孕中期妊娠期糖尿病患者血清Hcy、甘露聚糖结合凝集素、TyG指数及胰岛素抵抗与不良妊娠结局的关系  

Relationship between serum Hcy,mannose-binding lectin,TyG index,insulin resistance and adverse pregnancy outcomes in patients with gestational diabetes mellitus during the second trimester

作　　者：肖媛 望烨昕 陈华群 汪丽兰[1] 曹伍兰[1] Xiao Yuan;Wang Yexin;Chen Huaqun;Wang Lilan;Cao Wulan(Department of Obstetrics,Zhongshan People′s Hospital,Zhongshan 528400,China)

机构地区：[1]中山市人民医院产科,中山528400

出　　处：《中国医师杂志》2024年第12期1784-1788,共5页Journal of Chinese Physician

基　　金：广东省自然科学基金(2021A1515011649)。

摘　　要：目的探讨孕中期妊娠期糖尿病(GDM)患者血清同型半胱氨酸(Hcy)、甘露聚糖结合凝集素(MBL)、甘油三酯葡萄糖(TyG)指数及稳态模型评估的胰岛素抵抗指数(HOMA-IR)与不良妊娠结局的关系。方法回顾性选取中山市人民医院产科2020年4月至2022年6月收治的98例孕中期GDM患者,干预前采用酶联免疫吸附法检测血清Hcy、MBL,按照稳态模型评估HOMA-IR,采用氧化酶法检测空腹血糖(FBG),采用全自动化学发光免疫分析仪检测甘油三酯(TG)水平,计算TyG指数。给予患者健康宣教、饮食指导、胰岛素等治疗,随访观察至分娩并记录妊娠结局,结合患者妊娠结局分为不良妊娠结局组和无不良妊娠结局组。分析影响孕中期GDM患者不良妊娠结局的因素,用受试者工作特征(ROC)曲线分析血糖控制状况、血清Hcy、MBL、TyG指数对孕中期GDM患者不良妊娠结局的预测价值。结果干预后,孕中期GDM患者不良妊娠结局有24例(占比24.49%),其中羊水过多、产后出血、新生儿低血糖各2例,胎膜早破、早产各4例,巨大儿6例、低出生体重3例、新生儿高胆红素血症1例。GDM不良妊娠结局组与GDM无不良妊娠结局组孕期血糖控制不佳占比、Hcy水平、TyG指数、HOMA-IR、MBL水平比较差异均有统计学意义(均P<0.05)。经二元logistic回归分析,Hcy、TyG指数、HOMA-IR、孕期血糖控制不佳是孕中期GDM患者不良妊娠结局的危险因素,MBL是孕中期GDM患者不良妊娠结局的保护因素(均P<0.05)。孕期血糖控制不佳、Hcy、MBL、TyG指数、HOMA-IR单独及联合预测孕中期GDM患者不良妊娠结局的灵敏度分别为75.00%、79.17%、70.83%、75.00%、66.67%、91.67%;特异度分别为74.32%、78.38%、71.62%、75.68%、71.62%、91.89%。孕期血糖控制不佳、Hcy、MBL、TyG指数、HOMA-IR联合预测孕中期GDM患者不良妊娠结局的价值较高(均P<0.05)。经Pearson相关性分析显示,Hcy、TyG与HOMA-IR呈正相关(r=0.712、P<0.ObjectiveTo investigate the relationship between serum homocysteine(Hcy),mannose-binding lectin(MBL),triglyceride glucose(TyG)index and homeostasis model assessment-insulinresistance(HOMA-IR)and adverse pregnancy outcomes in patients with second-trimester gestational diabetes mellitus(GDM).MethodsNinety-eight patients with GDM in the second trimester of pregnancy admitted to the Obstetrics Department of Zhongshan People′s Hospital from April 2020 to June 2022 were retrospectively selected.Serum Hcy and MBL were detected by enzyme-linked immunosorbent assay before intervention,HOMA-IR was evaluated according to homeostasis model,and fasting blood glucose(FBG)was detected by oxidase method.The level of triglyceride(TG)was detected by automatic chemiluminescence immunoassay and TyG index was calculated.The patients were given health education,dietary guidance,insulin and other treatment,followed up until delivery and pregnancy outcomes were recorded.The patients were divided into adverse pregnancy outcome group and no adverse pregnancy outcome group based on pregnancy outcomes.The factors influencing adverse pregnancy outcomes in GDM patients in the second trimester were analyzed,and the predictive value of blood glucose control,serum Hcy,MBL and TyG index on adverse pregnancy outcomes in GDM patients in the second trimester was analyzed by receiver operating characteristics(ROC)curve.ResultsAfter intervention,there were 24 cases(24.49%)of adverse pregnancy outcomes in GDM patients in the second trimester,including 2 cases of polyhydramnios,postpartum hemorrhage,neonatal hypoglycemia,4 cases of premature membranes breaking,4 cases of premature delivery,6 cases of fetal macrosomia,3 cases of low birth weight,and 1 case of neonatal hyperbilirubinemia.There were statistically significant differences in the proportion of poor glycemic control,Hcy level,TyG index,HOMA-IR and MBL level between the GDM group with adverse pregnancy outcome and the GDM group without adverse pregnancy outcome(all P<0.05).By binary logistic

关 键 词：糖尿病 妊娠 胰岛素抵抗 同型半胱氨酸 甘露糖结合凝集素 妊娠结局 

分 类 号：R714.256[医药卫生—妇产科学]