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妊娠期糖代谢异常孕妇并发子痫前期的相关因素探讨
作者姓名:Yang HX  Zhang MH  Sun WJ  Dong Y
作者单位:1. 100034,北京大学第一医院妇产科
2. 山西省太原市妇幼保健院妇产科
基金项目:北京大学211工程循征医学基金资助项目(91000-242156028)
摘    要:目的探讨妊娠期糖代谢异常孕妇子痫前期的发病情况,以及与发病相关的因素。方法回顾性分析1981至2003年23年间,在我院分娩的1202例妊娠期糖代谢异常孕妇的病例资料,其中151例(Ⅰ组)并发子痫前期,1051例(Ⅱ组)未并发子痫前期,分析与子痫前期发病相关的危险因素。结果(1)妊娠期糖代谢异常孕妇子痫前期的发生率为12.6%(151/1202)。其中糖尿病合并妊娠(DM)、妊娠期糖尿病(GDM)、妊娠期糖耐量降低(GIGT)患者中,子痫前期的发生率分别为34.8%(39/112)、11.8%(89/753)、6.8%(23/337),3者比较,差异有统计学意义(P<0.01)。(2)Ⅰ组孕妇分娩前体重指数(BMI)为(31±4)kg/m2,Ⅱ组为(29±4)kg/m2,两组比较,差异也有统计学意义(P=0.027);Ⅰ组孕期血糖升高出现的时间(27±11)周]明显早于Ⅱ组(30±7)周],平均产次也高于Ⅱ组。(3)有不良孕产史、合并慢性高血压者,子痫前期的发生率分别为18.5%(32/173)、41.9%(18/43),明显高于无不良孕产史及慢性高血压者(P=0.03、0.000)。(4)Ⅰ组孕妇的口服50g葡萄糖负荷试验(GCT)、口服75g葡萄糖耐量试验(OGTT,空腹、服糖后2、3h)及糖化血红蛋白(HbA1c)各值均明显高于Ⅱ组。(5)需要胰岛素治疗者,子痫前期的发生率为15.6%,高于饮食控制者(9.9%,P=0.009);血糖控制不满者子痫前期的发生率为17.0%,明显高于血糖控制满意者(10.0%,P=0.000)。(6)logistic回归分析显示,妊娠期糖代谢异常孕妇合并慢性高血压、HbA1c水平升高为子痫前期发病的独立危险因素。结论不同类型糖代谢异常者,并发子痫前期的发生率存在明显差异,GDM确诊时血糖水平、孕期血糖控制情况等与子痫前期发病存在明显相关性,慢性高血压与糖代谢异常并存,将明显增加子痫前期的发生率。

关 键 词:糖尿病  妊娠  先兆子痫  葡萄糖代谢障碍  糖代谢异常孕妇  妊娠期糖尿病  子痫前期  并发  logistic回归分析  慢性高血压  妊娠期糖耐量降低
收稿时间:2004-12-10
修稿时间:2004年12月10

Associated factors of pre-eclampsia complicated in pregnant women with abnormal glucose metabolism
Yang HX,Zhang MH,Sun WJ,Dong Y.Associated factors of pre-eclampsia complicated in pregnant women with abnormal glucose metabolism[J].Chinese Journal of Obstetrics and Gynecology,2005,40(9):577-580.
Authors:Yang Hui-xia  Zhang Mei-hua  Sun Wei-jie  Dong Yue
Institution:Department of Obstetrics and Gynecology, Peking University First Hospital, Beijing 100034, China.
Abstract:OBJECTIVE: To investigate the incidence and associated factors of pre-eclampsia in women with abnormal glucose metabolism in pregnancy. METHODS: A retrospective study was conducted on 1202 pregnant women with abnormal glucose metabolism who delivered their babies in our hospital between 1981-2003. All women were divided into 2 groups: group I included 151 women with pre-eclampsia; group II consisted of 1050 women without pre-eclampsia. The risk factors of pre-eclampsia were analyzed. RESULTS: (1) The incidence of pre-eclampsia was 12.6% as a whole and was 34.8% (39/112), 11.8% (89/753) and 6.8% (23/337) in diabetes mellitus (DM), gestational diabetes mellitus (GDM) and gestational impaired glucose tolerance (GIGT) groups, respectively (P < 0.01). (2) The average pre-pregnant body mass index (BMI), the gestational age at the presence of elevated blood glucose and the parity in group I were significantly different from that of group II (31 +/- 4) kg/m(2) vs (29 +/- 4) kg/m(2), P = 0.027; (27 +/- 11) weeks vs (30 +/- 7) weeks, P = 0.001; (1.0 +/- 0.6) vs (0.8 +/- 0.6), P = 0.01]. No difference was shown in these two groups in maternal age and gravida. (3) The incidence of pre-eclampsia was increased in women who had poor obstetric history and chronic hypertension (18.5% vs 11.6%, 41.9% vs 11.5%, P = 0.03, 0.000). (4) In group I, the glucose level of glucose challenge test (GCT), oral glucose tolerance test (OGTT, fasting, 2 hr and 3 hr) and the hemoglobin A(1)c (HbA(1)c) value were all higher than those of group II (P = 0.002, 0.000, 0.009, 0.001, 0.004, respectively). (5) Those with insulin treatment had a rate of 15.6% of pre-eclampsia, which was higher than those with diet control (9.9%, P = 0.009), and the glucose not well controlled women had a higher rate of pre-eclampsia than the well controlled ones (17.0% vs 10.0%, P = 0.000). (6) Logistic regression analysis showed that the independent risk factors of pre-eclampsia were pregnant women with chronic hypertension and the level of HbA(1)c. CONCLUSIONS: Types of abnormal glucose metabolism have significant effect on the incidence of pre-eclampsia. The occurrence of pre-eclampsia in these women is closely related to the plasma glucose level at GDM diagnosis and how well the maternal glucose level is controlled.
Keywords:Diabetes  gestational  Pre-eclampsia  Glucose metabolism disorders
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