妊娠期糖尿病患者孕晚期体质量增长与糖化血清白蛋白、内脂素水平及新生儿体成分的相关性研究

目的:探讨非肥胖的妊娠期糖尿病(GDM)患者孕晚期体质量增长与母体糖化血清白蛋白(GA)、内脂素水平及新生儿体成分的相关性。方法:200例GDM患者[孕前体质量指数(BMI)均25 kg/m~2]进入本研究,以孕28周至分娩期体质量增长速度分为过度增重GDM组(n=77)和适宜增重GDM组(n=123)。比较不同组别GA、内脂素等糖脂代谢指标及新生儿出生体质量、体脂百分含量的差异;进一步分析GDM患者妊娠晚期体质量增长与上述指标的相关性。结果:1过度增重GDM组患者GA、糖化血清蛋白(HbA1c)、内脂素及血脂总胆固醇(TC)、甘油三酯(TG)、低密度脂蛋白(LDL)、极低密度脂蛋白(VLDL)水平均高于适宜增重GDM组(P0.05)。2两组平均分娩孕周、新生儿出生即刻Apgar评分、男婴比例、阴道分娩率的差异均无统计学意义(P0.05)。与适宜增重GDM组相比,过度增重GDM组新生儿具有较高的平均出生体质量、较低的血糖水平,该组大于胎龄儿(LGA)比例增加,新生儿腹围/头围比(AC/HC)、体脂百分含量均显著增高(P0.01)。3GDM患者孕晚期体质量增速与GA、内脂素、HbA1c及新生儿出生体质量、新生儿体脂百分含量均呈显著正相关(r=0.524、0.470、0.456、0.329、0.473,P0.001)。结论:GA、内脂素水平的监测可能在评估GDM患者孕晚期体质量增长方面具有一定临床实用价值,而GDM患者孕晚期体质量增长过速则可能加速内脏脂肪积累、加重原有的糖脂代谢紊乱,并与新生儿出生体质量及体脂含量的增加密切相关。

Correlation between Weight Gain during Late Pregnancy and Glycated Albumin,Visfatin Level and Neonatal Body Composition in Gestational Diabetes Mellitus Patients

Objective:To evaluate the association between weight gain in late gestation and glycated albumin (GA),visfatin level and neonatal body composition in gestational diabetes mellitus (GDM) patients who are non-obese.Methods:200 pregnant women were enrolled.The preconception body mass index(BMI) of all the research object was less than 25 kg/m2.According to the speed of body mass growth from 28th week of gestation to delivery,the subjects were divided into two groups:excessive weight gain group (n =77) and appropriate weight gain group(n=123).Variance of serum GA,visfatin levels and neonatal birth weight(BW),the percent of body fat in newborn(F％) between two groups were compared,and the relationship between weight gain in late pregnant GDM patients and above values was analyzed.Results:①Serum GA,HbA1 c,visfatin and total cholesterol,triglyceride,low density lipoprotein,very low density lipoprotein levels in excessive weight gain group were higher than those in appropriate weight gain group(P ＜ 0.05).②Mean gestational age,newborn Apgar score immediately,the ratio of baby boys and vaginal delivery rate in two group had no significant difference(P＞0.05).Compared with the appropriate weight gain group,the excessive weight gain group had higher average birth weight and lower blood glucose levels.The proportion of large for gestational ages(LGA) was increased in appropriate weight gain group,and the ratio of abdomen circumference (AC) and head circumference (HC) and the percent of body fat in newborn(F％) were significantly increased in this group(P ＜0.01).③The speed of body mass growth in late pregnancy in GDM patients was positively related with serum GA,visfatin,HbA1c levels and newborn birth weight and the percent of body fat in newborn(r=0.524,0.470,0.456,0.329,0.473,P＜0.001).Conclusions:The monitoring of the serum GA and visfatin levels may have certain clinical value to evaluate the weight gain in late pregnancy of GDM patients.The rapid body mass growth in those patients may accelerate the visceral fat accumulation and worsen existing glucolipid metabolic disorders,and is also closely related to the increase of neonatal BW and F％.