妊娠期糖尿病临床危险因素聚集性探讨

The clustering of risk factors in gestational diabetes mellitus

目的 探讨妊娠期糖尿病（GDM）临床危险因素聚集性的特点,并对相关临床危险因素进行分析.方法 选取203例孕妇为研究对象,根据75 g口服葡萄糖耐量试验结果分为葡萄糖耐量正常（NGT）组（69例）和GDM组（134例）.测定两组血糖、血脂、胰岛素,并计算稳态模型评估法胰岛素抵抗指数（HOMA-IR）、胰岛β细胞功能指数（HOMA-β）和胰岛素敏感指数（ISI）,分析各因素与GDM关系.结果 GDM组年龄、孕前体质量指数（BMI）、空腹血糖、空腹胰岛素、总胆固醇、三酰甘油、低密度脂蛋白胆固醇（LDL-C）、HOMA-IR及糖尿病家族史阳性率均高于NGT组[（30.8±4.1）岁比（28.7±3.9）岁、（24.29±3.65） kg/m2比（21.35±2.39） kg/m2、（5.22±1.26） mmol/L比（4.33±0.53） mmol/L、（9.27±3.55） mU/L比（4.75 ±2.73） mU/L、（5.54±1.26） mmol/L比（3.74±1.07）mmol/L、（2.63±1.43） mmol/L比（1.73±0.76） mmol/L、（3.02±0.97） mmol/L比（2.10±0.75） mmol/L、0.67±0.47比0.43±0.34、40.3％（54/134）比26.1％（18/69）],差异有统计学意义（P＜ 0.01或＜0.05）;GDM组HOMA-β、ISI明显低于NGT组（4.62±0.72比5.57±1.30、-3.79±0.47比-2.91±0.48）,差异有统计学意义（P＜0.01）.Logistic回归分析显示,空腹血糖（OR=6.016,95％ CI：1.603～ 22.585,P=0.008）、总胆固醇（OR=2.823,95％ CI：1.568～5.083,P=0.001）、糖尿病家族史（OR=2.780,95％ CI：1.168～6.617,P=0.021）、空腹胰岛素（OR=1.954,95％CI：1.371～2.785,P=0.001）、孕前BMI（OR=1.787,95％ CI：1.124～2.839,P=0.014）、年龄（OR=1.374,95％ CI：1.087～ 1.737,P=0.008）和舒张压（OR=1.184,95％ CI：1.045 ～ 1.342,P=0.008）是孕妇发生GDM的危险因素.结论 GDM具有遗传易感性和多种代谢综合征危险因素聚集性的特点;脂代谢和糖代谢紊乱、遗传易感性、年龄等因素在促进GDM发生、发展中具有重要作用.

Objective To study the clinical features and the clustering of risk factors in gestational diabetes mellitus （GDM）,and analyze the risk factors.Methods Two hundred and three gravida were selected.According to the result of 75 g oral glucose tolerance test,they were divided into 2 groups：GDM group（134 cases） and normal glucose tolerance （NGT） group （69 cases）.Blood sugar,blood fat and insulin were measured,and the homeostasis model of assessment for insulin resistance index （HOMA-IR）,pancreatic islet beta cell function index （HOMA-β） and insulin sensitivity index （ISI） were calculated.The relation was analyzed between the risk factors and GDM.Results The age,progestation body mass index （BMI）,fasting blood glucose,fasting insulin,total cholesterol,triglyeride,low density lipoprotein-eholesterol （LDL-C）,HOMA-IR and the positive rate of diabetes mellitus family history in GDM group were significantly higher than those in NGT group [（30.8 ±4.1） years vs.（28.7 ±3.9） years,（24.29 ±3.65） kg/m2 vs.（21.35 ±2.39） kg/m2,（5.22 ±1.26） mmol/L vs.（4.33 ±0.53） mmol/L,（9.27 ±3.55） mU/L vs.（4.75 ±2.73） mU/L,（5.54 ± 1.26） mmol/L vs.（3.74 ± 1.07） mmol/L,（2.63 ± 1.43） mmol/L vs.（1.73 ± 0.76） mmol/L,（3.02 ± 0.97） mmol/L vs.（2.10 ± 0.75） mtmol/L,0.67 ± 0.47 vs.0.43 ± 0.34,40.3% （54/134） vs.26.1%（18/69）],there were statistical differences （P〈 0.01 or 〈 0.05）.The HOMA-β and ISI in GDM group were significantly lower than those in NGT group （4.62 ± 0.72 vs.5.57 ± 1.30 and-3.79 ± 0.47 vs.-2.91 ± 0.48）,there were statistical differences （P 〈 0.01）.Logistic regression analysis result showed that fasting blood glucose （OR =6.016,95% CI：1.603-22.585,P =0.008）,total cholesterol （OR =2.823,95% CI：1.568-5.083,P=0.001）,diabetes mellitus family history （OR =2.780,95% CI：1.168-6.617,P=0.021）,fasting insulin（OR =1.954,95% CI：1.371-2.785,P=0.001）,progestation BMI（OR =1.787,95% CI：1.124-2.839,P =0.014）,age （OR =1.374,95% CI：1.087-1.737,P =0.008） and diastolic pressure （OR =1.184,95% CI：1.045-1.342,P =0.008） were the risk factors of GDM.Conclusions GDM has the clinical features of the clustering of risk factors and genetic susceptibility.The disorder of lipid metabolism and glycometabolism,genetic susceptibility and age are the main risk factors in the development of GDM.