孕中期血清铁蛋白预测妊娠期糖尿病的研究  

Study on serum ferritin to predict the risk of gestational diabetes mellitus

作　　者：简泸红 饶明礼 廖娟[1] 余莉华[1] 刘学[1] 成岚 肖正华[1] JIAN Luhong;RAO Mingli;LIAO Juan;YU Lihua;LIU Xue;CHENG Lan;XIAO Zhenghua(Department of Obstetrics,Yongchuan Hospital of Chongqing Medical University,Chongqing 402160,China)

机构地区：[1]重庆医科大学附属永川医院产科,重庆402160

出　　处：《热带医学杂志》2023年第4期512-515,521,共5页Journal of Tropical Medicine

基　　金：重庆市医学重点学科建设项目(2021MSXM081)。

摘　　要：目的利用血清铁蛋白预测妊娠期糖尿病(GDM)的发病风险,为孕期妇女合理补铁和预防妊娠期糖尿病的发生提供参考。方法选取2017-2021年在重庆医科大学附属永川医院规范产检并分娩的孕妇630例,根据是否患有妊娠期糖尿病分为妊娠期糖尿病组(病例组)129例和未患妊娠期糖尿病组(对照组)501例。收集年龄、身高、体重等信息。在妊娠14~27+6周检测血清铁蛋白浓度;在妊娠24~28周规范进行75 g口服糖耐量试验(OGTT),按国家标准诊断妊娠期糖尿病。用单因素分析法筛选妊娠期糖尿病发病的影响因素,将有统计学意义的因素进一步进行多因素logistic回归分析;将有统计学意义的单因素作受试者工作特征曲线下面积(ROC-AUC)拟合,预测妊娠期糖尿病发病风险。结果共观察孕妇630例,血清铁蛋白中位数为26.66μg/L,诊断妊娠期糖尿病129例,发病率为20.48%。单因素分析血清铁蛋白、年龄、孕次、产次、孕前BMI和学历6个因素,病例组与对照组有统计学意义的有:血清铁蛋白分别为49.24(15.95~155.93)μg/L和22.00(8.00~71.85)μg/L(Z=-14.379,P<0.001),年龄分别为(30.83±4.80)岁和(29.05±4.44)岁(t=-4.00,P<0.001),孕次分别为(2.92±1.59)次和(2.47±1.48)次(t=-3.03,P<0.005),孕前BMI分别为(22.79±3.35)kg/m^(2)和(21.90±3.35)kg/m^(2)(t=-2.70,P<0.01)。多因素分析结果显示,血清铁蛋白和年龄是妊娠期糖尿病发生的风险因素,OR(95%CI)分别为1.042(1.033~1.052)(P<0.001)和1.081(1.027~1.134)(P=0.002)。血清铁蛋白预测妊娠期糖尿病的AUC(95%CI)为0.790(0.75~0.83);发生妊娠期糖尿病的阈值为30.28μg/L,其敏感性为78.29%(101/129),特异性为64.87%(325/501),阳性预测值为36.46%(101/277),阴性预测值为92.07%(325/353),超过该阈值发生妊娠期糖尿病的风险为6.66倍(Kappa=0.303,P<0.001),调整年龄风险因素后为1.45倍,仍显示妊娠期糖尿病发生的风险显著增加。结论血清铁蛋白可作为预测妊娠期糖尿Objective To predict the risk of gestational diabetes mellitus(GDM)by serum ferritin,and provide reference for pregnant women to supplement iron reasonably and prevent the occurrence of GDM.Methods The pregnant women with standardized antenatal examination and delivery were included in the study and unqualified cases were excluded.Age,height,weight and other information were collected.Serum ferritin was measured at 14-27~(+6)weeks of gestation;75 g oral glucose tolerance test(OGTT)test was performed at 24-28 weeks of gestation,and GDM was diagnosed according to the national standard.The single factor analysis method was used to screen the influencing factors of GDM,and the multivariate logistic regression analysis method was used to screen the factors with statistical significance as the indicators for joint prediction of the risk of GDM.GDM variables and index variables affecting GDM incidence were analyzed by ROC curve fitting;GDM incidence threshold and related parameters were calculated.Results A total of 630 pregnant women were observed,and the median serum ferritin concentration was 26.66μg/L.Among them,129 were diagnosed as GDM,and the incidence rate was 20.48%.Single factor analysis showed that there were 6 factors including serum ferritin,age,pregnancy,parity,pre pregnancy BMI and education background.The median serum ferritin was 49.24(95%CI:15.95-155.93)and 22.00(95%CI:8.00-71.85)(Z=-14.379,P<0.001)in the case group and the control group,respectively;the average age was(30.83±4.80)and(29.05±4.44)years old,respectively(t=-4.00,P<0.001);the pregnancy times were(2.92±1.59)and(2.47±1.48),respectively(t=-3.03,P<0.005),and the pre pregnancy BMI were(22.79±3.35)and(21.90±3.35)kg/m^(2),respectively(t=-2.70,P<0.01).Logistic regression analysis showed that serum ferritin and age were risk factors for GDM;the OR of serum ferritin and age were 1.042(95%CI:1.033-1.052,P<0.001)and 1.081(95%CI:1.027-1.134,P=0.002),respectively.The differences were statistically significant(P<0.05).ROC curve fitting,the AUC(95%

关 键 词：血清铁蛋白 孕中期妇女 妊娠期糖尿病 

分 类 号：R714.256[医药卫生—妇产科学]