38351.6(0.7~3.7)巨大儿（％）33172.4(0.9~6.7)肩难产（％）7130.5(0.1~2.1)胰岛素治疗30281.1(0.4~2.7)根据危险因素，妊娠糖尿病妇女围产期特点特点危险因素比值比（916妊娠糖尿病诊断的评价2课件17妊娠糖尿病诊断的评价2课件18有妊娠糖尿病史妇女此后发生糖尿病的相关因素的对数回归分析因素比值比95％可信区间诊断时空腹血糖6.941.83~26.24产后OGTT0～120分血糖AUC3.151.08~9.23诊断OGTT0～60分胰岛素AUC5.261.13~22.50有妊娠糖尿病史妇女此后发生糖尿病的相关因素的对数回归分析因素19随访妊娠糖尿病史和健康对照组妇女的糖耐量情况随访状态妊娠糖尿病（n＝139）对照（n＝27）正常OGTT64.7(90)88.9(24)糖耐量受损20.1(28)11.1(3)2型糖尿病10.8(15)--1型糖尿病4.3(6)--随访妊娠糖尿病史和健康对照组妇女的糖耐量情况随访状态妊娠糖尿20总结（1）J.Nerup说1型糖尿病是遗传学家的恶梦，同样，妊娠糖尿病是流行病学家的恶梦。对它的定义，最佳诊断方法，诊断标准，确定筛检人群都一直存有争论。总结（1）J.Nerup说1型糖尿病是遗传学家的恶梦，同样21总结（2）尽管如此，对这些情况的处理已经有了很大改进。除了巨大儿，妊娠糖尿病母亲胎儿的围产期结局已经和非糖尿病母亲的相似了。总结（2）尽管如此，对这些情况的处理已经有了很大改进。除了巨22总结（3）有更多的证据表明，有妊娠糖尿病史的妇女得糖尿病(尤其是2型糖尿病)的危险性增加在肥胖的妊娠糖尿病妇女中，即使是在产后数年，胰岛素抵抗仍然存在。总结（3）有更多的证据表明，有妊娠糖尿病史的妇女得糖尿病(尤237JaMdPhSkWnZq$u*x-A2D5H8KbNfQiTlXo#s%v(y0B3E6I9LdOgRjVmYp!t&w)z1C4G7JaMePhSkWnZr$u*x+A2D5H8KcNfQiUlXo#s%v)y0B3F6I9LdOgSjVmYq!t&w-z1D4G7JbMePhTkWoZr$u(x+A2E5H8KcNfRiUlXp#s%v)y0C3F6IaLdOgSjVnYq!t*w-z1D4G8JbMeQhTkWoZr%u(x+B2E5H9KcOfRiUmXp#s&v)z0C3F7IaLdPgSkVnYq$t*w-A1D4G8JbNeQhTlWoZr%u(y+B2E6H9KcOfRjUmXp!s&v)z0C4F7IaMdPgSkVnZq$t*x-A1D5G8KbNeQiTlWo#r%v(y+B3E6H9LcOfRjUmYp!s&w)z0C4F7JaMdPhSkVnZq$u*x-A2D5G8KbNfQiTlXo#r%v(y0B3E6I9LcOgRjVmYp!t&w)z1C4G7JaMePhSkWnZq$u*x+A2D5H8KbNfQiUlXo#s%v(y0B3F6I9LdOgRjVmYq!t&w-z1C4G7JbMePhTkWnZr$u(x+A2E5H8KcNfRiUlXp#s%v)y0C3F6IaLdOgSjVmYq!t*w-z1D4G7JbMeQhTkWoZr$u(x+B2E5H9KcNfRiUmXp#s&v)y0C3F7IaLdPgSjVnYq$t*w-A1D4G8JbiUlXp#s%v)y0B3F6IaLdOgSjVmYq!t*w-z1D4G7JbMeQhTkWoZr$u(x+B2E5H9KcNfRiUmXp#s&v)y0C3F7IaLdPgSjVnYq$t*w-A1D4G8JbMeQhTlWoZr%u(x+B2E6H9KcOfRiUmXp!s&v)z0C3F7IaMdPgSkVnYq$t*x-A1D5G8JbNeQiTlWo#r%u(y+B3E6H9LcOfRjUmXp!s&w)z0C4F7IaMdPhSkVnZq$t*x-A2D5G8KbNeQiTlXo#r%v(y+B3E6I9LcOgRjUmYp!t&w)z1C4F7JaMePhSkWnZq$u*x-A2D5H8KbNfQiTlXo#s%v(y0B3E6I9LdOgRjVmYp!t&w-z1C4G7JaMePhTkWnZr$u*x+A2E5H8KcNfQiUlXp#s%v)y0B3F6IaLdOgSjVmYq!t&w-z1D4G7JbMePhTkWoZr$u(x+A2E5H9KcNfRiUlXp#s&v)y0C3F6IaLdPgSjVnYq!t*w-A1D4G8JbMeQhTlWoZr%u(x+B2E5H9KcOfRiUmXp#s&v)z0C3F7IaLdPgSkVnYq$t*w-A1D5G8JbNeQhTlWo#r%u(y+B2E6H9LcOfRjUmXp!s&w)z0C4F7IaMdPhSkVnZq$t*x-A1D5G8KbNeQiTlWo#r%v(y+B3E6H9LcOgRjUmYp!s&w)z1C4F7JaMdPhSkWnZq$u*x-A2D5H8KbNfQiTlXo#s%v(y0B3E6I9LcOgRjVmYp!t&w)z1C4G7JaMePhSkWnZr$u*x+A2D5H8KcNfQiUlXo#s%v)y0B3F6I9LdOgSjVmYq!t&w-z1D4G7JbMePhTkWnZr$u(x+A2E5H8KcNfRiUlXp#s%v)y0C3F6IaLdOgSjVnYq!t+A2D5H8KcNfQiUlXo#s%v)y0B3F6I9LdOgSjVmYq!t&w-z1C4G7JbMePhTkWnZr$u(x+A2E5H8KcNfRiUlXp#s%v)y0C3F6IaLdOgSjVnYq!t*w-z1D4G8JbMeQhTkWoZr%u(x+B2E5H9KcNfRiUmXp#s&v)y0C3F7IaLdPgSjVnYq$t*w-A1D4G8JbNeQhTlWoZr%u(y+B2E6H9KcOfRjUmXp!s&v)z0C4F7IaMdPgSkVnZq$t*x-A1D5G8JbNeQiTlWo#r%u(y+B3E6H9LcOfRjUmYp!s&w)z0C4F7JaMdPhSkVnZq$u*x-A2D5G8KbNfQiTlXo#r%v(y0B3E6I9LcOgRjUmYp!t&w)z1C4F7JaMePhSkWnZq$u*x+A2D5H8KbNfQiUlXo#s%v(y0B3F6I9LdOgRjVmYq!t&w-z1C4G7JbMePhTkWnZr$u*x+A2E5H8KcNfQiUlXp#s%v)y0B3F6IaLdOgSjVmYq!t*w-z1D4G7JbMeQhTkWoZr$u(x+B2E5H9KcNfRiUmXp#s&v)y0C3F7IaLdPgSjVnYq!t*w-A1D4G8JbMeQhTlWoZr%u(x+B2E6H9KcOfRiUmXp!s&v)z0C3F7IaMdPgSkVnYq$t*x-A1D5G8JbNeQiTlWo#r%u(y+B2E6H9LcOfRjUmXp!s&w)z0C4F7IaMdPhSkVnZq$t*x-A2D5G8KbNeQiTlXo#r%v(y+B3E6I9LcOgRYq$t*x-A1D5G8JbNeQhTlWo#r%u(y+B2E6H9LcOfRjUmXp!s&w)z0C4F7IaMdPhSkVnZq$t*x-A2D5G8KbNeQiTlXo#r%v(y+B3E6I9LcOgRjUmYp!s&w)z1C4F7JaMdPhSkWnZq$u*x-A2D5H8KbNfQiTlXo#s%v(y0B3E6I9LdOgRjVmYp!t&w-z1C4G7JaMePhTkWnZr$u*x+A2D5H8KcNfQiUlXo#s%v)y0B3F6I9LdOgSjVmYq!t&w-z1D4G7JbMePhTkWoZr$u(x+A2E5H9KcNfRiUlXp#s&v)y0C3F6IaLdPgSjVnYq!t*w-z1D4G8JbMeQhTkWoZr%u(x+B2E5H9KcOfRiUmXp#s&v)z0C3F7IaLdPgSkVnYq$t*w-A1D5G8JbNeQhTlWo#r%u(y+B2E6H9KcOfRjUmXp!s&v)z0C4F7IaMdPgSkVnZq$t*x-A1D5G8KbNeQiTlWo#r%v(y+B3E6H9LcOgRjUmYp!s&w)z1C4F7JaMdPhSkWnZq$u*x-A2D5G8KbNfQiTlXo#r%v(y0B3E6I9LcOgRjVmYp!t&w)z1C4G7JaMePhSkWnZr$u*x+A2D5H8KcNfQiUlXo#s%v)y0B3F6I9LdOgVnZq$u*x-A2D5G8KbNfQiTlXo#r%v(y0B3E6I9LcOgRjVmYp!t&w)z1C4G7JaMePhSkWnZr$u*x+A2D5H8KcNfQiUlXo#s%v(y0B3F6I9LdOgRjVmYq!t&w-z1C4G7JbMePhTkWnZr$u(x+A2E5H8KcNfRiUlXp#s%v)y0C3F6IaLdOgSjVnYq!t*w-z1D4G7JbMeQhTkWoZr$u(x+B2E5H9KcNfRiUmXp#s&v)y0C3F7IaLdP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