妊娠期糖尿病母体及新生儿25-羟维生素D3水平与新生儿呼吸窘迫综合征发病的关系研究

目的研究妊娠期糖尿病（GDM）母体和新生儿25-羟维生素D₃［25（OH）D₃］水平与新生儿呼吸窘迫综合征（NRDS）的关系。 方法选取2018年3月至2020年9月安徽医科大学附属阜阳医院148例GDM孕妇，记录产后NRDS发生率。分别在孕28~36周和新生儿出生时采血，检测血清25（OH）D₃水平。采用二分类Logistic回归模型分析GDM孕妇发生NRDS的独立影响因素。采用受试者工作特征（ROC）曲线分析母体和新生儿25（OH）D₃判断NRDS的价值。 结果148例新生儿中28例发生NRDS，发生率为18.92%。NRDS组和非NRDS组新生儿1 min和5 min Apgar评分、吸入羊水、胎膜早破、产前糖皮质激素治疗情况、母体和新生儿25（OH）D₃水平比较差异均有统计学意义（P＜0.05）。Logistic分析结果显示，1 min Apgar评分（OR=2.243，95%CI：1.795~2.803）、5 min Apgar评分（OR=3.662，95%CI：2.074~6.466）、吸入羊水（OR=2.893，95%CI：1.325-6.317）、新生儿25（OH）D₃（OR=0.483，95%CI：0.271~0.861）及母体25（OH）D₃（OR=0.501，95%CI：0.282~0.890）是产后NRDS的独立影响因素（P＜0.05）。ROC曲线分析结果显示，新生儿25（OH）D₃预测NRDS的AUC值为0.741，敏感度和特异度分别为86.7%和54.6%；母体25（OH）D₃预测NRDS的AUC值为0.648，敏感度和特异度分别为89.2%和35.7%。根据Logistic多因素分析结果建立预测模型：logit（P）=0.119+0.808X₁+1.298X₂+1.062X₃-0.728X₄-0.691X₅［1 min Apgar评分=X₁，5 min Apgar评分=X₂，吸入羊水=X₃，新生儿25（OH）D₃=X₄，母体25（OH）D₃=X₅］。ROC曲线分析显示，预测模型判断NRDS的AUC值为0.844（SE=0.041，95%CI：0.764~0.924，P＜0.001），敏感度为0.929，特异度为0.675。 结论GDM患者母体和新生儿25（OH）D₃水平是NRDS的独立影响因素，监测母体和新生儿25（OH）D₃水平有助于NRDS早期筛查，指导临床。

Relationship between maternal and neonatal 25(OH)D3 levels and neonatal respiratory distress syndrome among women with gestational diabetes mellitus

ObjectiveTo investigate the relationship between maternal and neonatal 25-hydroxy vitamin D₃ 25(OH)D] levels and neonatal respiratory distress syndrome (NRDS) among woman with gestational diabetes mellitus (GDM). MethodsA total of 148 pregnant women with GDM at Fuyang Hospital Affiliated to Anhui Medical University from March 2018 to September 2020 were selected. The incidence of postpartum NRDS was recorded. The blood was collected at 28 to 36 weeks of gestation and at birth of the newborn, and the serum 25-(OH)D levels were detected. Binary Logistic regression model was used to analyze the independent influence factors of NRDS in pregnant women with GDM. The value of maternal and neonatal 25-(OH)D for predicting NRDS was evaluated by receiver operating characteristic (ROC) curve analysis. ResultsThere were 28 cases of NRDS in the 148 newborns, with an incidence of 18.92%. There were statistically significant differences between the NRDS group and the non-NRDS group in Apgar scores at 1 min and 5 min, amniotic fluid inhalation, premature rupture of membranes, prenatal glucocorticoid treatment, and maternal and neonate 25(OH)D₃ levels (P＜0.05). Logistic regression analysis showed that Apgar scores at 1 min (odds ratio OR]=2.243, 95% confidence interval CI]: 1.795-2.803) and 5 min (OR=3.662, 95%CI: 2.074-6.466), amniotic fluid inhalation (OR=2.893, 95%CI: 1.325-6.317), neonatal 25(OH)D₃ (OR=0.483, 95%CI: 0.271-0.861), and maternal 25(OH)D₃ (OR=0.501, 95%CI: 0.282-0.890) were independent influence factors for postpartum NRDS (P＜0.05). ROC analysis results showed that the AUC of neonatal 25(OH)D₃ in predicting NRDS was 0.741, with a sensitivity and specificity of 86.7% and 54.6%, respectively. The AUC of maternal 25(OH)D₃ in predicting NRDS was 0.648, and the sensitivity and specificity were 89.2% and 35.7%, respectively. The prediction model was established based on the results of Logistic multi-factor analysis: logit(P)=0.119+0.808X₁+1.298X₂+1.062X₃-0.728X₄-0.691X₅ 1 min Apgar score=X₁, 5 min Apgar score=X₂, inhalation of amniotic fluid=X₃, newborn 25(OH)D₃=X₄, and maternal 25(OH)D₃=X₅]. ROC analysis showed that the AUC value of the prediction model for diagnosing NRDS was 0.844 (SE=0.041, 95%CI: 0.764-0.924, P＜0.001), with a sensitivity of 0.929 and specificity od 0.675. ConclusionMaternal and neonatal 25(OH)D₃ levels in GDM woman are independent influencing factors of NRDS. It is helpful for early screening of NRDS and guiding clinical practice to monitor the maternal and neonatal 25(OH)D₃ levels in GDM woman.