尿酸联合糖化血红蛋白测定对妊娠期糖尿病患者妊娠结局的预测价值  

Predictive value of determination of uric acid combined with glycosylated hemoglobin for pregnancy outcome in patients with gestational diabetes

作　　者：朱筱丹 王春茶 郑东方 王杭英 ZHU Xiao-dan;WANG Chun-cha;ZHENG Dong-fang;WANG Hang-ying(Department of Obstetrics,Jinhua Maternal and Child Health Hospital,Jinhua,Zhejiang 321000,China)

机构地区：[1]金华市妇幼保健院产科,浙江金华321000

出　　处：《中国妇幼保健》2023年第13期2333-2336,共4页Maternal and Child Health Care of China

基　　金：浙江省金华市科技局公益类项目(2020-4-073)。

摘　　要：目的探讨妊娠期糖尿病(GDM)患者血清尿酸、糖化血红蛋白(HbA1c)水平与不良妊娠结局的关系。方法选取2018年1月—2021年1月金华市妇幼保健院产科门诊就诊并住院分娩的孕妇516例,根据口服葡萄糖耐量试验(OGTT)检查结果分为GDM组和对照组,收集血样本用于测定HbA1c、血尿酸及血糖等,并记录不良妊娠结局等数据。结果GDM患者血清尿酸、HbA1c水平均高于对照组,差异均有统计学意义(均P<0.05);血尿酸>425μmol/L和HbA1c>5.5%组妊娠期高血压疾病、胎膜早破、胎儿窘迫及早产儿发生率均显著高于血尿酸≤425μmol/L和HbA1c≤5.5%组,差异均有统计学意义(均P<0.05),而发生巨大儿、羊水过多、羊水浑浊、手术助产、新生儿低血糖情况无明显差异;logistic回归分析提示,血清尿酸水平(OR=2.006,95%CI:1.552~3.018,P=0.017)和HbA1c(OR=2.013,95%CI:1.653~3.023,P=0.016)同为GDM患者出现不良妊娠结局的高危因素。结论HbA1c和血清尿酸水平上升是GDM患者出现不良妊娠结局的独立高危因素,采取联合检测能较早预测GDM的不良妊娠结局,运用早期干预措施,使不良妊娠结局的发生减少或避免。Objective To explore the relationship between serum uric acid,glycosylated hemoglobin levels and adverse pregnancy outcomes in patients with gestational diabetes(GDM).Methods A total of 516 pregnant women were selected and classified into the experimental group(GDM group)and the control group according to the results of the OGTT examination.Blood samples were collected to determine glycosylated hemoglobin,blood uric acid and blood glucose,and the data of adverse pregnancy outcomes were recorded.Results The results showed that the levels of serum uric acid and glycosylated hemoglobin in patients with GDM were significantly higher than those in the control group(P<0.05);blood uric acid>425μmol/L and glycosylated hemoglobin>5.5%group had hypertension in pregnancy,premature rupture of membranes,and fetus The incidence of distress and preterm infants was significantly higher than that of the blood uric acid≤425μmol/L and glycosylated hemoglobin≤5.5%group(all P<0.05),and the occurrence of macrosomia,polyhydramnios,turbid amniotic fluid,surgical delivery,and neonatal hypoglycemia There was no significant difference;logistic regression analysis indicated that the serum uric acid level(OR=2.006,95%CI:1.552-3.018,P=0.017)and the glycated hemoglobin level(OR=2.013,95%CI:1.653-3.023,P=0.016)were gestational diabetes.Patients have high risk factors for adverse pregnancy outcomes.Conclusion the increase of glycosylated hemoglobin and serum uric acid is a high risk factor for adverse pregnancy outcomes in patients with gestational diabetes mellitus.Through the joint detection of these two indicators,we can predict early adverse pregnancy outcomes of gestational diabetes mellitus.Through early warning and early intervention measures,the occurrence of adverse pregnancy outcomes can be reduced or avoided.

关 键 词：妊娠期糖尿病 尿酸 糖化血红蛋白 妊娠结局 

分 类 号：R587.1[医药卫生—内分泌]