双胎妊娠早期糖尿病相关危险因素分析及预测  

Risk Factors Analysis and Prediction of Twin Pregnancies Complicated with Gestational Diabetes Mellitus in Early Pregnancy

作　　者：崔金晖[1] 李萍[1] 欧阳丽萍 陈新娟[1] 李玲[1] 范建辉[1] CUI Jin-hui;LI Ping;OUYANG Li-ping;CHEN Xin-juan;LI Ling;FAN Jian-hui(Department of Obstetrics,The Third Affiliated Hospital,Sun Yat-sen University,Guangzhou 510630,China)

机构地区：[1]中山大学附属第三医院产科,广东广州510630

出　　处：《中山大学学报（医学科学版）》2020年第6期944-950,共7页Journal of Sun Yat-Sen University:Medical Sciences

基　　金：广东省科技计划项目(20116061300030)。

摘　　要：【目的】探讨双胎妊娠期糖尿病(GDM)早孕期的相关危险因素,以寻找早孕期预测双胎GDM的有效指标。【方法】回顾性分析2015年1月至2019年6月在中山大学附属第三医院规律产检并分娩,且病例资料完整的双胎妊娠孕妇共318例,根据75克口服葡萄糖耐量试验(OGTT)结果,将其分为双胎GDM组84例,正常双胎组(双胎未合并GDM)234例,收集记录研究对象的临床特征,包括年龄、孕前体质量指数、孕产次、既往病史、此次受孕方式、双胎绒毛膜性质;早孕期(11~13+6周)的空腹血糖(FPG)、总胆固醇(TC)、甘油三酯(TG)、高密度脂蛋白(HDL)、低密度脂蛋白(LDL)及早孕期唐氏筛查生物学标记物妊娠相关血浆蛋白A(PAPP-A)和人绒毛膜促性腺激素β亚单位(Freeβ-HCG)的检测结果,通过多因素Logistic逐步回归分析法分析双胎GDM的早孕期相关危险因素,采用受试者工作特征曲线评价双胎GDM的早期预测。【结果】①两组比较,双胎GDM组的年龄、孕前体质量指数高于正常双胎组(P<0.001),双胎GDM组合并多囊卵巢综合征病史的比例高于正常双胎组(P<0.05);②双胎GDM组早孕期FPG、TG高于双胎正常组(P<0.05),而两组TC、HDL、LDL及PAPP-A MOM值及Freeβ-HCG MOM值差异无统计学意义(P>0.05);③年龄、孕前体质量指数、PCOS病史、早孕FPG水平均为双胎GDM发生的独立危险因素(P<0.05);④早孕期FPG预测双胎GDM的ROC曲线下面积(AUC)为0.617(95%CI:0.547~0.688),FPG为4.495 mmo/L时,约登指数为0.223,敏感度、特异度分别为65.5%、56.8%;早孕期TG预测双胎GDM的AUC为0.65(95%CI:0.584~0.716),TG为1.195 mmo/L时,约登指数为0.24,敏感度、特异度分别为77.4%、46.6%;而早孕期FPG、TG结合孕妇年龄、孕前体质量指数、PCOS病史预测双胎GDM的AUC为0.751(95%CI:0.693~0.810),敏感度、特异度分别为73.8%、70.1%。【结论】孕妇年龄、孕前体质量指数、PCOS病史、早孕FPG水平均为双胎GDM发生的独立危险�【Objective】To explore the risk factors of twin pregnancies complicated with gestational diabetes mellitus(GDM)in early pregnancy,and search for effective predictors of GDM in twin pregnancy.【Methods】Retrospective analysis was performed on 318 patients of twin pregnancies who had regular prenatal examinations and delivered in The Third Affiliated Hospital of Sun Yat-sen University between January,2015 and June,2019.According to the results of 75 g oral glucose tolerance test(OGTT),84 cases were assigned to the GDM group,and 234 cases were assigned to non-GDM group.The clinical characteristics of the subjects were recorded,including age,pre-pregnancy body mass index,gravidity,parity,medical history,mode of conception and chorionicity.The subjects′results of fasting plasma glucose,total choles⁃terol,triglycerides,high density lipoprotein,low density lipoprotein,and pregnancy-associated plasma protein-A,free beta subunit of human chorionic gonadotropin for Down′s screening in early pregnancy(11~13+6 weeks)were also included.Risk factors were analyzed by multivariate-Logistic stepwise regression,and receiver-operating characteristic curve was used to evaluate the prediction of GDM in twin pregnancy.【Results】①The age and pre-pregnancy body mass index of GDM group were higher than those of non-GDM group(P<0.001),and the proportion of GDM group combined with polycystic ovary syndrome was higher(P<0.05);②FPG and TG in GDM group were higher than those of non-GDM group(P<0.05),however,there was no difference in TC,HDL,LDL,PAPP-A MOM and Freeβ-HCG MOM between the two groups(P>0.05);③Age,pre-pregnancy body mass index,PCOS history and FPG in early pregnancy were independent risk factors of GDM in twin pregnancy;④The AUC of FPG for predicting GDM in twin pregnancy was 0.617(95%CI:0.547~0.688),when FPG was 4.495 mmol/L,the Youden′s index was 0.223 with sensitivity and specificity of 65.5%and 56.8%,respectively;The AUC of TG was 0.65(95%CI:0.584~0.716),when TG was 1.195 mmol/L,the Youden′s index was

关 键 词：妊娠期糖尿病 双胎妊娠 空腹血糖 甘油三酯 早期预测 

分 类 号：R714.4[医药卫生—妇产科学]