胰岛素抵抗指标在预测妊娠期糖尿病孕妇并发重度子痫前期中的价值  

Value of insulin resistance indexes in the prediction of gestational diabetes mellitus complicated with severe preeclampsia

作　　者：黄诗韵[1] 于博 何欣[1] 陈奕[1] Huang Shiyun;Yu Bo;He Xin;Chen Yi(Department of Perinatal Medicine,Beijing Obstetrics and Gynecology Hospital,Capital Medical University y Beijing 100026,P.R.China)

机构地区：[1]首都医科大学附属北京妇产医院围产医学部,北京100026

出　　处：《中国计划生育和妇产科》2021年第9期84-87,96,I0001,共6页Chinese Journal of Family Planning & Gynecotokology

摘　　要：目的 评价孕中期胰岛素抵抗(insulin resistance,IR)相关指标在预测妊娠期糖尿病(gestational diabetes mellitus,GDM)孕妇并发重度子痫前期(severe preeclampsia,sPE)中的诊断价值.方法 回顾性分析2018年6月至2019年6月在首都医科大学附属北京妇产医院规律产检及分娩孕妇的临床资料,根据是否并发sPE分为GDM并发sPE组(研究组,106例)和单纯GDM组(对照组,228例),分析患者一般资料、孕前体质量指数(body mass index,BMI)、孕24周生化指标:空腹血糖、糖化血红蛋白,空腹胰岛素、血清总胆固醇(total cholesterol,TC)、甘油三酯(triglyceride,TG)、低密度脂蛋白胆固醇(low density lipoprotein cholesterol,LDL-c)、高密度脂蛋白胆固醇(high density lipoprotein cholesterol,HDL-c)水平,并计算IR指标:稳态模型评估的IR指数(HOMA-IR)、TG/HDL-c 比值和 TyG 指数(the product of triglycerides and glucose,TyG).以临床诊断作为"金标准",应用受试者工作特征(receiver operating characteristic,ROC)曲线比较不同指标对于预测GDM并发sPE的诊断价值及效能,联合指标预测应用Logistic回归模型拟合检验变量后分析.结果 研究组孕前BMI与孕中期TC、TG、HOMA-IR、TG/HDL-c值和TyG指数明显高于对照组(P<0.05).Youden指数得出孕中期HOMA-IR和TyG指数的最佳截点分别为HOMA-IR≥2.09 和 TyG≥3.36;应用孕中期HOMA-IR和TyG指数联合预测GDM并发sPE组具有较高的诊断价值及效能:AUC = 0.910,准确率83.8%,敏感度为95.2%,均显著高于两者单独预测.Logistic 回归分析:HOMA-IR(OR=6.832,95%CI:2.648-17.621,P<0.001),TyG(OR = 5.927,95%CI:1.934-17.427,P<0.001),均为独立危险因素.结论 孕中期HOMA-IR联合TyG指数对预测GDM孕妇并发sPE具有较高的诊断价值及效能,其中HOMA-IR≥2.09和TyG≥3.36是较好的截点.Objective To assess the insulin resistance(IR) indexes in the prediction of gestational diabetes mellitus(GDM complicated with severe preeclampsia(sPE).Methods Retrospective analyzed the clinical data of pregnant women undergoing regular prenatal examination and childbirth at theBeijing Obstetrics and Gynecology Hospital of Capital Medical Universityfrom June 2018 to June 2019,and they were divided into GDM complicated with sPE group(observation group,106 cases) and GDM-only group(control group,228 cases). Analyzed their general data,body mass index(BMI),and biochemical indicators at 24 weeks of pregnancy:fasting blood glucose, glycosylated hemoglobin, fasting insulin, serum total cholesterol( TC), triglyceride( TG), low-density lipoprotein cholesterol(LDL-c),high-density lipoprotein cholesterol(HDL-c) levels,and calculated the IR index:HOMA-IR,TG/HDL-c ratio and TyG index. Using the clinical diagnosis as the "golden standard",the receiver operating characteristic(ROC) curves were used to compare the diagnostic value and diagnostic efficacy of those indicators for predicting GDM complicated with sPE.Results In observation group, the levels of pre-pregnancy BMI, TC、 TG、 HOMA-IR、 TG/HDL-c and TyG index were significantly increased compared with control group(P< 0. 05). The Youden index showed that the best cut-off of HOMA-IR and TyG index were HOMA-IR≥2. 0 and TyG≥3. 36. The diagnostic value of HOMA-IR combined with TyG index(AUC = 0. 910) was significantly higher than that of HOMA-IR or TyG index alone. The sensitivity and diagnostic accuracy of HOMA-IR combined with TyG index were 95. 2% and83. 8%. Logistic regression analysis showed HOMA-IR(OR= 6. 832,95% CI:2. 648-17. 621,P< 0. 001) and TyG index(OR=5. 927,95% CI:1. 934-17. 427,P< 0. 001) were independent risk factors for GDM complicated with sPE.Conclusion HOMA-IR combined with TyG index have a high value in the prediction of GDM complicated with sPE in the second trimester of pregnancy,of which the best cut-off of them are HOMA-IR≥2. 0 and TyG≥3

关 键 词：妊娠期糖尿病 子痫前期 胰岛素抵抗 联合指标预测 诊断效能 

分 类 号：R714.244[医药卫生—妇产科学] R714.256[医药卫生—临床医学]