孕7～15周空腹血浆葡萄糖水平和血脂水平预测妊娠期糖尿病发生风险的临床价值  

The value of fasting plasma glucose and lipid profiles between 7 and 15 gestational weeks in the prediction of gestational diabetes mellitus

作　　者：赵明[1] 李光辉[1] 

机构地区：[1]首都医科大学附属北京妇产医院营养科,100026

出　　处：《中华妇产科杂志》2016年第11期835-839,共5页Chinese Journal of Obstetrics and Gynecology

摘　　要：目的探讨以孕7～15周空腹血浆葡萄糖（FPG）水平和血脂水平预测妊娠期糖尿病（GDM）发生的临床价值。方法回顾性分析2011年8月至2012年2月在首都医科大学附属北京妇产医院进行常规产前检查的2138例孕妇的临床资料，根据孕中期75 g口服葡萄糖糖耐量试验检查结果分为GDM组（240例）和糖耐量正常组（1898例）。分别比较两组孕妇孕7～15周时的FPG和血脂[包括三酰甘油（TG）、高密度脂蛋白胆固醇（HDL-C）、低密度脂蛋白胆固醇（LDL-C）和总胆固醇（TC）]水平；并利用多因素logistic回归分析确定GDM发生独立危险因素，建立logistic回归模型，绘制模型受试者工作特征曲线（ROC），并记录曲线下面积以分析孕7～15周FPG和血脂水平预测GDM发生的临床价值。结果 FPG、TG、TG/HDL-C、LDL-C/HDL-C和TC预测GDM的曲线下面积分别为0.718（95%CI为0.684～0.753）、0.607（95%CI为0.567～0.647）、0.619（95%CI为0.579～0.659）、0.602（95%CI为0.562～0.641）和0.550（95%CI为0.510～0.590）。校正混杂因素后，多因素logistic回归分析显示，孕妇年龄（OR=1.046，95%CI为1.003～1.090）、孕前体质指数（OR=1.104，95%CI为1.049～1.161）、孕次〉3次（OR=1.768，95%CI为1.071～2.920）、孕7～15周FPG水平（OR=8.137，95%CI为5.412～12.236）、TG水平（OR=1.460，95%CI为1.148～1.858）均为GDM发生的独立危险因素（P〈0.05）。logistic回归模型，即PGDM=1/｛1＋exp[-（-16.542＋0.045x年龄＋0.103x孕前BMI＋0.551x孕次〉3次＋2.110xFPG＋0.372x TG）]｝预测GDM的曲线下面积为0.751（95%CI为0.718～0.783，P〈0.01），界值为0.11（敏感度为67.5%，特异度为70.5%）。结论将孕7～15周实验室指标（包括FPG、TG）与临床指标相结合，可更好地预测GDM的发生风险。Objective To explore the value of using fasting plasma glucose （FPG） and lipid profiles between 7 and 15 gestational weeks to predict gestational diabetes mellitus （GDM）. Methods The medical records of 2 138 pregnant women who had prenatal care in Beijing Obstetrics and Gynecology Hospital from August 2011 to February 2012 were analyzed retrospectively. According to results of the oral glucose tolerance tests, women were devided into the GDM group （n=240） and the normal group （n=1 898）. Maternal characteristics, FPG and lipid levels between 7 and 15 gestational weeks were compared between the two groups. Logistic regression analysis and receiver operator characteristics（ROC） curve were used in the analysis. Results Potential markers for the prediction of GDM included total cholesterol, triglyceride （TG）, low-density lipoprotein cholesterol/high-density lipoprotein cholesterol ratios（LDL-C/HDL-C）, triglyceride to high-density lipoprotein cholesterol ratios（TG/HDL-C）and FPG. After adjustment of confounding factors,＆amp;nbsp;age （OR=1.046, 95%CI：1.003-1.090）, pre- pregnancy body mass index （OR=1.104, 95%CI： 1.049-1.161）, gravidity〉3 （OR=1.768, 95%CI：1.071-2.920）, FPG （OR=8.137, 95%CI：5.412-12.236）, TG （OR=1.460, 95%CI：1.148-1.858） were independently associated with the risk of developing GDM. Equation ,PGDM=1/{1＋exp[-（-16.542＋0.045xage＋0.103xpre-pregnancy body mass index＋0.551xgravidity〉3＋2.110xFPG＋0.372x TG）]},was constructed by the logistic regression analysis. Sensitivity （67.5%） and specificity （70.5%） were determined by the calculated risk score, with a cut-off value of 0.11 （area under the curve： 0.751, 95%CI：0.718-0.783, P〈0.001）. Conclusions FPG and TG, together with clinical characteristics may have a better predictive value for the risk of GDM.

关 键 词：糖尿病 妊娠 血糖 脂类 预测 

分 类 号：R714.256[医药卫生—妇产科学]