【医学课件】妊娠糖尿病诊断的评价.pptVIP

* However, when applying the sensitivity and specificity values of the test to a population with a prevalence of GDM of about 4% (as in most reported studies), the Positive Predictive Value of the proposed cut-off blood glucose level was reduced to 19.5%, too low to serve as a single diagnostic test. 然而，当他们把敏感性和特异性用在妊娠糖尿病患病率约4％的人群中去时，阳性预期值就只有19.5%,作为一个独立的诊断试验，这个值太低了。 * Universal screening for GDM was recommended in 1985. According to this recommendation, all pregnant women, regardless of the presence of risk factors should be screened for GDM. In 1999, the American Diabetes Association changed the previous recommendations from universal screening to high risk groups screening. High risk women include those age 25, overweight before pregnancy, members of an ethnic group with a high prevalence of diabetes, having first relatives with diabetes, history of abnormal glucose tolerance and history of poor obstetric outcome. 妊娠糖尿病的群体筛检实在1985年提出来的。根据这个建议，所有妊娠妇女，不管有没有危险因素，都应该进行妊娠糖尿病的筛检。1999年，美国糖尿病协会将群体筛检改为了高危人群的筛检。高危妇女包括：年龄大于25岁，怀孕前超重，是糖尿病患病率高的人种，第一亲属患有糖尿病，糖耐量异常病史，不良生产史。 * Magee et al (1993) described the advantages and disadvantages of each of the screening strategies. While universal screening was supposed to provide a solution to undiagnosed GDM, it showed that only about half of eligible women would agree to screening, only 27.7% of those with an abnormal GCT had an abnormal OGTT, and those who refused to screening had in fact more risk factors. In contrast, high risk group screening would miss about 40% of GDM women. Magee等（1993）描述了筛选策略各自的优点和缺点。假定群体筛查为未诊断的妊娠糖尿病提供一个解决方案，只有近一半的符合条件的妇女愿意筛查，而糖负荷试验异常的人群中只有27.7%口服糖耐量试验是异常的。事实上拒绝筛查的人却具有更多的危险因素 。相反，高危人群筛查将漏诊40％的妊娠糖尿病妇女。 * Data from Holcberg et al (1994) in the Negev region of Israel, confirm the findings by Magee. Although Jewish women had a higher rate of participation than Bedouin women, the overall participation rate was 60%. Holcberg 等人 (1994)在以色列内盖夫地区获得的数据证明了Magee的发现。尽管犹太妇女的参与率比贝多因妇女高，总体的参与率为60％。 * In this section we