胰岛素释放试验异常和妊娠期糖尿病孕妇脂代谢情况及其与妊娠结局的关系  

Lipid metabolism in pregnant women with gestational diabetes and abnormal insulin release test and its relationship with pregnancy outcome

作　　者：张惠 陈伟 陈沈苗 罗琼[2] ZHANG Hui;CHEN Wei;CHEN Shenmiao(Department of Obstetrics,Wenling Maternal and Child Health Hospital,Wenling 317500,China)

机构地区：[1]温岭市妇幼保健院产科,浙江温岭317500 [2]浙江大学医学院附属妇产科医院产科

出　　处：《全科医学临床与教育》2021年第1期44-47,共4页Clinical Education of General Practice

摘　　要：目的分析胰岛素释放试验异常孕妇与妊娠期糖尿病孕妇脂代谢情况及其与妊娠结局的关系。方法选取定期产检的764例孕妇作为研究对象,按照孕24~28周口服葡萄糖耐量试验和胰岛素释放试验结果的不同,分为妊娠期糖尿病组148例、胰岛素释放试验异常组217例以及正常组399例,比较三组孕妇孕晚期空腹血脂、餐后甘油三酯(PTG)、胰岛素水平以及不良妊娠结局情况,采用logistic回归分析巨大儿的影响因素。结果妊娠期糖尿病组的空腹甘油三酯(FTG)、FTG/高密度脂蛋白胆固醇(HDL-C)以及PTG水平明显比正常组和胰岛素释放试验异常组更高,HDL-C水平明显比正常组和胰岛素释放试验异常组更低,差异均有统计学意义(LSD-t分别=9.23、4.15、2.99、-6.45;2.98、4.86、7.10、-6.69,P均<0.05);妊娠期糖尿病组的空腹胰岛素、2 h胰岛素水平均明显比正常组更高,差异均有统计学意义(LSD-t分别=10.47、7.41,P均<0.05);妊娠期糖尿病组巨大儿发生率均明显比正常组、胰岛素释放试验异常组高,差异均有统计学意义(χ^2分别=17.07、9.08,P均<0.05)。FTG、PTG为出现巨大儿的危险因素(OR分别=1.41、1.24,P均<0.05)。结论妊娠期糖尿病与胰岛素释放试验异常的孕妇血脂水平与妊娠结局密切相关,应维持脂代谢良好状况,以减少不良妊娠结局。Objective To explore the lipid metabolism in pregnant women with abnormal insulin release test and gestational diabetes and its relationship with pregnancy outcome.Methods Totally 764 pregnant women undergoing periodic checkups were selected as the research objects.According to the results of oral glucose tolerance test and insulin release test at 24 to 28 weeks of pregnancy,the objects were divided into gestational diabetes mellitus group with 148 cases,abnormal insulin release test group with 217 cases,and normal group with 399 cases.The fasting blood lipids,postprandial triglycerides(PTG),insulin levels and adverse pregnancy outcomes among the three groups were compared.Logistic regression was used to analyze the influencing factors of macrosomia.Results The levels of FTG,FTG/HDL-C and PTG in gestational diabetes mellitus group were significantly higher than those in normal group and abnormal insulin release test group,while HDL-C level was significantly lower than that in normal group and abnormal insulin release test group(LSD-t=9.23,4.15,2.99,-6.45;2.98,4.86,7.10,-6.69,P<0.05).The fasting insulin,insulin at 2 hours in gestational diabetes mellitus group were significantly lower than those in normal group and abnormal insulin release test group(LSD-t=10.47,7.41,P<0.05).The incidence of macrosomia in gestational diabetes mellitus group was significantly higher than that in normal group and abnormal insulin release test group(χ^2=17.07,9.08,P<0.05).The results of multivariate regression analysis confirmed that FTG and PTG are independent risk factors for macrosomia(OR=1.41,1.24,P<0.05).Conclusion The blood lipid levels of pregnant women with gestational diabetes mellitus and abnormal insulin release test are closely related to pregnancy outcome,and good lipid metabolism should be maintained to aviod the adverse pregnancy outcomes.

关 键 词：孕妇 胰岛素释放试验 妊娠期糖尿病 脂代谢 妊娠结局 

分 类 号：R714.256[医药卫生—妇产科学]