孕中晚期糖脂代谢指标和TyG指数与GDM巨大儿的相关性研究  

Association of glucose and lipid metabolism indicators and triglyceride⁃glucose index with macrosomia in gestational diabetes mellitus during the second and third trimesters

作　　者：张钰婷 胡诗曼 诸清逸 石中华[1,2] ZHANG Yuting;HU Shiman;ZHU Qingyi;SHI Zhonghua(Changzhou Medical Center,Changzhou Key Laboratory of Maternal and Child Health Medicine,Changzhou Maternal and Child Health Care Hospital,Nanjing Medical University,Changzhou 213000;State Key Laboratory of Reproductive Medicine and Offspring Health of Nanjing Medical University,Nanjing 211166;Department of Obstetrics,Nanjing Women and Children’s Healthcare Hospital,Nanjing 210004,China)

机构地区：[1]南京医科大学常州医学中心,常州市妇幼医学重点实验室,常州市妇幼保健院,江苏常州213000 [2]南京医科大学生殖医学与子代健康全国重点实验室,江苏南京211166 [3]南京市妇幼保健院产科,江苏南京210004

出　　处：《南京医科大学学报(自然科学版)》2025年第1期41-47,共7页Journal of Nanjing Medical University(Natural Sciences)

基　　金：国家重点研发计划(2022YFC2703500);国家自然科学基金(82371697);江苏省重大疾病生物资源样本库出生队列子库开放课题(TC2021B024);常州市妇幼医学重点实验室(CM20240013)。

摘　　要：目的:探讨孕中、晚期妊娠期糖尿病(gestational diabetes mellitus,GDM)母体糖脂代谢指标和甘油三酯葡萄糖乘积(triglyceride-glucose,TyG)指数与GDM巨大儿的相关性。方法:基于GDM队列,根据严格入组和排除标准选择2022年1—8月于南京市妇幼保健院剖宫产分娩的产妇,按照有无GDM和新生儿出生体重分为正常对照组(NC,n=23)、GDM非巨大儿组(GDM-N,n=23)和GDM巨大儿组(GDM-M,n=23)。收集3组一般资料和孕中、晚期糖脂代谢指标,计算TyG指数和胰岛素抵抗指数(HOMA-IR),采用Spearman相关检验和线性回归模型分析母体孕中、晚期各指标与GDM巨大儿的相关性。结果:孕中期GDM-M组母体空腹血糖(fasting plasma glucose,FPG)、糖化血红蛋白(glycated hemoglobin,HbA1c)和TyG水平升高,直接胆红素(direct bilirubin,DBIL)和肌酐(creatinine,Cr)水平降低,餐后1 h、2 h血糖水平高于NC组,但低于GDM-N组(P<0.05),孕晚期C肽(C-peptide,CP)、甘油三酯(triglycerides,TG)、HbA1c和TyG升高,丙氨酸氨基转移酶(alanine aminotransferase,ALT)高于NC组,低于GDM-N组(P<0.05)。Spearman相关检验提示,新生儿出生体重与母体孕中期FPG、HbA1c以及孕晚期CP、HbA1c、TG、TyG呈正相关(P<0.05),与孕中期DBIL、Cr呈负相关(P<0.05)。多因素线性回归模型分析结果显示,孕中期母体FPG、HbA1c和DBIL,孕晚期HbA1c、TG和TyG指数为巨大儿的影响因素(P<0.05)。结论:孕中、晚期母体糖脂代谢指标及TyG指数与GDM巨大儿的发生密切相关,HbA1c、FPG、TG和TyG可作为GDM巨大儿发生的重要监测评估指标。Objective:To investigate the correlation between maternal glucose and lipid metabolism indicators,triglyceride-glucose(TyG)index,and macrosomia in gestational diabetes mellitus(GDM)during the second and third trimesters of pregnancy.Methods:Based on a GDM cohort,pregnant women who underwent cesarean section delivery at the Nanjing Maternity and Child Health Hospital from January to August 2022 were selected according to strict inclusion and exclusion criteria.Participants were divided into three groups based on GDM status and newborn birth weight:normal control group(NC,n=23),GDM non-macrosomia group(GDM-N,n=23),and GDM macrosomia group(GDM-M,n=23).General information and glucose and lipid metabolism indicators from the second and third trimesters were collected for all three groups.The TyG index and the homeostasis model assessment of insulin resistance(HOMA-IR)were calculated.Spearman correlation analysis and linear regression models were used to analyze the correlation between maternal indicators in the second and third trimesters and GDM macrosomia.Results:In the second trimester,the GDM-M group showed elevated levels of fasting plasma glucose(FPG),glycated hemoglobin(HbA1c),and TyG index,while direct bilirubin(DBIL)and creatinine(Cr)levels were decreased.The 1 h and 2 h postprandial glucose levels were higher than the NC group but lower than the GDM-N group(P<0.05).In the third trimester,C-peptide(CP),triglycerides(TG),HbA1c,and TyG index were increased,and alanine aminotransferase(ALT)was higher than the NC group but lower than the GDM-N group(P<0.05).Spearman correlation analysis indicated that neonatal birth weight was positively correlated with maternal FPG and HbA1c in the second trimester,and with CP,HbA1c,TG,and TyG in the third trimester(P<0.05).Negative correlations were observed with DBIL and Cr in the second trimester(P<0.05).Multiple linear regression analysis revealed that maternal FPG,HbA1c,and DBIL in the second trimester,and HbA1c,TG,and TyG index in the third trimester were significant facto

关 键 词：TyG指数 妊娠期糖尿病 巨大儿 

分 类 号：R714[医药卫生—妇产科学]