妊娠期糖尿病患者血糖波动与妊娠期高血压发病相关  

Blood glucose fluctuations are associated with the onset of gestational hypertension in gestational diabetes mellitus patients

作　　者：王瑞[1] 张玉萍 李蕊[1] 李运龙 李元[1] 张园 刘燕萍[1] WANG Rui;ZHANG Yuping;LI Rui;LI Yunlong;LI Yuan;ZHANG Yuan;LIU Yanping(Department of Clinical Nutrition,Peking Union Medical College Hospital,CAMS&PUMC,Beijing 100730,China;Outpatient Department,Peking Union Medical College Hospital,CAMS&PUMC,Beijing 100730,China)

机构地区：[1]中国医学科学院,北京协和医学院,北京协和医院临床营养科,北京100730 [2]中国医学科学院,北京协和医学院,北京协和医院门诊部,北京100730

出　　处：《基础医学与临床》2025年第5期664-670,共7页Basic and Clinical Medicine

基　　金：国家高水平医院临床研究基金(2022-PUMCH-B-015);中国医药教育协会(药教协项字[2021]第007号)。

摘　　要：目的分析妊娠期糖尿病(GDM)患者血糖变异度(GV)对妊娠期高血压的影响,并探讨描述血糖变异度不同指标之间的差异,评估不同指标的预测价值,提出管理方案。方法本研究共纳入127例GDM孕妇。在诊断为GDM后进行连续血糖监测(CGM)、血压测量并记录妊娠期高血压疾病的发生。血糖变异性指数使用自动化计算程序EasyGV 9.0进行计算。结果在GDM患者中,孕期较高的血糖变异度与血压的升高显著相关。出院诊断中2例(1.6%)患者被诊断为子痫前期,9(7.1%)例患者被诊断为妊娠期高血压。低于目标范围时间(TBR)%水平与孕29~32周的舒张压、分娩时的舒张压、收缩压之间存在显著的负相关,目标范围内时间(TIR)%与两次产检间收缩压变化率存在负相关。血糖变异度指标中CONGA(OR:3.648;95%CI:1.046,12.721;P=0.042)是妊娠期高血压的独立影响因素,当CONGA高于4.856时,GDM患者发生妊娠期高血压的风险增加。结论血糖变异度是GDM妇女妊娠期高血压发生的独立影响因素。对于妊娠期高血压疾病高风险的GDM患者来说,应当尽可能保持血糖合理、平稳。Objective To identify the impact of glucose variability(GV)on the development of gestational hypertension(GH)in patients with gestational diabetes mellitus(GDM),and to find the differences between various GV metrics as well as to evaluate their predictive value in management strategy development.Methods A total of 127 pregnant women diagnosed with GDM were included in this study.After the diagnosis of GDM,continuous glucose monitoring(CGM)and blood pressure measurements were performed,and the occurrence of gestational hypertensive disorders was recorded.Indices of glucose variability were calculated using an automated software EasyGV version 9.0.Results The results revealed an association between gestational hypertension and glucose variability in GDM patients.Among the study participants,2 cases(1.6%)were diagnosed with preeclampsia and 9 cases(7.1%)were diagnosed with gestational hypertension.TBR%(time below range)showed a significantly negative correlation with diastolic blood pressure at 29-32 weeks of gestation and with both diastolic and systolic blood pressure during delivery.TIR%(time in range)showed a negative correlation with the rate of change in systolic blood pressure between two prenatal visits.CONGA(continuous overlapping net glycemic action)emerged as an independent predictor of gestational hypertension(OR:3.648;95%CI:1.046,12.721;P=0.042).When CONGA exceeded 4.856,the risk of gestational hypertension in GDM patients increased.Conclusions Blood glucose variation is an independent factor affecting the occurrence of pregnancy-induced hypertension in GDM women.This study suggests new targets for the use and management of CGM in pregnant women with GDM.For GDM patients at high risk of hypertensive disease during pregnancy,blood glucose should be kept at a reasonable and stable level.

关 键 词：妊娠期糖尿病 连续血糖监测 葡萄糖变异性 先兆子痫 妊娠期高血压 

分 类 号：R714.2[医药卫生—妇产科学]