足月分娩妊娠期糖尿病母亲新生儿脐血糖化血红蛋白 糖化白蛋白和胰岛素样生长因子-1水平变化及意义  

Changes and significance of HbA1c GA and IGF-1 levels in cord blood of newborn mothers with full-term delivery of GDM

作　　者：李锐[1,2] 李波 罗会涛[1,2] 鲁巧珍 Li Rui;Li Zhiqi;Li Bo;Luo Huitao;Lu Qiaozhen(Department of Neonatal Pediatrics,Maternity and Child Health Hospital of East China Normal University Changning Maternity and Child Health Hospital,Shanghai 200051,China)

机构地区：[1]上海华东师范大学附属妇幼保健院,上海200051 [2]上海市长宁区妇幼保健院新生儿科,上海200051

出　　处：《山西医药杂志》2024年第7期509-513,共5页Shanxi Medical Journal

基　　金：上海市长宁区妇幼保健院临床医学科研项目(2020Y-2)。

摘　　要：目的 分析足月分娩妊娠期糖尿病(GDM)母亲新生儿脐血糖化血红蛋白(HbA1c)、糖化白蛋白(GA)和胰岛素样生长因子-1(IGF-1)水平与新生儿不良妊娠结局的相关性。方法 选取2019年2月至2022年2月收治的220例足月分娩GDM母亲新生儿为观察对象,根据妊娠结局分为妊娠结局良好组159例、妊娠结局不良组61例。比较妊娠结局良好组和妊娠结局不良组的临床资料,检测妊娠结局良好组和妊娠结局不良组新生儿的脐血HbA1c、GA、IGF-1水平,采用Spearman相关分析法分析脐血HbA1c、GA和IGF-1水平与新生儿不良妊娠结局的关系,采用受试者工作曲线(ROC)分析脐血HbA1c、GA和IGF-1水平预测新生儿不良妊娠结局的价值。结果 妊娠结局不良组母亲空腹血糖[(6.68±0.61)mmol/L]、母亲口服葡萄糖耐量试验(OGTT)后1 h血糖[(12.54±1.12)mmol/L]、2 h血糖[(10.35±0.91)mmol/L]均高于妊娠结局良好组[(5.43±0.26)mmol/L、(11.38±1.03)mmol/L、(9.26±0.64)mmol/L](t=21.330、7.297、9.991,均P<0.05)。妊娠结局不良组新生儿的脐血HbA1c[(7.07±0.56)%]、GA[(18.19±0.76)%]和IGF-1[(77.56±7.37)ng/ml]水平均高于妊娠结局良好组(5.25±0.32)%、(12.27±0.52)%、(59.13±5.04)ng/ml (t=30.161、65.977、21.187,均P<0.05)。脐血HbA1c、GA和IGF-1水平与新生儿低血糖、新生儿窒息、胎儿窘迫、羊水过多、巨大儿呈正相关(均P<0.05)。受试者工作特征(ROC)曲线分析结果显示,HbA1c、GA、IGF-1单独预测新生儿不良妊娠结局的曲线下面积(AUC)分别为0.832、0.806、0.812,对新生儿不良妊娠结局均有一定预测价值(均P<0.05),且以3项联合检测(AUC=0.935)的预测价值优于单一指标(P<0.05)。结论 足月分娩GDM母亲新生儿脐血HbA1c、GA、IGF-1水平与新生儿不良妊娠结局存在相关性,其水平升高时更易出现新生儿不良妊娠结局,检测脐血HbA1c、GA、IGF-1水平对预测新生儿不良妊娠结局具有一定的价值。Objective To analyze the correlation between neonatal cord blood glycated hemoglobin A1c(HbA1c),glycosylated albumin(GA),and insulin-like growth factor-1(IGF-1)levels and neonatal adverse pregnancy outcomes in mothers with gestational diabetes mellitus(GDM)during full-term delivery.Methods A total of 220 newborns of full-term mothers with GDM were selected from February 2019 to February 2022.According to pregnancy outcome,newborns were divided into the good pregnancy outcome group(159 cases)and the bad pregnancy outcome group(61 cases).The clinical data of the good pregnancy outcome group and the bad pregnancy outcome group were compared,the levels of cord blood HbA1c,GA,and IGF-1 in the good pregnancy outcome group and the bad pregnancy outcome group were detected,and the relationship between cord blood HbA1c,GA and IGF-1 levels and the adverse pregnancy outcome of the newborn was analyzed by Spearman correlation analysis.The value of cord blood HbA1c,GA,and IGF-1 levels in predicting neonatal adverse pregnancy outcomes was analyzed by receiver operating curve(ROC).Results In the bad pregnancy outcome group,the fasting blood glucose of mothers[(6.68±0.61)mmol/L],the blood glucose 1 h after oral glucose tolerance test(OGTT)[(12.54±1.12)mmol/L]and the blood glucose 2 h after OGTT[(10.35±0.91)mmol/L]was higher than that of good pregnancy outcome group(5.43±0.26)mmol/L、(11.38±1.03)mmol/L、(9.26±0.64)mmol/L(t=21.330,7.297,9.991,all P<0.05).The levels of cord blood HbA1c[(7.07±0.56)%],GA[(18.19±0.76)%]and IGF-1[(77.56±7.37)ng/ml]in the bad pregnancy outcome group were higher than those in the good pregnancy outcome group(5.25±0.32)%、(12.27±0.52)%、(59.13±5.04)ng/ml(t=30.161,65.977,21.187,all P<0.05).The levels of cord blood HbA1c,GA,and IGF-1 were positively correlated with neonatal hypoglycemia,neonatal asphyxia,fetal distress,hyperamniotic fluid,and macrosomia(all P<0.05).ROC curve analysis results showed that the area under the curve(AUC)of HbA1c,GA,and IGF-1 alone in predicting neonatal adverse p

关 键 词：足月分娩 糖尿病 妊娠 糖基化血红蛋白A 白蛋白类 妊娠结局 

分 类 号：R714.256[医药卫生—妇产科学]