妊娠中期维生素D与妊娠糖尿病的交互效应分析  

Interaction effect between vitamin D and gestational diabetes mellitus in the second trimester

作　　者：马梓汶 丁晓颖[1] 储莉鸣[1] 张焱[1] 张爱凤[1] 朱燕军 王珣 谢震宇 MA Ziwen;DING Xiaoying;CHU Liming;ZHANG Yan;ZHANG Aifeng;ZHU Yanjun;WANG Xun;XIE Zhenyu(Shanghai Pudong New Area Health Care Hospital for Women and Children,Shanghai 201206,China)

机构地区：[1]上海市浦东新区妇幼保健院,上海201206

出　　处：《上海预防医学》2024年第11期1094-1099,共6页Shanghai Journal of Preventive Medicine

基　　金：上海市浦东新区科技发展基金资助项目(PKJ2020-Y72);上海市浦东新区卫生健康委员会卫生科技项目资助(PW2022A-23)。

摘　　要：【目的】探讨妊娠中期血清25(OH)D与妊娠糖尿病(GDM)的关系及其关键风险因素的交互效应分析,为临床个性化补充维生素D提供依据。【方法】选取2022年6—12月在上海市浦东新区妇幼保健院建卡并定期产检的266名孕妇作为研究对象。根据口服葡萄糖耐量试验(OGTT)结果,将受试者分为GDM组(131例)和对照组(135例)。检测每位受试者OGTT时的血清25(OH)D水平并随访相关指标。【结果】GDM组孕妇的年龄、妊娠早期收缩压、孕前体重指数(BMI)、空腹血糖、OGTT-1 h血糖、OGTT-2 h血糖、糖化血红蛋白、胰岛素抵抗指数(HOMA-IR)、甘油三酯(TG)、天冬氨酸转氨酶、肌酐、D-二聚体、纤维蛋白原降解产物及孕35周时铁蛋白均高于正常组孕妇,而孕期增重及血清25(OH)D水平则低于正常组孕妇(P<0.05)。血清25(OH)D水平与胰岛素抵抗程度、白细胞计数呈负相关而与TG、丙氨酸转氨酶呈正相关。且血清25(OH)D水平与GDM的发病风险呈倒J型非线性相关,高龄、孕前肥胖及维生素D缺乏对GDM的发病风险存在交互效应。【结论】维生素D与GDM的发病风险呈非线性相关,当血清25(OH)D水平≥30 ng·mL^(-1)可降低GDM的发病风险。[Objective]To investigate the relationship between serum 25(OH)D and gestational diabetes mellitus in the second trimester(GDM),to analyze the interaction effect of key risk factors,so as to provide a basis for clinical personalized vitamin D supplementation.[Methods]A total of 266 pregnant women who registered and took regular obstetric check-ups in Shanghai Pudong New Area Health Care Hospital for Women and Children from June to December 2022,were selected as the research subjects.According to the results of oral glucose tolerance test(OGTT),the subjects were divided into the GDM group(131)and control group(135).The level of serum 25(OH)D at the time of OGTT were detected and other clinical indicators were followed up.[Results]The age,systolic blood pressure in early pregnancy,pre-pregnancy BMI,FPG,OGTT 1-hour and 2-hour glucose,GHb,HOMA-IR,TG,AST,Cr,D-D,FDP and SF at 35 weeks’gestation of the pregnant women were higher in the GDM group than that of the pregnant women in the normal group,while gestational weight gain and serum 25(OH)D level were significantly lower than that of the pregnant women in the normal group.Serum 25(OH)D was negatively correlated with HOMA-IR and WBS’s,but positively correlated with TG and ALT.Serum 25(OH)D was non-linearly correlated with the risk of GDM in an inverted J-shape,and there was an interaction effect of advanced age,pre-pregnancy obesity and vitamin D deficiency on the risk of GDM.[Conclusion]Vitamin D is nonlinearly associated with the risk of GDM.The risk of GDM is significantly reduced when serum 25(OH)D level≥30 ng∙mL^(-1).

关 键 词：血清25(OH)D 孕前体重指数 高龄 妊娠糖尿病 交互 

分 类 号：R193[医药卫生—卫生事业管理]