妊娠糖尿病各时期胎儿心脏结构及心功能分析

Analysis of fetal cardiac structure and function of different period's gestational diabetes mellitus

目的：探讨妊娠糖尿病（GDM）早、中、晚期胎儿心脏结构及心功能的变化,为临床预防GDM胎儿心脏相关并发症提供依据。方法选择2010年6月-2012年6月沧州市中心医院妇产科诊断为GDM的单胎妊娠孕妇145例,根据孕龄分为GDM早期组（46例）、GDM中期组（60例）、GDM晚期组（39例）；另选择同期正常妊娠的胎儿86例,分为正常早期组（26例）、正常中期组（35例）、正常晚期组（25例）。将各孕期GDM胎儿与相同孕期正常妊娠胎儿心脏结构及心功能进行比较分析。结果 GDM晚期组胎儿室间隔舒张末期厚度（IVSd）、室间隔收缩末期厚度（IVSs）、左室壁厚度（LVWT）、右室壁厚度（RVWT）分别为（5.22±1.27）、（5.15±1.08）、（5.28±1.27）、（5.30±1.20）mm,正常晚期组胎儿分别为（4.60±0.91）、（4.55±1.01）、（4.62±1.22）、（4.65±1.19）mm,GDM晚期组胎儿明显增厚（P〈0.05）。 GDM早期组胎儿右室射血分数（RVEF）为（54.80±2.72）%,明显高于正常早期组胎儿的（53.58±2.50）%（P〈0.05）；GDM中期组胎儿左室射血分数（LVEF）、RVEF、右室Tei指数分别为（58.28±3.22）%、（60.35±3.58）%、（0.39±0.05）,明显高于正常中期组胎儿[（55.42±3.05）%、（55.61±3.29）%、（0.36±0.07）],差异有统计学意义（P〈0.05）；GDM晚期组胎儿LVEF、RVEF、左室Tei指数、右室Tei指数分别为（70.24±5.32）%、（73.12±4.20）%、（0.46±0.10）、（0.49±0.08）,较正常晚期组胎儿[（57.28±3.36）%、（58.06±3.42）%、（0.38±0.07）、（0.39±0.07）]明显增高,而二尖瓣A/E、三尖瓣A/E分别为（1.27±0.12）%、（1.30±0.13）%,较正常晚期组胎儿[（1.38±0.13）%、（1.40±0.15）%]明显降低,差异有统计学意义（P〈0.05）。结论 GDM对胎儿心脏结构及功能产生不利的影响,尤其是在中、晚期,而心功能的损伤出现较早,因此,尽量在早期对GDM孕妇血糖进行控制以减少GDM对胎儿心脏的影响,同时减少相关并发症的发生,以获得良好的妊娠结局。

Objective To investigate the fetal cardiac structure and function changes of gestational diabetes mellitus （GDM） in early, medium, late period, in order to provide basis for clinical prevention of fetal cardiac complications re-lated to GDM. Methods 145 singleton pregnancy women diagnosed with GDM in Cangzhou Central Hospital from June 2010 to June 2012 were selected and divided into GDM early group （n = 46）, GDM mid group （n = 60）, GDM late group （n = 39） according to gestational age. And 86 normal pregnancy fetuses in the same term were selected and di-vided into normal early group （n=26）, normal mid group （n= 35）, normal late group （n=25）. The fetal cardiac struc-ture and function at the same pregnancy term between GDM fetus and normal fetus were compared and analyzed. Re-sults The IVSd, IVSs, LVWT, RVWT of GDM late group were respectively （5.22±1.27）, （5.15±1.08）, （5.28±1.27）, （5.30±1.20） mm, the IVSd, IVSs, LVWT, RVWT of normal late group were respectively （4.60±0.91）, （4.55±1.01）, （4.62±1.22）, （4.65±1.19） mm, the indexes in GDM late group were obviously thicker than those in normal late group （P〈0.05）. The RVEF of GDM early group were （54.80±2.72） %, it was higher than that of normal early group [（53.58±2.50）%], the difference was statistically significant （P〈 0.05）; the LVEF, RVEF, right ventricular Tei index of GDM mid group were （58.28±3.22） %, （60.35±3.58） %, （0.39±0.05） respectively, they were obviously higher than those of normal mid group [（55.42±3.05） %, （55.61±3.29） %, （0.36±0.07）], the differences were statistically significant （P〈 0.05）. The LVEF, RVEF, left ventricle Tei index, right ventricular Tei index of GDM late group [（70.24±5.32） %, （73.12±4.20） %, （0.46±0.10）, （0.49±0.08）] were obviously higher than those of normal late group [（57.28±3.36） %, （58.06±3.42）%, （0.38±0.07）, （0.39±0.07）], but the mitral A/E, tricus-pid A/E [（1.27±0.12） %, （1.30±0.13） %] were obviously lower than those of normal late group [（1.38±0.13） %, （1.40±0.15） %], the differences were statistically significant （P〈 0.05）. Conclusion GDM has a negative effect on fetal car-diac structure and function, especially in middle and late pregnancy term, but heart function damage appeared earlier, therefore, in the early pregnancy term, it is right to control the blood glucose of GDM women in order to reduce influ-ence of GDM on fetal heart as far as possible, and reduce the incidence of complications, and get a good pregnancy outcome.