影响妊娠期糖尿病孕妇产后糖代谢的相关因素分析及列线图预测模型的构建  

Analysis of factors affecting postnatal glucose metabolism in pregnant women with gestational diabetes and construction of a nomogram prediction model

作　　者：施娟[1] 颜云华[1] 张爱华[1] 郦培昕 李宁[1] 陈伟[1] Shi Juan;Yan Yunhua;Zhang Aihua;Li Peixin;Li Ning;Chen Wei(Department of Obstetrics and Gynecology,Danyang People′s Hospital,Danyang 212300,China)

机构地区：[1]丹阳市人民医院妇产科,丹阳212300

出　　处：《中国医师进修杂志》2024年第6期487-492,共6页Chinese Journal of Postgraduates of Medicine

基　　金：江苏省妇幼健康科研项目(F201736)。

摘　　要：目的分析影响妊娠期糖尿病孕妇产后糖代谢的相关因素,并构建列线图预测模型。方法采用回顾性研究的方法,选取2019年3月至2021年11月丹阳市人民医院收治的210例妊娠期糖尿病患者为研究对象,根据产后糖代谢情况分为正常组125例和异常组85例。采用受试者工作特征(ROC)曲线分析预测价值;采用Logistic回归分析影响妊娠期糖尿病孕妇产后糖代谢异常的危险因素;采用内部数据验证列线图模型临床效能。结果两组年龄等一般资料比较差异无统计学意义(P>0.05);与正常组比较,异常组孕妇总胆固醇(TG)、餐后2 h血糖(OGTT 2 h)、糖化血红蛋白、孕前体质量指数(BMI)值均较高[(4.23±1.35)mmol/L比(3.65±1.50)mmol/L、(9.36±1.25)mmol/L比(8.20±1.51)mmol/L、(8.31±2.96)%比(6.73±2.23)%、(24.96±4.21)kg/m^(2)比(23.20±3.25)kg/m^(2)],有糖尿病家族史者较多[47.06%(40/85)比20.80%(26/125)],差异有统计学意义(P<0.05);TG、OGTT 2 h、糖化血红蛋白、孕前BMI的曲线下面积(AUC)为0.605、0.720、0.670、0.616,最佳截断值为4.65 mmol/L、8.33 mmol/L、8.06%、25.27 kg/m^(2);TG(>4.65 mmol/L)、OGTT 2 h(>8.33 mmol/L)、糖化血红蛋白(>8.06%)、孕前BMI(>25.27 kg/m^(2))、糖尿病家族史(有)是孕妇糖代谢异常的危险因素(P<0.05);列线图模型预测妊娠期糖尿病孕妇产后糖代谢的风险C-index为0.750(95%CI 0.672~0.864),模型预测妊娠期糖尿病孕妇产后糖代谢的风险阈值>0.07。结论TG(>4.65 mmol/L)、OGTT 2 h(>8.33 mmol/L)、糖化血红蛋白(>8.06%)、孕前BMI(>25.27 kg/m^(2))、糖尿病家族史(有)是孕妇糖代谢异常的危险因素,且基于变量构建的模型有较好的预测能力。Objective To analyze the relevant factors affecting postnatal glucose metabolism in pregnant women with gestational diabetes and construct a nomogram prediction model.Methods Using a retrospective study method,210 cases of gestational diabetes patients admitted to Danyang People′s Hospital from March 2019 to November 2021 were selected as the study subjects,and they were divided into 125 cases of normal group and 85 cases of abnormal group according to the postnatal glucose metabolism.The predictive value was analyzed using the subject work characteristics(ROC)curve experiment;the risk factors affecting abnormal postpartum glucose metabolism in pregnant women with gestational diabetes mellitus were analyzed using Logistic regression experiment;and the clinical efficacy of the column-line diagram model was verified using internal data.Results There was no statistically significant difference between the two groups when comparing the general information such as age(P>0.05);compared with the normal group,the abnormal group had higher values of total cholesterol(TG),postprandial 2 h blood glucose(OGTT 2 h),glycosylated hemoglobin,and pre-pregnancy body mass index(BMI):(4.23±1.35)mmol/L vs.(3.65±1.50)mmol/L,(9.36±1.25)mmol/L vs.(8.20±1.51)mmol/L,(8.31±2.96)%vs.(6.73±2.23)%,(24.96±4.21)kg/m^(2) vs.(23.20±3.25)kg/m^(2),and those with a family history of diabetes mellitus were higher:47.06%(40/85)vs.20.80%(26/125),there were statistical differences(P<0.05);the area under the curve(AUC)of TG,OGTT 2 h,glycated hemoglobin,and pre-pregnancy BMI were 0.605,0.720,0.670,and 0.616,with optimal cut off values of 4.65 mmol/L,8.33 mmol/L,8.06%,and 25.27 kg/m^(2);TG(>4.65 mmol/L),OGTT 2 h(>8.33 mmol/L),glycated hemoglobin(>8.06%),and preconception BMI(>25.27 kg/m^(2)),and family history of diabetes mellitus(yes)were risk factors for abnormal glucose metabolism in pregnant women(P<0.05);the C-index of the risk of postpartum glucose metabolism in pregnant women with gestational diabetes mellitus predicted by the column chart

关 键 词：糖尿病 妊娠 糖代谢异常 列线图预测模型 影响因素 

分 类 号：R714.256[医药卫生—妇产科学]