不同糖化血红蛋白水平妊娠糖尿病孕妇血小板参数变化及与妊娠结局的关系  

Changes of platelet parameters in pregnant women with different glycosylated hemoglobin levels and their relationship with pregnancy outcome

作　　者：李莉 高英 肖凡 LI Li;GAO Ying;XIAO Fan(Department of Obstetric,Tangshan Maternal and Children Health Hospital,Tangshan,Hebei 063200,China)

机构地区：[1]唐山市妇幼保健院产科,河北唐山063200

出　　处：《中国优生与遗传杂志》2024年第12期2632-2638,共7页Chinese Journal of Birth Health & Heredity

基　　金：河北省卫生健康委2024年度医学科学研究课题计划(20240715)。

摘　　要：目的探究不同糖化血红蛋白(HbA1c)水平妊娠糖尿病(GDM)孕妇血小板参数变化及与妊娠结局的关系。方法回顾性选取2022年2月至2024年2月于唐山市妇幼保健院接受治疗的130例GDM孕妇进行研究,根据HbA1c水平不同(4分位数)将孕妇分为以下4组:Q1组(HbA1c≤6.0%,n=40)、Q2组(HbA1c 6.1%~6.5%,n=36)、Q3组(HbA1c 6.6%~7.0%,n=30)和Q4组(HbA1c≥7.1%,n=24)。比较不同HbA1c水平孕妇临床资料、血小板参数、不良妊娠结局;分层回归分析HbA1c水平与血小板参数的关系;LOWESS分析HbA1c水平、血小板参数与不良妊娠结局发生率间的曲线关系;分析不同HbA1c水平不同血小板参数下不良妊娠结局差异及HbA1c水平、血小板参数对不良妊娠结局的交互作用。结果随着HbA1c水平逐渐升高(Q1~Q4)血小板计数(PLT)逐渐降低,平均血小板体积(MPV)、血小板分布宽度(PDW)、不良妊娠结局总发生率逐渐升高(P<0.05);PLT会对HbA1c水平产生显著的负向影响(P<0.05);MPV、PDW会对HbA1c水平产生显著的正向影响(P<0.05);不良妊娠结局发生率与HbA1c、PLT、MPV、PDW均具有一定的非线性关系;Q4(≥7.1%)组患者在PLT≤131.62×10^(9)/L的不良妊娠结局发生率为41.67%、在MPV≥12.89 fL的不良妊娠结局发生率为54.17%、在PDW≥18.76 fL的不良妊娠结局发生率为45.83%;PLT、MPV、PDW与HbA1c水平对GDM孕妇不良妊娠结局的影响在相加和相乘模型中存在交互作用,表现为协同作用。结论GDM孕妇HbA1c水平与血小板参数变化及不良妊娠结局之间具有明显相关性。Objective To investigate the changes of platelet parameters in pregnant women with gestational diabetes(GDM)with different glycosylated hemoglobin(HbA1c)levels and their relationship with pregnancy outcome.Methods A total of 130 pregnant women with GDM who were treated in Tangshan Maternal and Child Health Hospital from February 2022 to February 2024 were retrospectively selected for the study.According to different HbA1c levels(quartiles),pregnant women were divided into the following four groups:Group Q1(HbA1c≤6.0%,n=40),group Q2(HbA1c 6.1%‒6.5%,n=36),group Q3(HbA1c 6.6%‒7.0%,n=30)and group Q4(HbA1c≥7.1%,n=24).The clinical data,platelet parameters and adverse pregnancy outcomes of pregnant women with different HbA1c levels were compared.Hierarchical regression analysis was used to analyze the relationship between HbA1c level and platelet parameters.LOWESS was used to analyze the curvilinear relationship between HbA1c level,platelet parameters and the incidence of adverse pregnancy outcomes.The differences of adverse pregnancy outcomes under different HbA1c levels and platelet parameters and the interaction between HbA1c level and platelet parameters on adverse pregnancy outcomes were analyzed.Results As HbA1c levels gradually increased(Q1‒Q4),platelet count(PLT)gradually decreased,mean platelet volume(MPV),platelet distribution width(PDW),and overall incidence of adverse pregnancy outcomes gradually increased(P<0.05).PLT had a significant negative impact on HbA1c levels(P<0.05).MPV and PDW had a significant positive impact on HbA1c levels(P<0.05).MPV and PDW had a significant positive impact on HbA1c levels(P<0.05).There was a certain nonlinear relationship between the incidence of adverse pregnancy outcomes and HbA1c,PLT,MPV,and PDW.There was a nonlinear relationship between the incidence of adverse pregnancy outcomes and HbA1c,PLT,MPV and PDW.In Q4(≥7.1%)group,the incidence of adverse pregnancy outcomes was 41.67%in PLT≤131.62×10^(9)/L,54.17%in MPV≥12.89 fl and 45.83%in PDW≥18.76 fL.The eff

关 键 词：HBA1C 妊娠糖尿病 血小板 妊娠结局 不良妊娠 

分 类 号：R71[医药卫生—妇产科学]