妊娠期糖代谢异常与妊娠期高血压疾病的关系

目的:探讨妊娠期糖代谢异常与妊娠期高血压疾病的关系。方法:回顾分析2003年至2007年在我院住院分娩的6748例孕妇的临床资料,分析不同程度糖代谢异常孕妇妊娠期高血压疾病的发生情况;将妊娠期糖代谢异常并发高血压疾病(PHD)患者分为妊娠期高血压组(Ⅰ组)、轻度子痫前期组(Ⅱ组)和重度子痫前期组(Ⅲ组),比较3组孕妇不同糖负荷后血糖水平(GCT、OGTT)、糖化血红蛋白水平及胰岛素抵抗指数的差异。结果:(1)6748例孕妇发生PHD252例,发生率3.7%(252/6748),妊娠期糖代谢异常孕妇1402例,发生率20.8%(1402/6748);妊娠期糖代谢异常孕妇82例并发PHD,发生率5.8%(82/1402);糖代谢正常孕妇PHD发生率为3.2%(170/5346),差异有统计学意义(P<0.001);(2)82例妊娠期糖代谢异常并发PHD患者中,糖尿病合并妊娠(DM)、妊娠期糖尿病(GDM)、妊娠期糖耐量降低(GIGT)、妊娠期50g葡萄糖筛查(GCT)(+)的PHD发生率分别为8.5%(12/141),7.9%(45/571),3.4%(9/265),3.8%(16/425);DM、GDM组与GIGT、GCT(+)组的差异有统计学意义(P=0.010、0.001);DM组与GDM组的差异无统计学意义(P=0.805);GIGT组与GCT(+)组相比及两组与糖代谢正常组的差异无统计学意义(P=0.801、0.535)。(3)82例妊娠期糖代谢异常并发PHD患者,妊娠期高血压(Ⅰ组)27例、轻度子痫前期(Ⅱ组)24例、重度子痫前期(Ⅲ组)31例,3组血糖(GCT、OGTT)、糖化血红蛋白水平及胰岛素抵抗指数无统计学差异。结论:妊娠期糖代谢异常的孕妇更易发生妊娠期高血压疾病;随糖代谢异常程度加重,妊娠期高血压疾病发病率呈增加趋势。

Abnormal gestational glucose metabolism and pregnancy hypertension disease

Objective:To investigate the development of pregnancy hypertension disease(PHD) in women with abnormal gestational glucose metabolism.Methods:A retrospective study was conducted on 6748 pregnant women who delivered in our hospital between 2003 to 2007.Eighty two cases developed PHD complicated with abnormal gestational glucose metabolism,which could be classified into three groups:gestational hypertension group,mild preeclampsia group and severe preeclampsia group.After taking different load of glucose,plasma glucose level,HbA1c and insulin resistance index were compared among three groups.Results:(1)The incidence of gestational glucose metabolism disorder was 20.8%(1402/6748),and the incidence of PHD was 3.7%(252/6748).The incidence rate of PHD in gestational glucose metabolism disorder patients was significantly higher than that in normal glucose metabolism control(5.8% vs 3.2%,P<0.001).(2)The incidence of PHD was higher in diabetes mellitus(DM)(8.5%,12/141) and gestational diabetes mellitus(GDM)(7.9%,45/571) groups compared with gestational impaired glucose tolerance(GIGT)(3.4%,9/265) and glucose challenge test(GCT)(+)(3.8%,16/425) groups(P=0.010,P=0.001,respectively),while no statistic significance was found between DM and GDM group as well as GIGT and GCT(+) group.(3)No differences were found in plasma glucose level,HbA1c and insulin resistance index in gestational hypertension group,mild preeclampsia group and severe preeclampsia group.Conclusion:Pregnant women with abnormal glucose metabolism developed PHD more frequently,and the risk of PHD incresed according to the severity of glucose metabolism disorder.