妊娠期糖尿病史与生物节律紊乱对产后心血管代谢指标的联合作用  

Combined effects of prior gestational diabetes history and biorhythm disturbances on postpartum cardiovascular metabolic indicators

作　　者：朱甜丽 严双琴 谢兰茨 高国朋 范图艳 刘晶晶 曹译丹 宫可心 余夏妍 强文静 朱贝贝 陶芳标[1] Zhu Tianli;Yan Shuangqin;Xie Lanci;Gao Guopeng;Fan Tuyan;Liu Jingjing;Cao Yidan;Gong Kexin;Yu Xiayan;Qiang Wenjing;Zhu Beibei;Tao Fangbiao(Department of Maternal,Child and Adolescent Health,School of Public Health,Anhui Medical University,Key Laboratory of Birth Population,Ministry of Health and Education,Anhui Provincial Key Laboratory of Population Health and Eugenics,Hefei 230032,China;Department of Child Health Care,Ma′anshan Maternal and Child Health Hospital of Anhui Province,Ma′anshan 243000,China;Ma′anshan Maternal and Child Health Hospital of Anhui Province,Ma′anshan 243000,China)

机构地区：[1]安徽医科大学公共卫生学院儿少卫生与妇幼保健学系,出生人口健康教育部重点实验室,人口健康与优生安徽省重点实验室,合肥230032 [2]马鞍山市妇幼保健院儿童保健科,马鞍山243000 [3]马鞍山市妇幼保健院,马鞍山243000

出　　处：《中华糖尿病杂志》2024年第6期654-662,共9页CHINESE JOURNAL OF DIABETES MELLITUS

基　　金：国家自然科学基金(82073564);安徽省重点研究与开发计划项目(202104j07020034);高校优秀青年人才支持计划重点项目(gxyqZD2021101)。

摘　　要：目的探讨生物节律紊乱对女性心血管代谢指标的单独作用及其与妊娠期糖尿病(GDM)史的联合作用。方法本研究为队列研究,并依托马鞍山优生优育队列(MABC)。MABC为自2013年5月至2014年9月在马鞍山妇幼保健院建立的出生队列,在妊娠24~28周时进行75 g口服葡萄糖耐量试验以诊断GDM。对来自MABC的女性,采用随机数字表法按照1∶2的比例选取有GDM病史的女性120例,无GDM病史的女性240名,于2021年7月至2022年8月进行随访。最终共纳入符合纳入排除标准的研究对象307例,其中有GDM病史女性99例,无GDM病史女性208例。在随访时,收集研究对象的基本信息,包括年龄、体重指数(BMI)、文化程度、工作性质、婚姻状态、税后总收入、饮酒情况、吸烟情况、不良孕产史、妊娠高血压病史、糖尿病家族史、心血管疾病家族史等,并采集空腹血样检测以下生化指标:空腹血糖(FPG)、糖化血红蛋白(HbA1c)、甘油三酯(TG)、总胆固醇(TC)、尿酸和肌酐等。采用神经精神病学评估生物节律访谈问卷调查研究对象的生物节律并计算得分,选取生物节律得分中位数作为截断值,小于中位数表示生物节律紊乱程度较低,反之生物节律紊乱程度较高。采用线性回归分析法分析生物节律紊乱与心血管代谢指标的关联以及其与GDM病史对心血管代谢指标的联合作用,采用线性模型分析GDM病史和生物节律对于女性产后代谢指标的相加交互作用,使用Benjaminiand Hochberg方法对多重检验P值进行校正,以控制错误发现率(FDR),当调整后的PFDR值<0.05认为有统计学意义。结果线性回归分析结果显示,在调整年龄、BMI、文化程度、工作性质、婚姻状态、税后总收入、饮酒情况、吸烟情况、不良孕产史、GDM病史、妊娠高血压病史、糖尿病家族史、心血管疾病家族史后,与生物节律紊乱程度较低的女性相比,紊乱程度高会增加其HbA1c水�Objective To investigate the sole effect of biorhythm disturbances and its combined effect with a history of gestational diabetes mellitus(GDM)on postpartum cardiovascular metabolic indicators.Methods This was a cohort study based on the Ma′anshan birth cohort(MABC),a birth cohort established at Ma′anshan Maternal and Child Health Care Center from May 2013 to September 2014,where a 75 g oral glucose tolerance test was performed at 24—28 weeks of gestation to diagnose GDM.A total of 120 women and 240 women with and without a history of GDM were selected using the random number table method in a ratio of 1∶2.The participants were followed up from July 2021 to August 2022,and 307 study participants were eventually included in this study,including 99 women with a history of GDM and 208 women without a history of GDM.At the time of follow-up,basic information about the women was collected,including age,body mass index(BMI),education,job nature,marital status,gross after-tax income,alcohol consumption,smoking status,adverse pregnancy and childbirth history,gestational hypertension history,family history of diabetes,family history of cardiovascular disease,etc.Fasting blood samples were collected for measurement of the following biochemical indices:fasting plasma glucose(FPG),glycated hemoglobin A1c(HbA1c),triglycerides(TG),total cholesterol(TC),uric acid and creatinine.The Neuropsychiatric Assessment of Biorhythms Interview Questionnaire was used to assess the biorhythms of the study participants and scores were calculated using the median biorhythm score as the cut-off value,with less than the median indicating low level of biorhythm disturbance,and vice versa for high levels of biorhythm disturbance.Linear regression was used to analyze the associations between biorhythm disturbances and cardiovascular metabolic markers and their combined effect with a history of GDM on cardiovascular metabolic markers,Linear model was used to analyze the summation interaction of GDM history and biorhythms on metabolic indexe

关 键 词：糖尿病 妊娠 心血管疾病 生物节律 联合作用 

分 类 号：R714.256[医药卫生—妇产科学]