妊娠期糖尿病患者羊水葡萄糖水平与羊水量及新生儿出生体重的关系

Correlation between amniotic fluid glucose concentration and amniotic fluid volume and neonatal birth weight in pregnancy complicated by gestational diabetes mellitus

目的探讨妊娠期糖尿病（GDM）孕妇羊水葡萄糖水平变化与羊水最及新生儿出生体重的关系。方法对255例足月、单胎孕妇，于孕24～28周行50g葡萄糖筛查试验（50g GCT），口服葡萄糖后1h血糖≥7．8mmol／L，且〈10．6mmoL／L者为葡萄糖筛奄阳性，阳性者进一步行75g葡萄糖耐量试验（75gOG＇IT）。根据两项试验结果分为GDM组、妊娠期糖耐量低减（GIGT）组和正常妊娠组，每组85例：分别测定3组孕妇的羊水葡萄糖水平、羊水指数、新牛儿出生体重、孕妇空腹血糖、脐静脉血糖，并进行各指标间相关与回归的统计学分析。结果（1）GDM组羊水葡萄糖水平为（1．30±0．71）mmol／L，明显高于GIGT组的（1．02±0．57）mmol／L和正常妊娠组的（0．90±0．58）mmol／L，分别比较，差异均有统计学意义（P均〈0．01）。（2）GDM组羊水指数为（16．1±4．6）cm，稍高于GIGT组的（14．8±4．3）cm，差异无统计学意义（P〉0．05）；明显高于正常妊娠组的（12．7±3．2）cm，差异有统计学意义（P〈0．01）。（3）GDM组新生儿出生体重为（3612±510）g，低于GIGT组的（3694±490）g，高于正常妊娠组的（3487±458）g，但分别比较，差异均无统计学意义（P〉0．05）。（4）GDM组羊水葡萄糖水平分别与羊水指数（r=0．330，P=0．002）、新生儿出生体重（r=0．347，P=0．001）、孕妇空腹血糖（r=0．589，P〈0．01）、脐静脉血糖（r=0．218，P=0．045）呈正相天关系。GICT组和正常妊娠组羊水葡萄糖水平仅与羊水指数呈正相关关系。（5）GDM组中血糖控制理想孕妇的羊水葡萄糖水平、羊水指数及新生儿出生体重分别为（1．02±0．50）mmol／L、（13．9±4．2）cm及（3497±475）g，血糖控制不理想孕妇分别为（1．92±0．76）mmol／L、（16．4±4．4）cm及（3869±481）g，两者分别比较，差异均有统计学意义（P〈0．01、P〈0．05、P〈0．01）。GDM组中血糖控制理想孕妇的以上3项指标接近正常妊娠组（P〉0．05）。结论GDM患者的千水葡萄糖水平与羊水量、新生儿出生体重有密切关系。血糖控制理想与否对GDM合并羊水过多、巨大儿等并发症起决定因素，而积极管理可极大地改善GDM患者的母儿预后。

Objective To investigate the relationship between amniotic fluid glucose concentration, amniotic fluid volume and neonatal birth weight in gestational diabetes mellitus （ GDM）. Methods Two hundred and fifty-five singleton, normal term pregnant women were divided into three groups： GDM, gestational impaired glucose tolerance （GIGT） and normal pregnancy according to the results of a 50 g, 1 hour glucose challenge test （GCT） or of a 75 g oral glucose tolerance test （OGTF）. There were 85 study subjects in each group. All women had GCT at 24 -28 gestational weeks. When they had a positive GCT, in which glucose level was 〉17.8 mmol/L,and 〈 10. 6 mmol/L at 1 hour after oral 50 g glucose, they were required to have a 75 g OGTF. Amniotic fluid glucose concentration （AFG）, amniotic fluid index （AFI）, neonatal birth weight （ NBW）, maternal fasting glucose level （MFG） and umbilical venous glucose level （UvG） were compared in three groups. Statistical analysis of linear regression was done on these indices. Results （ 1 ） The mean AFG in group GDM was （ 1.30 ±0.71 ） mmol/L , which was significantly greater than that in group GIGT, （1.02±0. 57）mmoL/L and that in normal group, （0. 90 ±0. 58）mmol/I, There were significant differences among three groups （P 〈0. 01 ）. （2） In group GDM, the mean AFI was （16. 1 ±4. 6） cm , which was slightly greater than that in group GIGT, （ 14. 8 ± 4. 3 ） cm （ P 〉 0. 05 ）, but was significantly higher than that in normal group, （ 12. 7 ± 3.2 ） em（ P 〈 0. 01 ）. （ 3 ） The NBW of group GDM was （3612 ±510）g, which was lower than that of group GIGT, （3694 ±490）g, and higher than that of normal group, （3487 ±458） g, but there were no significant differences among three groups （P 〉 0. 05）. （4） Among women with GDM, AFG was significantly correlated with AFI （r--0. 330, P =0. 002）, NBW （r=0.347, P=0.001）, MFG （r=0.589, P〈0.01）, and with UvG （r=0.218, P=0.045）. But in group GIGT and normal group, AFG was only correlated with AFI. （5） In GDM group, the AFG, （1.02 ~ ＋0. 50）retool/L; AFI, （ 13.9 ± 4. 2） cm; and NBW, （3497 ± 475） g in women who had ideal blood glucose level were significantly lower than that in women whose blood glucose levels were not well-controlled [AFG, （1. 92 ± 0. 76 ） mmol/L , AFI, （16.4±4.4）cm, NBW, （3869±481）g （P〈0.01, P〈0.05, P 〈 0. 01 ） ] , and the mean values of these three indices were close to those of the control group. Conclusion In the cohort with GDM, there were correlations between AFG, AFI, and NBW. The results show that an active management could significantly improve the prognoses of the diabetes mothers and their fetuses.