家族病史妊娠糖尿病患者产后发生2型糖尿病的高危特征与潜在风险分析  

Family history high-risk characteristics and potential risk analysis of postpartum type 2 diabetes in pregnant women with diabetes

作　　者：宋三娣 万燕 刘运芳 SONG Sandi;WAN Yan;LIU Yunfang(Department of Obstetrics and Gynecology,Huangshan Shoukang Hospital,Huangshan,Anhui 245000,China)

机构地区：[1]安徽省黄山首康医院妇产科,安徽黄山245000

出　　处：《中国优生与遗传杂志》2023年第7期1420-1425,共6页Chinese Journal of Birth Health & Heredity

摘　　要：目的探讨家族病史妊娠糖尿病(GDM)患者产后发生2型糖尿病(T2DM)的高危特征及潜在风险。方法选择2019年6月至2022年6月安徽省黄山首康医院收治待产的236例合并糖尿病家族史的GDM产妇作为观察对象,根据产后是否发生T2DM,分为T2DM组和无T2DM组,对比两组临床资料,多因素分析通过Logistic回归模型,构建列线图预测模型并验证,并通过X-tile软件对患者进行危险分层。结果与产后未发生T2DM的GDM产妇比较,发生T2DM的产妇年龄更大,孕前BMI、FPG、2 h PG、LDL-C、HbA1c、MAGE及MODD更高(P<0.05),HDL-C、ApoA、ApoB更低。年龄、孕前BMI、FPG、2 h PG以及HbA1c是GDM患者产后发生T2DM的独立危险因素(P<0.05)。依据独立影响因素构建的列线图预测模型具有较高的区分度、准确性和临床适用性。使用X-tile软件患者分为三个组,依次为<162分(低危),≥162分且小于204分(中危),≥204分(高危)。生存曲线表明,总分越高的患者产后发生T2DM的风险更高。结论年龄、孕前BMI、FPG、2 h PG以及HbA1c是GDM患者产后发生T2DM的独立危险因素,临床应予以重视。Objective To explore the high-risk characteristics and potential risks of postpartum type 2 diabetes(T2DM)in pregnant women with gestational diabetes mellitus(GDM).Methods 236 GDM pregnant women with family history of diabetes who were admitted to Huangshan Shoukang Hospital from June 2019 to June 2022 were selected as the observation objects,they were divided into T2DM group and non T2DM group according to whether they had T2DM after delivery.The clinical data of the two groups were compared,and the multivariate Logistic regression was carried out to analyze the influencing factors of postnatal T2DM in GDM patients,and a nomogram prediction model was constructed and verified.Results Compared with GDM women without T2DM after delivery,women with T2DM were older,with higher BMI,FPG,2 h PG,LDL-C,HbA1c,MAGE and MODD before pregnancy(P<0.05),and lower HDL-C,ApoA and ApoB.The multivariate logistic regression analysis showed that the age,pre-pregnancy BMI,FPG,2 h PG and HbA1c were independent risk factors for T2DM in GDM patients(P<0.05).The nomogram prediction model based on independent influencing factors has high discrimination,accuracy and clinical applicability.The X-tile software was performed to determine the optimal critical value(162.3 points and 204.2 points),patients can be divided into three groups:<162 points(low risk),≥162 points and less than 204 points(medium risk),≥204 points(high risk).The survival curve showed that the higher the total score,the higher the risk of postpartum T2DM.Conclusion The age,pre-pregnancy BMI,FPG,2 h PG and HbA1c are independent risk factors for postpartum T2DM in GDM patients.

关 键 词：妊娠糖尿病 2型糖尿病 糖尿病家族史 危险因素 列线图 

分 类 号：R714.256[医药卫生—妇产科学]