妊娠糖尿病孕妇骨代谢状况的研究

The research on bone metabolism of pregnant women with gestational diabetes mellitus

目的探讨妊娠糖尿病(GDM)孕妇与正常孕妇骨代谢特点的异同。方法比较67例妊娠糖尿病患者(GDM组)与13例正常糖耐量孕妇(NGT组)血钙、磷、ALP、25OHD、CTx、24h尿钙、跟骨超声(SOS)等骨代谢指标的异同。然后将GDM组患者分为A、B两组,分别给予低、高两种不同剂量钙和维生素D干预至分娩前,比较两组治疗前后上述指标的差异。结果 GDM组血钙、磷为(2.3±0.1)mmol/L、(1.3±0.2)mmol/L,NGT组血钙、磷分别为(2.2±0.1)mmol/L,(1.1±0.1)mmol/L(P<0.05);GDM组和NGT组24h尿钙均升高;GDM B组24h尿钙治疗前为(11.0±-6.9)mmol/L,治疗后为(8.2±4.3)mmol/L,明显下降(P<0.05)。结论 GDM孕妇骨代谢特点和NGT孕妇基本相同,24h尿钙均显著增加。GDM可能导致血钙、磷轻度增加。补充足量的钙剂和维生素D可使尿钙丢失减少。

Objective To explore the similarities and differences in bone metabolism between pregnant women with gestational diabetes mellitus （GDM） and healthy pregnant women with NGT. Methods The bone metabolism indexes between 67 pregnant women with GDM （GDM group） and 13 healthy pregnant women with normal glucose tolerance （NGT group） were compared. These bone metabolism indexes included serum levels of calcium, phosphorus, alkaline phosphatase （ALP）, 25-OH- D, CTx, 24-hour urine calcium and calcaneus ultrasound. Then the patients in GDM group were divided into two groups（ group A and B）, which were treated with low and high dose of calcium and vitamin D till delivery, respectively. The bone metabolism indexes were compared between group A and B. Results The serum calcium and phosphorus were 2.3±0.1,1.3±0. 2mmol/L in GDM group, and 2.2±0. 1,1.1 ±0. lmmol/L in NGT group（P〈0.05）, respectively. 24-hour urinary calcium in the two groups was increased. 24-hour urinary calcium levels of group B before and after treatment were 11.0±6.9 and 8.2± 4.3mmol/L（P〈0. 05）, respectively. Conclusions The bone metabolism characteristics between GDM group and NGT group are similar. The 24-hour urinary calcium of the two groups significantly increases. Serum calcium and phosphorus of GDM group are slightly higher than those of NGT group. Supplement of enough calcium and vitamin D may decrease urinary calcium excretion.