既往妊娠糖尿病患者代谢综合征患病情况及与炎性因子和其他因素的相关性分析

The study of incidence of metabolic syndrom in patients with previous gestational diabetes mellitus and the association of metabolic syndrome with inflammatory mediators as well as other factors

目的了解既往妊娠糖尿病（GDM）患者分娩2年后代谢综合征的患病情况，及其与血清c反应蛋白（cRP）、血清淀粉样蛋白A（sAA）等因素的相关性。方法将120名于2010年7月-12月，在天津市中心妇产科医院分娩的孕妇纳入本巢式病例对照研究。将60例曾被诊断为GDM的孕妇建立研究队列作为病例组，从同期来该院分娩未曾患GDM孕妇中抽取60名作为对照组。随访时间为2011年7月—2012年12月，通过查阅病历档案、体格测量和实验室检查获取相关信息。体格测量项目主要包括：身高、体重、腰围、臀围、血压和体脂含量；实验室检查主要包括：空腹血糖、甘油三酯、总胆固醇、低密度脂蛋白-胆固醇、高密度脂蛋白-胆固醇、糖化血红蛋白A1c、稳态模型评估-胰岛素抵抗指数、SAA和CRP。SAA采用ELIA进行测定，CRP采用免疫比浊法测定。结果两组研究对象入组时在家庭经济状况、血压、甘油三酯、总胆固醇等指标方面均衡可比。病例组怀孕年龄、新生儿出生体重、孕前体重指数、体脂含量和腰臀比均高于对照组（P〈0．05）。另外，有糖尿病家族史和心血管疾病家族史者所占比例亦高于对照组（P〈0．05）。分娩2年后病例组代谢综合征的发生率为18．3％（11／60），高于对照组的5．0％（3／60）（X^2=5．175，P=0．023）；体重指数、体脂含量、腰围和腰臀比，甘油三酯、低密度脂蛋白-胆固醇、稳态模型评估一胰岛素抵抗指数、HbAlc、SAA以及cRP均高于对照组（P均〈0．05）。多因素Logistic分析结果显示，怀孕年龄大（DR=1．369，P=0．000）、孕前体重指数高（OR=1．199，P：0．000）、有糖尿病家族史（OR=1．223，P=0．000）、胎儿出生体重大（OR=1．267，P=O．015）及患有GDM（0R=2．824，P=0．000）是产后患代谢综合征的危险因素；SAA和CRP随代谢综合征组分的增加而升高（F=38．625，P〈0．01）。结论SAA和CRP参与代谢综合征的慢性炎性反应状态，两者的检测结合怀孕年龄、糖尿病家族史等信息可能是预测GDM患者产后发生代谢综合征的可行手段。

Objective To investigate the incidence of metabolic syndrome in patients with previous gestational diabetes （GDM） and the association of C-reactive protein（ CRP）, serum amyloid A（SAA） and other factors with metabolic syndrome two years after delivery. Methods A total of 120 pregnant women who went to Tianjin central obstetrics and gynecology hospital for delivery from July 2010 to December 2010 were collected into the nested case-control cohort. Patients with previous GDM were classified into case group （ n = 60 ） , and sixty women who went to the hospital for delivery without GDM over the same period were classified into control group. We collected data from July 2011 to December 2012 by means of refering to document, anthropometric and laboratory tests. The anthropometric items included height, weight, waist, hip circumfer-ence, blood pressure and body fat. The laboratory tests included fast blood glucose, triglyceride （TG）, total cholesterol（TC） ,low density lipoprotein-cholesteral（LDL-C） ,high density lipoprotein-cholesterol（ HDL-C）,HbAlc, homeostatic model assessment of insulin resistance （HOMA-IR） , SAA and CRP. SAA was deter-mined by means of ELISA and CRP was determined by the method of immunonephelometry. Results The two groups were comparable in the factors of family economic status, blood pressure, TG and TC. The preg- nancy age, fetal birth weight, pre-pregnancy body mass index （ BMI）, body fat and waist-hip ratio of case group were higher than those in control group（ P all 〈 0.05 ）. Besides, the ratio of family history of diabetes and cardiovascular disease of case group were higher than those in the control group （ P 〈 0.05 ）. Two years after delivery, the incidence of metabolic syndrome of case group （ 18.3 % , 11/60 ） was higher than that in the control group（5.0%, 3/60） （ OR = 5. 175, P = 0. 023）. BMI, body fat, waist circumference, waist-hip ratio, TC, LDL-C, HOME-IR, HbAlc, SAA and CRP of case group were signifantly higher than those in the control group （ P 〈 0.05 ）. The multiple logistic regression revealsed that high pregnancy age （ OR = 1. 369 ,P = 0. 000 ）, high pre-pregnancy BMI （ OR = 1. 199, P = 0. 000 ）, diabetes family history （ OR = 1. 223 ,P =0. 000）, high fetal birth weight（ OR = 1. 267 ,P = 0. 015 ）, previous GDM（ OR = 2. 824,P = 0. 000） were risk factors of metabolic syndrome after delivery. SAA and CRP were positively associated with the numbers of components of metabolic syndrome （ F = 38. 625, P 〈 0.01 ）. Conclusions Both SAA and CRP may participate in the chronic inflammatory state of metabolic syndrome. Determining them cominbing with family history of diabetes and pregnancy age might be an applicable means for predicting metabolic syn-drome in previous GDM women.