摘要
目的:探讨妊娠早期血清25-羟基维生素D3(25[OH]D3)水平与妊娠期糖尿病(GDM)发病的相关性。方法选取2011年6月到2013年3月在广东省妇幼保健院产科产检并住院分娩的孕妇1768名作为研究对象,所有研究对象均于妊娠6-13周登记入组,入组时检测糖脂代谢指标和血清25[OH]D3水平,妊娠24-28周进行75 g口服葡萄糖耐量试验(OGTT);根据妊娠早期空腹血糖(FBG)及OGTT结果,分为GDM组[n=350,年龄(29±5)岁]和正常孕妇组[n=1418,年龄(29±4)岁],比较两组间妊娠早期血清25[OH]D3水平和糖脂代谢指标;统计分析采用t检验、Pearson相关分析、logistic回归分析。结果 GDM组孕妇孕前体质指数(BMI)明显高于正常孕妇组(t=5.913,P〈0.05);两组年龄差异无统计学意义(t=0.342,P〉0.05);GDM组妊娠早期血清25[OH]D3水平明显低于正常孕妇组(t=17.936,P〈0.05);Pearson相关分析显示血清25[OH]D3水平与稳态模型胰岛素抵抗指数(HOMA-IR)、TG、孕前BMI呈负相关(r=-0.867、-0.133、-0.244,均P〈0.05);Logistic回归分析显示血清25[OH]D3水平与GDM发病相关,校正孕前BMI、TG、LDL-C、FBG和HOMA-IR的影响因素后,血清25[OH]D3水平仍与GDM发病相关,是GDM独立危险因素,其缺乏的孕妇发生GDM的风险是不缺乏者的1.669倍(比值比1.669,95%可信区间:1.460-1.912,P〈0.05);受试者工作曲线(ROC)显示,妊娠早期血清25[OH]D3小于28.2 nmol/L时,预测GDM发病的灵敏度为85.9%,特异度为83.7%。结论 GDM孕妇妊娠早期血清25[OH]D3水平明显降低,妊娠早期维生素D缺乏与GDM发病相关;血清25[OH]D3水平可能与妊娠早期糖脂代谢异常有关;妊娠早期25[OH]D3水平小于28.2 nmol/L对GDM发病具有预测意义。
Objective To explore the relationship between serum level of 25-hydroxyvitamin D3 (25-[OH]D3)at first trimester of pregnancy and gestational diabetes mellitus(GDM). Methods The prospective case-control study involved 1 768 women who took antenatal care at Guangdong Women and Children Hospital from June 2011 to March 2013. All subjects were enroled at 6-13 weeks of gestation and blood sample was taken to measure glucolipid metabolic index and 25-[OH]D3 levels. At 24-28 weeks of gestation,all subjects took 75 g oral glucose tolerance test(OGTT). The subjects were divided into GDM group(n=350,maternal age(29±5)years)and control group(n=1 418,maternal age(29±4)years)according to results of OGTT and fasting blood glucose(FBG),and then 25-[OH] D3 levels and glucolipid metabolic index between the two groups were compared. Data was analyzed by using independent t test,Pearson correlation,logistic regression. Results The progestational body mass index(BMI)of GDM patients was significantly higher((22.6 ± 3.1 vs 20.5 ± 2.1)kg/m^2,t=5.913,P〈0.05)as compared with the controls.There was no significant difference of maternal age between the two groups(t=0.342,P〉0.05).Among women who developed GDM,maternal serum 25-[OH] D3 concentrations at first trimester of pregnancy were significantly lower than the controls((23.8 ± 3.3 vs 37.8 ± 12.8)nmol/L,t=17.936,P〈0.05);The serum 25-[OH] D3 levels were significantly and negatively correlated with HOMA-IR(r=-0.867,P〈0.05),TG(r=-0.133,P〈0.05), progestational BMI(r=-0.244,P〈0.05);Women who were classified as being deficient for vitamin D had a 1.669-fold increased subsequent risk of GDM,as compared with vitamin D sufficient women after adjustment for progestational BMI,TG,LDL-C,FBG,HOMA-IR(adjusted OR:1.669;95%CI:1.460-1.912, P〈0.05);The receiver operating characteristic curve(ROC)analysis showed that the sensitivity was 85.9%and the specificity was 83.7%in predicting GDM at point of 28.2 nmol/L of serum 25-[OH] D3 concentration. Conclusions The serum 25-[OH] D3 concentrations at first trimester of pregnancy were significantly decreased in women who were subsequently developed GDM. Maternal vitamin D deficiency at first trimester of pregnancy is associated with an elevated risk for GDM.
出处
《中华糖尿病杂志》
CAS
CSCD
2015年第3期152-155,共4页
CHINESE JOURNAL OF DIABETES MELLITUS
基金
广东省社会发展项目(20118031800264)
关键词
糖尿病
妊娠
骨化二醇
胰岛素抵抗
Diabetes,gestational
Calcifediol
Insulin resistance