妊娠期糖尿病孕晚期脂代谢异常对妊娠结局的影响  

Effect of abnormal lipid metabolism in late pregnancy on pregnancy outcome in patients with gestational diabetes mellitu

作　　者：潘怡慧 殷亚东 崔县伟[2] 刘岚[1] PAN Yi-Hui;YIN Ya-Dong;CUI Xian-Wei(Department of Obstetrics,Women’s Hospital of Nanjing Medical University,Nanjing,Jiangsu 210004,China)

机构地区：[1]南京医科大学附属妇产医院产科,江苏南京210004 [2]南京医科大学附属妇产医院医学研究中心,江苏南京210004

出　　处：《中国妇幼保健》2022年第1期1-5,共5页Maternal and Child Health Care of China

基　　金：国家自然科学基金项目(82070879)。

摘　　要：目的探讨妊娠期糖尿病(GDM)孕妇孕晚期血脂水平与妊娠结局的关系。方法选取2020年11月—2021年2月在南京医科大学附属妇产医院分娩的GDM孕妇200例为GDM组,另选取同期糖耐量正常孕妇(NGT)200例为NGT组,根据三酰甘油(TG)水平将两组研究对象分别分为血脂异常亚组和血脂正常亚组,比较亚组间妊娠结局,利用相关性分析和多元线性回归分析孕晚期血脂水平对妊娠结局的影响。结果NGT亚组妊娠结局比较,差异均无统计学意义(均P>0.05)。GDM血脂异常亚组新生儿出生体质量、巨大儿发生率明显高于血脂正常亚组,差异均有统计学意义(均P<0.05)。整组人群相关性分析显示,新生儿出生体质量与孕前体质指数(BMI)、孕期增重及TG均呈正相关关系(r=0.122、0.165、0.241,P=0.015、0.001、0.000),与高密度脂蛋白胆固醇(HDL-C)呈负相关关系(r=-0.193,P=0.000)。多元线性回归分析显示,孕期增重、TG及HDL-C是新生儿出生体质量的独立影响因素(均P<0.05),回归方程:出生体质量(g)=2932.842+孕期增重(kg)×21.252+TG(mmol/L)×76.410-HDL-C(mmol/L)×194.194。结论GDM孕妇孕晚期存在以TG升高、HDL-C降低为主的显著脂代谢异常,脂代谢水平与新生儿出生体质量相关,糖代谢异常合并脂代谢异常增加巨大儿发生率。Objective Investigate the relationship between plasma lipid in the third trimester and pregnancy outcome in women with GDM.Methods From November 2020 to February 2021,a total of 200 pregnant women with GDM delivered in Women’s Hospital of Nanjing Medical University were selected and compared with another 200 normal glucose tolerance women in the same period.According to the level of triglycerides they were divided into dyslipidemia subgroup and normal plasma lipid subgroup.The pregnancy outcomes were compared between twosubgroups.Correlation analysis and Logistic retrospective analysis were performed to analyze the effect of plasma lipid in the third trimester on pregnancy outcome.Results There was no significant difference in pregnancy outcome among NGT subgroups(P>0.05).The birth weight and the incidence of macrosomia in the NGT subgroup were significantly higher than those in the normal lipidemia subgroup(P<0.05).Correlation analysis showed that newborn birth weight was positively correlated with pre-pregnancy BMI(r=0.122,P=0.015),weight gain during pregnancy(r=0.165,P=0.001),TG(r=0.241,P=0.000),and negatively correlated with HDL-C(r=-0.193,P=0.000).Logistic retrospective analysis showed that weight gain during pregnancy,TG and HDL-C were independent influencing factors of birth weight(all P<0.05).The regression equation was:birth weight(g)=2932.842+pregnancy weight gain(kg)×21.252+TG(mmol/L)×76.410-HDL-C(mmol/L)×194.194.Conclusion In the third trimester of pregnancy,women with GDM have significant abnormal plasma lipid metabolism,which is mainly caused by the increase of TG and the decrease of HDL-C.The level of lipid metabolism is related to the birth weight of newborns.Abnormal glucose metabolism combined with disorderedplasma lipid metabolism willmainlyincrease the incidence of macrosomia.

关 键 词：妊娠期糖尿病 血脂 新生儿出生体质量 巨大儿 

分 类 号：R714.2[医药卫生—妇产科学]