孕妇外周血总胆汁酸水平与妊娠期糖尿病风险关系的研究  

Study on relationship between total bile acid level in peripheral blood of pregnant women and risk of gestational diabetes mellitus

作　　者：郭笑丹 张彦利 朱国优 王婷 董鹏[5] 曹静雯 GUO Xiaodan;ZHANG Yanli;ZHU Guoyou;WANG Ting;DONG Peng;CAO Jingwen(Department of Endocrinology and Metabolism,No.215 Hospital of Shaanxi Nuclear Industry,Shaanxi Xianyang 712000,China;Department of Endocrinology and Metabolism,Yulin Municipal Traditional Chinese Medicine Hospital of Shaanxi Province,Shaanxi Yulin,716000,China;Department of Emergency,No.215 Hospital of Shaanxi Nuclear Industry,Shaanxi Xianyang712000,China;Department of Respiratory Medicine,Xi′an Municipal Fourth Hospital,Shaanxi Xi'an 710000,China;Department of Endocrinology and Metabolism,The Second Affiliated Hospital of Xi′an Jiaotong University,Shaanxi Xi'an 710004,China)

机构地区：[1]陕西省核工业二一五医院内分泌代谢科,陕西咸阳712000 [2]陕西省榆林市中医医院内分泌代谢科,陕西榆林719000 [3]陕西省核工业二一五医院急诊科,陕西咸阳712000 [4]西安市第四医院呼吸内科,陕西西安710004 [5]西安交通大学第二附属医院内分泌代谢科,陕西西安710004

出　　处：《中国妇幼健康研究》2022年第9期51-56,共6页Chinese Journal of Woman and Child Health Research

基　　金：陕西省重点研发计划资助项目(NO.2018SF-219)。

摘　　要：目的 探讨第14~18孕周孕妇外周血总胆汁酸(TBA)水平与第24~28孕周诊断为妊娠期糖尿病(GDM)的关系。方法 收集2013年9月至2020年9月于陕西省核工业二一五医院产检的第12~13孕周并随访至生产的1 554例孕妇。在第14~18孕周检测孕妇外周血中TBA水平。根据第24~28孕周口服75g葡萄糖耐量试验(OGTT),将正常标准葡萄糖耐量(NGT)者1 419例作为NGT组,非正常者135例作为GDM组。采用多因素Logistic回归方法验证TBA水平四分位数区间分层与GDM的相关性。结果 GDM占总孕妇的8.7%(135/1 554)。GDM组的TBA水平明显高于NGT组[(2.1±1.5)μmol/L vs.(1.5±0.8)μmol/L,t=3.291,P<0.001]。按照TBA水平四分位数区间分层,在调整年龄、糖尿病家族史和孕前体质量指数(pre-BMI)后,最高TBA水平分层(2.3~10.9μmol/L)孕妇患GDM的风险是最低TBA水平分层(0.0~0.7μmol/L)的1.340倍(95%CI:1.082~1.852,P<0.05)。TBA水平的升高与空腹血糖呈正相关(r=0.131,P=0.003),而与OGTT后1小时或OGTT后2小时的血糖水平均无相关性。结论 孕妇第14~18孕周较高的TBA水平与第24~28孕周GDM的发病有关;中期妊娠的早期外周血中TBA水平升高可能是患GDM的危险因素。Objective To study relationship between total bile acid(TBA) level in peripheral blood of pregnant women at 14-18 weeks of gestation and gestational diabetes mellitus(GDM) at 24-28 weeks of gestation.Methods 1554 pregnant women at 12-13 weeks of gestation who received prenatal examination and were followed up till to child birth in No.215 Hospital of Shaanxi Nuclear Industry over a period from September, 2013 to September, 2020 were enrolled.TBA levels of the pregnant women were detected at 14-18 weeks of gestation.The pregnant women were divided into normal glucose tolerance group(NGT group, n=1149) and GDM group(n=135),according to the diagnostic criteria of the International Association of Diabetes and Pregnancy Study Groups, which based on the results of their 75 gram oral glucose tolerance test(OGTT) at 24-28 weeks of gestation.The Multivariate Logistic regression was used to analyze relationship between each quartile of TBA concentration and GDM.Results The pregnant women with GDM accounted for 8.7% of all pregnant women(135/1554).The level of TBA of the pregnant women in GDM group was significantly higher than that in NGT group(2.1 ± 1.5 μmol/L vs.1.5 ± 0.8μmol/L,t=3.291,P<0.001).After adjusting for age, family history of diabetes, and pre-pregnancy body mass index(pre-BMI),the risk of developing GDM in women with the highest TBA stratification(2.3-10.9 umol/L) was higher(1.340 times) than that in those pregnant women with the lowest TBA stratification(0.0-0.7 umol/L)(95%CI: 1.082-1.852,P<0.05).The TBA level was positively correlated with the fasting glucose level, but not with 1 h or 2 h blood glucose level of the OGTT test.Conclusion High serum TBA level at 14-18 weeks of gestation is associated with development of GDM at 24-28 weeks of gestation.The elevated level of TBA in peripheral blood at the middle pregnancy may be a risk factor for GDM.

关 键 词：妊娠期糖尿病 总胆汁酸 危险因素 相关性 

分 类 号：R173[医药卫生—妇幼卫生保健]