孕晚期妊娠期糖尿病孕妇血清HbA1c水平及胎儿超声参数与妊娠结局的相关性  

Correlation between Serum HbA1c Level of Pregnant Women with Diabetes in the Third Trimester and Fetal Ultrasound Parameters and Pregnancy Outcome

作　　者：王格丽 邢悦 李大鹏 WANG Geli;XING Yue;LI Dapeng(Department of Ultrasonography,Baoji People's Hospital,Baoji Shaanxi 721000;不详)

机构地区：[1]宝鸡市人民医院超声科,陕西宝鸡721000 [2]西安市人民医院(西安市第四医院)超声医学中心,陕西西安710005 [3]西安医学院第三附属医院检验科,陕西西安710021

出　　处：《医学临床研究》2024年第9期1368-1371,共4页Journal of Clinical Research

摘　　要：【目的】探讨孕晚期妊娠期糖尿病患者血清糖化血红蛋白(HbA1c)水平及胎儿超声参数与妊娠结局的相关性。【方法】选取2021年3月至2022年3月宝鸡市人民医院收治的80例孕晚期妊娠期糖尿病孕妇(观察组),另选取同期在宝鸡市人民医院定期产检的50例正常血糖孕妇作为对照组,比较两组血糖水平、胎儿超声参数[脐动脉和大脑中动脉阻力指数(RI)、搏动指数(PI)、收缩期与舒张期比值(S/D)]。观察组随访直至孕妇分娩后,以新生儿结局不同分为不良组和良好组,比较各组产妇的血清HbA1c和超声参数,选取差异有统计学意义的临床指标构建受试者工作特征(ROC)曲线,采用Logistic回归分析导致新生儿不良结局的危险因素。【结果】观察组HbA1c、空腹血糖(FPG)、餐后2 h血糖(2hPG)水平及脐动脉S/D明显高于对照组,大脑中动脉S/D低于对照组(P<0.05);两组脐动脉RI、脐动脉PI、大脑中动脉RI、大脑中动脉PI比较,差异无统计学意义(P>0.05)。不良组HbA1c、FPG、2hPG水平及体重指数、脐动脉S/D明显高于良好组,大脑中动脉S/D低于良好组(P<0.05);两组脐动脉PI、脐动脉PI、大脑中动脉RI、大脑中动脉PI、年龄、孕周比较,差异无统计学意义(P>0.05)。ROC曲线分析结果显示:体重指数、HbA1c、FPG、2hPG、脐动脉S/D、大脑中动脉S/D可用于评估孕晚期妊娠期糖尿病患者不良妊娠结局,曲线下面积分别为0.875、0.864、0.901、0.973、0.873、0.838。Logisitic回归模型分析结果显示:体重指数>26.286 kg/m 2、HbA1c>6.421%、FPG>6.261 mmol/L、2hPG>8.651 mmol/L、脐动脉S/D>3.472、大脑中动脉S/D≤3.496均是导致孕晚期妊娠期糖尿病孕妇发生不良妊娠结局的危险因素(P<0.05)。【结论】监测孕晚期妊娠期糖尿病患者血清HbA1c水平、超声脐动脉S/D、大脑中动脉S/D变化,对判断胎儿宫内状况、预测不良妊娠结局具有一定的临床意义。【Objective】To investigate the relationship between the serum glycosylated hemoglobin(HbA1c)level,fetal ultrasound parameters and pregnancy outcome in patients with diabetes in the third trimester of pregnancy.【Methods】From March 2021 to March 2022,80 pregnant women with diabetes in the third trimester in Baoji People's Hospital(the observation group)were selected,and 50 pregnant women with normal blood glucose who had regular prenatal examination in Baoji People's Hospital during the same period were selected as the control group.Two groups of blood glucose levels and fetal ultrasound parameters were compared,including resistance index(RI),pulsatility index(PI),and systolic to diastolic ratio(S/D)of the umbilical and middle cerebral arteries.The observation group was followed up until after delivery,and was divided into a poor group and a good group based on different neonatal outcomes.We compared the serum HbA1c and ultrasound parameters of different groups of parturients.We selected clinical indicators with statistically significant differences and constructed receiver operating characteristic(ROC)curves for the subjects.Logistic regression was used to analyze the risk factors leading to adverse outcomes in newborns.【Results】The observation group had significantly higher levels of HbA1c,fasting blood glucose(FPG),2-hour postprandial blood glucose(2hPG),and umbilical artery S/D than the control group,while the middle cerebral artery S/D was lower than the control group(P<0.05);There was no statistically significant difference(P>0.05)between the two groups in terms of umbilical artery RI,umbilical artery PI,middle cerebral artery RI,and middle cerebral artery PI.The levels of HbA1c,FPG,2hPG,body mass index,and umbilical artery S/D in the poor group were significantly higher than those in the good group,while the middle cerebral artery S/D was lower than those in the good group(P<0.05);There was no statistically significant difference(P>0.05)between the two groups in terms of umbilical artery PI,umbili

关 键 词：糖尿病 妊娠 糖基化血红蛋白A/血液 妊娠末期 胎儿 超声检查 妊娠结局 

分 类 号：R714.256[医药卫生—妇产科学]