妊娠期糖尿病患者孕中期血清氨基酸水平与产后糖代谢异常的关系  

Associations between serum amino acids and postpartum abnormal glucose metabolism in patients with gestational diabetes mellitus

作　　者：崔玲玲 杨晓丽 陈婷婷 郭莹莹 李佳鑫 李芷茜 张正亚 高玉婷 郝倚德 徐冬梅[4] CUI Ling-ling;YANG Xiao-li;CHEN Ting-ting;GUO Ying-ying;LI Jia-xin;LI Zhi-qian;ZHANG Zheng-ya;GAO Yu-ting;HAO Yi-de;XU Dong-mei(Department of Nutrition and Food Hygiene,College of Public Health,Zhengzhou University,Zhengzhou,He'nan 450001,China;不详)

机构地区：[1]郑州大学公共卫生学院营养与食品卫生学教研室,河南郑州450001 [2]安阳市疾病预防控制中心 [3]新乡医学院 [4]郑州大学第三附属医院孕产保健部

出　　处：《中国妇幼保健》2023年第14期2523-2527,共5页Maternal and Child Health Care of China

基　　金：河南省医学科技攻关计划联合共建项目(LHGJ20220539)。

摘　　要：目的探讨妊娠期糖尿病(GDM)患者孕中期血清支链氨基酸(BCAAs)和芳香族氨基酸(AAAs)水平与产后糖代谢异常的关系。方法选取2020年10月—2021年7月郑州大学第三附属医院的300例GDM患者,随访至产后6~8周,其中75例产后糖代谢异常患者为病例组,糖代谢正常者75例为对照组,进行巢氏病例对照研究。采用条件logistic回归分析法分析孕中期血清BCAAs、AAAs水平与产后糖代谢异常的关系,绘制受试者工作特征(ROC)曲线,评价预测模型。结果病例组口服葡萄糖耐量试验(OGTT)1 h、2 h血糖水平,血清缬氨酸(Val)、苯丙氨酸(Phe)、氨基酸评分(AAS)水平均高于对照组,差异均有统计学意义(均P<0.05)。调整混杂因素后,OGTT 2 h血糖(OR=1.337,95%CI:1.006~1.776,P<0.05)、血清Val(OR=1.005,95%CI:1.000~1.010,P<0.05)、血清Phe(OR=1.007,95%CI:1.000~1.014,P<0.05)和AAS(OR=1.002,95%CI:1.001~1.004,P<0.05)是产后糖代谢异常的独立危险因素。含BCAAs、AAAs的联合模型(AUC=0.718,P<0.05)预测产后糖代谢异常的风险优于常规模型(AUC=0.597,P<0.05)。结论GDM患者孕中期血清Val、Phe水平升高可增加产后糖代谢风险;常规危险因素、OGTT时血糖、BCAAs和AAAs的联合模型可预测产后糖代谢异常。Objective To explore the associations between serum branched-chain amino acids(BCAAs)and aromatic amino acids(AAAs)during the second trimester of pregnancy and postpartum abnormal glucose metabolism in patients with gestational diabetes mellitus(CDM).Methods A total of 300 pregnant women diagnosed as CDM were chosen and followed up for 6-8 weeks after delivery in the Third Affiliated Hospital of Zhengzhou University from October 2020 to July 2021,75 patients with postpartum abnormal glucose metabolism were selected as case group,and 75 patients with postpartum normal glucose metabolism were selected as control group.Nested case-control study was conducted.Conditional logistic regression model was used to explore the relationships between levels of serum BCAAs,AAAs during the second trimester of pregnancy and postpartum abnormal glucose metabolism.The prediction model was assessed by receiver operating characteristic(ROC)curve.Results The levels of one-hour and two-hour blood glucose after oral glucose tolerance test(OGTT),valine,phenylalanine(Phe),and amino acid score(AAS)in case group were all significantly higher than those in control group(P<0.05).Afer adjustment for confounding factors,two-hour blood glucose after OCTT(OR=1.337,95%CI:1.006-1.776,P<0.05),serum valine(OR=1.005,95%CI:1.000-1.010,P<0.05),Phe(0R=1.007,95%CI:1.000-1.014,P<0.05)and AAS(0R=1.002,95%Cl:1.001-1.004,P<0.05)were independent risk factors of postpartum abnormal glucose metabolism.The combined model with BCAAs and AAAs(AUC=0.718,P<0.05)was superior to the conventional model in predicting postpartum abnormal glucose metablism(AUC=0.597,P<0.05).Conclusion Elevated mid-pregnancy serum valine,Phe,and AAS levels can increase the risk of postpartum abnormal glucose metabolism in GDM patients;BCAAs,AAAs,and blood glucose afer OGTT combined with conventional risk factors may be used for prediction of postpartum abnormal glucose metabolism.

关 键 词：妊娠期糖尿病 氨基酸代谢 糖代谢异常 

分 类 号：R714.256[医药卫生—妇产科学]