机构地区:[1]中山大学附属第一医院医学检验科,广州510080
出 处:《新医学》2023年第7期517-521,共5页Journal of New Medicine
摘 要:目的分析妊娠期糖尿病(GDM)孕妇孕期血脂水平的变化情况,探讨孕期血脂水平与GDM及新生儿体重及脐血C肽之间的关系。方法采用病例对照研究,收集673例孕妇的临床资料,根据其孕中期75 g口服葡萄糖耐量试验(OGTT)结果分为GDM组(150例)、糖耐量正常(NGT)组(523例)。采用Logistic回归分析GDM发生的风险因素。采用Spearman相关性分析GDM孕妇血脂水平与新生儿体重和新生儿脐血C肽之间的相关性。结果在孕早期阶段,与NGT组相比,GDM组甘油三酯水平更高、脂蛋白a[Lp(a)]水平更低;在孕中期阶段,与NGT组相比,GDM组总胆固醇及HDL-C水平更低;在孕晚期阶段,与NGT组相比,GDM组甘油三酯及载脂蛋白A1/载脂蛋白B(ApoA1/B)水平更高、ApoB水平更低(P均<0.05)。年龄(OR=1.111,95%CI=1.065~1.158,P<0.001)和孕早期Lp(a)(OR=0.660,95%CI=0.454~0.960,P=0.030)是GDM发生的独立因素。新生儿出生体重与孕妇年龄呈负相关(r_(s)=-0.253,P=0.013),与产后BMI(r_(s)=0.241,P=0.017)、孕期增重(r_(s)=0.270,P=0.017)、分娩时胎龄(r_(s)=0.34,P=0.001)呈正相关。在孕早期和孕晚期,新生儿出生体重与甘油三酯、ApoB呈正相关,与ApoA1/B呈负相关。新生儿出生体重与孕晚期ApoE呈正相关(r_(s)=0.227,P=0.025)。新生儿脐血C肽水平与孕中期(r_(s)=-0.218,P=0.038)和孕晚期(r_(s)=-0.227,P=0.031)的ApoE水平呈负相关。结论GDM孕妇在妊娠早期就发生脂代谢紊乱。在妊娠期间,监测血脂的变化,维持正常的血脂水平能有效控制妊娠期并发症,减轻不良妊娠结局对母儿的影响。Objective To analyze the changes of serum lipid levels in pregnant women with gestational diabetes mellitus(GDM)and the relationship between serum lipid levels during pregnancy and GDM,neonatal birth weight and cord-blood C-peptide.Methods In this case-control study,clinical data of 673 pregnant women were collected.According to the results of 75-g oral glucose tolerance test(OGTT)in the second trimester(Tr2),673 pregnant women were divided into the GDM group(n=150)and normal glucose tolerance(NGT)group(n=523).The risk factors of GDM were identified by Logistic regression analysis.The correlation between serum lipid level,neonatal weight and cord-blood C-peptide in GDM pregnant women was analyzed by Spearman correlation.Results During the first trimester(Tr1),triglyceride(TG)level was higher and lipoprotein(a)[Lp(a)]level was lower in the GDM group than those in the NGT group.During Tr2,TC and high-density lipoprotein cholesterol(HDL-C)levels in the GDM group were lower compared with those in the NGT group.In the third trimester(Tr3),TG level and apolipoprotein A1/B(ApoA1/B)ratio were higher and ApoB level was lower in the GDM group than those in the NGT group,with statistical significance(all P<0.05).Age(OR=1.111,95%CI=1.065-1.158,P<0.001)and Lp(a)in Tr1(OR=0.660,95%CI=0.454-0.960,P=0.030)were the independent factors of the incidence of GDM.Neonatal birth weight was negatively correlated with age(r_(s)=-0.253,P=0.013),whereas positively correlated with postpartal body mass index(BMI)(r_(s)=0.241,P=0.017),gestational weight gain(GWG)(r_(s)=0.270,P=0.017)and gestational age at delivery(r_(s)=0.34,P=0.001).In Tr1 and Tr3,neonatal birth weight was positively correlated with TG and ApoB levels,whereas negatively correlated with ApoA1/B ratio.Neonatal birth weight was positively correlated with ApoE level in Tr3(r_(s)=0.227,P=0.025).Neonatal cord-blood C-peptide level was negatively correlated with ApoE levels in Tr2(r_(s)=-0.218,P=0.038)and Tr3(r_(s)=-0.227,P=0.031).Conclusions Pregnant women with GDM develop lipid m
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