妊娠初期外周血白细胞计数与妊娠糖尿病发生的相关性研究

Relationship between first-trimester white blood cell count and subsequent gestational diabetes mellitus

目的探讨妊娠初期外周血白细胞（WBC）计数与随后发生的妊娠糖尿病（GDM）的相关性。方法在妊娠初期检测孕妇的外周血WBC计数，将以后发生GDM的232例作为病例组，糖耐量正常的482名孕妇作为对照组，比较两组的wBC计数；再按WBC计数四分位，从而将研究对象分为四组，进行Logistic回归分析。结果病例组的妊娠初期外周血WBC计数明显高于对照组（8．56×10^9／L vs8．18×10^9／L，P〈0．01）。根据wBC计数四分位的结果，将研究对象分为四组，第一组WBC〈7．46×10^9／L，第二组wBC（7．46～8．33）×10^／L，第三组WBC（8．34～9．16）×10^9／L，第四组wBC≥9．17×10^9／L，相应的GDM的检出率分别为20．13％、34．61％、36．02％、39．61％。调整年龄、孕次、孕前BMI、SBP、DBP及糖尿病家族史等因素，行Logistic回归发现，相对于第一组而言，第二组、第三组及第四组发生GDM的危险分别是第一组的2．17倍（95％CI 1．25～3．77）、2．15倍（95％CI1．23～3．76）及2．59倍（95％CI1．49～4．50）。结论GDM患者妊娠初期WEC计数升高，慢性炎症可能参与了GDM的发生。

Objective To investigate the relationship between peripheral white blood cell （WBC） of the first trimester and the subsequent development of gestational diabetes mellitus （GDM）. Methods WBC levels in first trimester were measured in 232 women who subsequently developed GDM and in 482 women who remained euglycemic throughout pregnancy. Wt~ median levels were compared between two groups using Wilcoxon＇s rank-sum test. Logistic regression was used to compute the unadjusted and multivariable-adjusted odds ratios for developing GDM among WBC quartile grouping. Results First trimester WBC levels were significantly increased among women who subsequently developed GDM as compared with control subjects （8. 56×10^9/L vs 8. 18×10^9/L,P〈0. 01）. The minimum-maximum values of white blood cell count for the first to the fourth quartile were [（2. 94-7. 46）×10^9/L], [（7. 47-8. 33）×10^9/L3, [（8. 34-9.16）×10^9/L], [（9. 17 - 9.99）×10^9/L], respectively. Detection rate of GDM for the respective quartiles were 20. 13%, 34. 61%, 36.02%, 39. 61%. After adjusting for age, parity, family history of diabetes, pregestational My mass index, and blood pressure, the relative risk was 2. 17 （95% CI 1.25-3. 77） for the second and 2. 15 （95%CI 1.23- 3. 76） for the third and 2. 59 （95%CI 1.49-4. 50） for the fourth guartile of WBC as compared with the first quartile. Conclusions In women who develop GDM, there is evidence of increased WBC count early in pregnancy. Systemic inflammation may be associated with the development of GDM.