孕中期血清Hcy、HbA1c及TyG指数对妊娠期糖尿病的预测价值  

Clinical significance of serum Hcy,HbA1c and TyG index in second trimester of gestational diabetes mellitus

作　　者：吴路路 王瑞亚 张雅宁 牛少欣 冯静[3] Wu Lulu;Wang Ruiya;Zhang Yaning(Graduate School of Hebei North University,Zhangjiakou 075000;Graduate School of Hebei Medical University,Shijiazhuang 050011)

机构地区：[1]河北北方学院研究生院,张家口075000 [2]河北医科大学研究生院,石家庄050011 [3]河北省人民医院产科,石家庄050051

出　　处：《现代妇产科进展》2023年第4期283-286,292,共5页Progress in Obstetrics and Gynecology

基　　金：河北省中医药科研计划项目(No:2022386);河北省2023年度医学科学研究课题计划(No:20230274)。

摘　　要：目的:探讨孕妇孕中期同型半胱氨酸(Hcy)、甘油三酯葡萄糖(TyG)指数及糖化血红蛋白(HbA1c)单独及联合预测妊娠期糖尿病(GDM)的价值。方法:选取2020年3月1日至2022年5月30日于河北省人民医院产科规律产检并住院分娩的孕产妇859例。根据孕妇24~28+6周75g口服葡萄糖耐量试验(75g OGTT)结果,将其分为GDM组(476例,55.4%)及对照组(383例,44.6%)。于孕中期,检测孕妇FPG、HbA1c、Hcy及血脂等各项指标。分析孕妇孕中期Hcy、TyG指数联合HbA1c与GDM的相关性。结果:GDM组的年龄、孕前BMI、FPG、HbA1c、TG、TyG指数、Hcy均高于对照组,差异有统计学意义(P<0.05)。Spearman相关分析结果显示,孕中期血清Hcy与HbA1c、TyG指数呈正相关,TyG指数与HbA1c呈正相关。多因素logistic回归分析结果显示,年龄、孕前BMI、HbA1c、TyG指数、Hcy均是GDM的独立影响因素(P<0.05)。孕中期HbA1c、TyG指数、Hcy及其联合预测GDM的ROC曲线分析结果显示,HbA1c、TyG指数及Hcy三者联合对于GDM具有较好的预测价值(AUC=0.840,95%CI为0.814~0.866,P<0.001)。结论:HbA1c、TyG指数、Hcy均为孕妇患GDM的独立危险因素,三者联合可较好地预测GDM。Objective:To investigate the value of mid-pregnancy homocysteine(Hcy),triglyceride glucose(TyG)index and glycosylated hemoglobin(HbA1c)alone and combined in predicting gestational diabetes mellitus(GDM).Methods:A total of 859 pregnant women who received regular birth examination and hospitalized delivery in the Obstetrics Department of Hebei General Hospital from March 1,2020 to May 30,2022 were studied.The clinical data and examination indexes of patients were analyzed.According to the results of 75g oral glucose tolerance test(75g OGTT)conducted at 24~28+6,pregnant women were divided into GDM group(476 cases,55.4%)and control group(383 cases,44.6%).Fasting venous blood of all pregnant women during the second trimester was collected to detect FPG,HbA1c,Hcy and lipid and other indicators.The correlation between Hcy and TyG index combined with HbA1c and gestational diabetes mellitus(GDM)in pregnant women during the second trimester was analyzed.Results:Age,pre-pregnancy BMI,FPG,HbA1c,TG,TyG index and Hcy in GDM group were higher than those in control group,and the difference was statistically significant(P<0.05).Spearman correlation analysis showed that serum Hcy was positively correlated with HbA1c and TyG index,and TyG index was positively correlated with HbA1c.Multiple logistic regression analysis showed that age,pre-pregnancy BMI,HbA1c,TyG index and Hcy were independent influencing factors of GDM(P<0.05).ROC curve analysis of mid-pregnancy HbA1c,TyG index,Hcy and their combined prediction of GDM showed that the combination of HbA1c,TyG index and Hcy had good predictive value for GDM(AUC:0.840,95%CI 0.814~0.866,P<0.001).Conclusions:HbA1c,TyG index and Hcy are independent risk factors for GDM in pregnant women,and the combination of these three factors can better predict GDM.

关 键 词：妊娠期糖尿病 甘油三酯葡萄糖指数 同型半胱氨酸 糖化血红蛋白 

分 类 号：R714.4[医药卫生—妇产科学]