妊娠期糖代谢异常孕妇血脂水平与围产结局的关系

目的 分析妊娠期糖代谢异常孕妇血脂水平与围产结局的关系。方法选 择确诊为妊娠期糖代谢异常的孕妇358例,包括妊娠合并糖尿病（DM）28例（DM组）,妊娠期糖尿病（GDM）178例（GDM组）,妊娠期糖耐量受损（GIGT）152例（GIGT组）,用Beckman—CX9型全自动生化分析仪测定血清总胆固醇（TC）、甘油三酯（TG）、高密度脂蛋白胆固醇（HDL—C）及低密度脂蛋白胆固醇（LDL—C）,详细记录各组孕妇确诊时血脂水平及孕妇年龄、孕周、检测时间、治疗方法、并发症等。结果 （1）GIGT组与GDM组TG分别为（2．7±0．7）mmoL／L和（2．9±0．7）mmoL／L,TC分别为（6．2±1．1）mmol／L和（6．7±1．9）mmol／L,HDL—C分别为（1．78±0．22）mmol／L和（1．64±0．31）mmol／L,LDL-C分别为（3．8±0．9）mmol／L和（3．7±0．8）mmol／L,两两比较,差异均无统计学意义（P〉0．05）;DM组TG和LDL—C分别为（3．6±0．9）mmol／L和（4．8±0．6）mmol／L,均高于GIGT组和GDM组,而HDL-C[（1．24±0．19）mmol／L]低于GIGT组和GDM组,差异均有统计学意义（P〈0．05）。（2）DM组、GDM组、GIGT组,子痫前期发生率分别为35．7％（10／28）、16．8％（30／178）和14．5％（22／152）;早产发生率分别为39．3％（11／28）、16．8％（30／178）和19．7％（30／152）,分别比较,差异均有统计学意义（P均〈0．05）;羊水过多、胎膜早破发生率3组比较,差异无统计学意义（P〉0．05）;胎儿窘迫发生率GDM组低于GIGT和DM组,分别为9．8％（15／152）、20．2％（36／178）和21．4％（6／28）;GDM组和GIGT组巨大儿发生率高于DM组,分别为11．2％（20／178）、14．5％（22／152）和3．5％（1／28）,分别比较,差异均有统计学意义（P〈0．05）。结论 妊娠期糖代谢异常孕妇血脂水平是监测围产结局的有效指标之一,有效降低血脂水平能降低子痫前期和早产的发生率。

Relationship between blood lipid levels of pregnant women with glucose metabolism disorders and perinatal outcomes

OBJECTIVE: To study the relationship between blood lipid levels of pregnant women with glucose metabolism disorders and the perinatal outcomes. METHODS: Three hundred and fifty-eight pregnant women with glucose metabolism disorders were enrolled in this study, including 28 cases with diabetes mellitus (DM), 152 cases with gestational diabetes mellitus (GDM), 178 cases with gestational impaired glucose tolerance (GIGT). Beckman-CX9 automatic biochemical analyzer was used to measure serum levels of total cholesterol (TC), triglyceride (TG), high density lipoprotein cholesterol (HDL-C) and low density lipoprotein cholesterol (LDL-C). RESULTS: (1) The TG, TC, HDL-C and LDL-C levels in GDM group was (2.9 +/- 0.7), (6.7 +/- 1.9), (1.64 +/- 0.31), and (3.7 +/- 0.8) mmol/L, respectively, which were not significantly different from those in GIGT group [TG (2.7 +/- 0.7), TC (6.2 +/- 1.1), HDL-C (1.78 +/- 0.22), and LDL-C (3.8 +/- 0.9) mmol/L, respectively (P > 0.05)]. Maternal serum concentrations of TG and LDL-C were significantly increased in DM group [(3.6 +/- 0.9) and (4.8 +/- 0.6) mmol/L] compared with GIGT group [(2.7 +/- 0.7) and (3.8 +/- 0.9) mmol/L] and GDM group [(2.9 +/- 0.7) and (3.7 +/- 0.8) mmol/L] (P < 0.05). However, the HDL-C (1.24 +/- 0.19) mmol/L in DM group was significantly lower than that in GDM group (1.64 +/- 0.31) mmol/L and GIGT group (1.78 +/- 0.22) mmol/L (P < 0.05). (2) The incidence of pre-eclampsia and preterm labor in the DM group (35.7% and 39.3%) was higher than that in GIGT group (16.8% and 16.8%) and GDM group (14.5% and 19.7%, P < 0.05). Among the three groups, the incidence of polyhydramnios and premature rupture of membrane had no significant difference (P > 0.05). The incidence of fetal distress in the GIGT group (9.8%) was lower than that in DM group (20.2%) and GDM group (21.4%, P < 0.05). The incidence of fetal macrosomia in GDM group (11.2%) and GIGT group (14.4%) was higher than that in DM group (3.5%, P < 0.05). CONCLUSION: The blood lipid level of pregnant women with glucose metabolism disorders is one of the effective indexes to prognosticate perinatal outcomes. Reducing blood lipid level can decrease the incidence of pre-eclampsia and preterm labor significantly.