妊娠期高血糖患者代谢特征及妊娠结局分析

目的 研究妊娠期高血糖患者临床代谢特征及妊娠结局.方法 2005年8月至2006年12月来我院就诊的130例孕妇据75 g口服葡萄糖耐量试验结果 分为葡萄糖耐最正常组(NGT组,n=26)、匍萄糖耐量受损组(IGT组,n=42)及妊娠糖尿病组(GDM组,n=62).测定空腹血糖、空腹胰岛素、糖化血红蛋白(HbA1c)、血脂谱及C反应蛋白,计算孕前体重指数、高龄孕妇比率、稳态模型胰岛素抵抗指数(HOMA-IR)、胰岛β细胞功能指数(HOMA-B)和胰岛素敏感性指数(ISI),记录糖尿病家族史和妊娠不良结局.数据分析采用方差分析、卡方检验及Logistic回归分析.结果 GDM组、IGT组和NGT组空腹血糖分别为(5.1±1.0)、(4.7±1.0)及(4.0±0.5)mmol/L]、空腹胰岛素分别为(9±4)、(9±4)及(6±4)Mu/L]、HbAIc分别为(5.67±0.76)%、(5.62±0.61)%及(4.03±0.27)%]、总胆固醇分别为(5.5±1.3)、(5.1±1.2)及(4.2±1.1)mmol/L]、低密度脂蛋白胆固醇分别为(3.1±1.0)、(2.8±0.8)及(2.3±0.8)mmol/L]、C反应蛋白(分别为2.7、3.8及1.8 mg/L)、HOMA-IR(分别为1.9、1.8及0.9)、孕前体重指数分别为(24.4±4.0)、(24.3±2.8)及(22.2±2.8)kg/m2]、剖宫产率(分别为71.0%、52.4%、19.2%)、新生儿体重分别为(3304±608)、(3345±463)及(2988±672)g]、孕妇并发症率(分别为69.4%、54.8%及23.1%)、新,丰儿并发症率(分别为29.0%、28.6%及3.8%)比较,GDM组和IGT组均高于NGT组,而GDM组及IGT组ISI(分别为0.023及0.024)均低于NGT组(0.052),差异有统计学意义(P<0.05).NGT组、IGT组和GDM组HOMA-B指数(分别为295.75、168.76及126.25)差异有统计学意义(F=11.932,P<0.05).GDM组糖尿病家族史阳性率(38.7%)高于NGT组(11.5%).Logistic回归分析显示,孕前体重指数、孕妇年龄和HbAIc是妊娠糖尿病妇女发生母儿并发症的危险因素.结论 重度胰岛素抵抗、胰岛β细胞分泌功能障碍、孕前体重指数过高、脂代谢异常、遗传易感性是妊娠期高血糖患者的主要代谢特征.孕前体重指数?

Metabolic features and pregnancy outcomes of pregnant women with hyperglycemia

Objective To analyze metabolic features and pregnancy outcomes of pregnant women with hyperglycemia. Methods One hundred and thirty pregnant women were enrolled between August 2005 and December 2006 and divided into the normal glucose tolerance group (NGT group, n = 26), impaired glucose tolerance group (IGT group, n =42), and gestational diabetes mellitus group (GDM group, n =62) based on 75 g oral glucose tolerance test. Serum fasting glucose and insulin, HbAlc, lipid spectrum,and C-reactive protein were measured. Pre-pregnant BMI, ratio of advanced age pregnant women, HOMA-IR, HOMA-B, and ISI were calculated. Family history of diabetes and adverse pregnancy outcomes were recorded. ANOVA ,2 test,and Logistic regression analysis were used for data analysis. Results Among three groups of GDM, IGT and NGT, serum fasting glucose((5.1±1.0), (4.7±1.0), and(4.0±0.5) mmol/L, respectively) and insulin((9±4) ,(9±4), and(6±4)mU/L, respectively), HbA1c((5.67± 0.76) %, (5.62±0.61) %, and (4.03±0.27) %, respectively), total cholesterol ((5.5±1.3), (5.1± 1.2), and(4.2±1.1) mmol/L, respectively), LDL-C ((3.1±1.0), (2.8±0.8), and (2.3±0.8) mmol/L, respectively), C-reactive protein (2.7, 3.8, and 1.8 mg/L, respectively), HOMA-IR (1.9, 1.8, and 0.9, respectively), pre-pregnant BMI((24.4±4.0), (24.3±2.8), and (22.2±2.8) kg/m2, respectively), the rate of cesarean delivery (71.0% , 52.4%, and 19.2% , respectively), infant birth weight((3304±608), (3345±463), and (2988±672) g, respectively), maternal complication rate (69.4%, 54.8%, and 23.1%, respectively), and neonatal complication rate (29.0%, 28.6%, and 3.8% , respectively) were increased in the GDM and IGT groups, although ISI(0.023, 0.024, and 0.052, respectively) was significantly decreased. HOMA-B (295.75, 168.76, and 126.25, respectively) was significantly different between the three groups. Family history of diabetes was more commonly seen in the GDM group(38.7%) than the NGT group(11.5%). Logistic analysis showed that adverse maternal-infant pregnancy outcomes were significantly related with pre-pregnant BMI, age and HbAic. Conclusions Severe insulin resistance, β cell dysfunction, increased pre-pregnant BMI, lipid disorders, and hereditary susceptibility may be the main metabolic features of women with pregnant hyperglycemia. Pre-pregnant BMI, maternal age and HbA1c could be the risk factors of adverse maternal-neonatal complications.