交界性糖耐量异常孕妇三酰甘油水平对新生儿出生体重的影响

Influence of serum triglyceride in pregnancies with borderline gestational glucose intolerance on infant birth weight

目的研究血清三酰甘油（TG）对交界性糖耐量异常（BGGI）孕妇新生儿出生体重的影响。方法取2009年7月-2011年6月符合纳入标准的葡萄糖负荷试验（GCT）筛查阳性孕妇180例，依据糖代谢状况将对象分为妊娠期糖尿病（GDM）组36例、妊娠期糖耐量异常（GIGT）组23例和BGGI组121例三组。随访并记录其一般资料、妊娠结局、糖脂代谢状况，检测载脂蛋白E（ApoE）等位基因和基因型表达，统计分析糖脂代谢指标和新生儿体重之间的相关性。结果GDM组血清TG水平[（2．47±0．77）mmol／L]显著高于BGGI组[（1．99±0．64）mmol／L]和GIGT组[（1．98±0．81）mmol／L）]（F=15，99，P〈0．01）。ApoE基因多态性方面，ApoE3等位基因频率为86．21％，ApoE3E3基因型频率最高（72．78％，131／180），各ApoE基因型之间TG水平差异无统计学意义（F=15．99．P=1．20）。BGGI组巨大儿发生率为9．91％（12／121），大于胎龄儿发生率为14．05％（17／121），同另外两组之间差异均无统计学意义（巨大儿发生率：X^2=4．01，P：0．13；大于胎龄儿发生率：X^2=3．67，P=0．15）。BGGI组中足月分娩的83例者，孕前体重指数（BMI）（占O．07，P=0．03）、孕期增重（r^2=0．06，P=0．01）、TG水平（r^2=0．09，P〈0．01）以及葡萄糖耐量实验（0GTT）2h血糖水平（r^2=0．04，P=0．03）和新生儿出生体重之间均存在线性关系，多元线性回归模提示TG水平（F=4．07，P〈0．01）和孕前BMI（F：7．26，P〈0．01）是影响新生儿出生体重的独立因素。结论孕期TG水平是影响BGGI孕妇新生儿出生体重的独立因素，且不受ApoE基因多态性的影响。

Objective To investigate whether serum triglyceride （TG） is the independent factor associated with newborn birth weight following maternal borderline gestational glucose intolerance （BGGI）. Methods 180 women with positive diabetic screening from July 2009 to June 2011 were divided into gestational diabetes mellitus （GDM group, 36 cases）, gestational impaired glucose tolerance in exclusive （GIGT group, 23 cases） and borderline gestational glucose intolerance （BGGI group, 121 cases） according to glucose metabolism conditions, indexes hke general information, pregnancy outcome, glucose and lipid metabolism and lipid polymorphism were recorded. Results The levels of TG in GDM group [（2.47±0.77） mmol/L] were significantly higher than those in BGGI [（1.99±0.64） mmol/L] or GIGT [（1.98±0.81） mmol/L） group （F = 15.99, P 〈 0.01）. ApoE3 allelic frequency was 86.21%, while ApoE3E3 genotype showed the highest frequency （72.78%, 131/180）, and TG levels were of no statistical significance （F =15.99, P = 1.20）. 9.91% （12/121） BGGI women delivered marosomic infant and 14.05% （17/121） were large for gestational age （LGA）. Neither marcosomia nor LGA incidence was of statistical significance （macrosomia： X^2 = 4.01, P = 0.13; LGA： X^2 = 3.67, P = 0.15）. In the 83 BGGI women with term delivery, pre-pregnancy BMI （r^2 = 0.07, P = 0.03）, pregnancy weight gain （r^2 = 0.06, P = 0.01）, TG levels （r^2 = 0.09, P 〈 0.01） and 2 h-serum glusoce （r^2 = 0.04, P = 0.05） were significantly correlated with newborn weight. Multi-variant liner regression indicated TG levels （F = 4.07, P 〈 0.01） and pre-pregnancy BMI （F = 7.26, P 〈 0.01） were independently associated with BGGI new born birth weight factors. Conclusion Serum TG level is independently associated with newborn birth weight in BGGI women. And such association is independent of ApoE＇s genetic polymorphism.