1378例不同年龄孕妇的糖耐量试验特点

Characteristics of oral glucose tolerance test in 1378 pregnant women of different ages

目的:了解不同年龄孕妇75g口服葡萄糖耐量试验(oral glucose tolerance test,OGTT)的血浆葡萄糖(简称血糖)值及特点。方法:取2014年2月至2014年12月,我院产科门诊妊娠24~28周直接行75g OGTT的孕妇1378例,年龄为(28.4±3.6)岁(19~44岁)。除外糖尿病合并妊娠和双(多)胎妊娠,将1 378例孕妇按照年龄分为5组:<25(n=195,14.2%)、25^(n=782,56.7%)、30^(n=252,18.3%)、35^(n=115,8.3%)及≥40岁组(n=34,2.6%)。空腹、服糖后lh和2h血糖界值分别为5.1、10.0和8.5mmol/L,任意一点血糖大于或等于界值即诊断为妊娠期糖尿病(gestational diabetesmellitus,GDM)。采用单因素方差分析比较同一时间点不同年龄组间的血糖值,两两比较采用LSD检验。采用两分类变量间关联程度的度量计算不同年龄组GDM的患病风险。结果:(1)1 378例孕妇空腹、服糖后lh和2h的血糖值均呈正态分布,分别为5.91、11.91和9.67mmol/L,第97.5百分位数分别为6.01、11.92和9.95 mmol/L。(2)<25、25~、30~、35~与≥40岁组空腹血糖分别为(4.82±0.51)、(4.89±0.50)、(4.91±0.46)、(5.07±0.55)与(5.20±0.49)mmol/L,服糖后1h血糖分别为(7.50±1.71)、(8.08±1.81)、(8.34±1.80)、(9.26±2.07)与(9.12±1.67)mmol/L,服糖后2h血糖分别为(6.41±1.20)、(6.83±1.32)、(7.16±1.41)、(7.77±1.43)与(7.79±1.17)mmol/L。单因素方差分析显示,不同年龄组同一时间点的血糖值比较,差异均有统计学意义(F值分别为7.52、20.31和24.23,值均<0.01)。随着年龄增加,空腹、服糖后1h和2h的血糖值均逐渐升高,不同年龄组间两两比较,差异均有统计学意义(LSD检验,P值均<0.05)。(3)GDM检出率为40.2%(554/1 378)。<25、25~、30~、35~与≥40岁组GDM检出率分别为27.7%(54/195)、38.2%(299/782)、43.7%(110/252)、57.4%(66/115)与73.5%(25/34),不同年龄组间比较差异有统计学意义(2=45.02,=0.00)。与<25岁年龄组比较,25~、30~、35~与≥40岁组GDM检出率的OR值(95%CI)分别为1.62(1.15~2.28)、2.02(1.36~3.02)、3.52(2.17~5.71)和7.25(3.18~16.53)。结论:高龄是GDM的高危因素,35岁后妊娠者,GDM风险显著增加。建议女性在35岁之前妊娠,可降低GDM患病风险。

Objective： To investigate the values and characteristics of 75 g oral glucose tolerance test（OGTT）in pregnant women.Methods：A total of 1 378 singleton pregnant women aged（28.4±3.6） year（19~44 years） who delivered in People＇s Hospital of Shihezi between February,2014 and December,2014 underwent the 75 g OGTT at gestational age of 24-28 weeks.Except of diabetic pregnancies and double（multiple） pregnancy,They were divided into five groups based on maternal age：〈25 years n=195,14.2%）,25-years（n=782,56.7%）,30-years（n=252,18.3%）,35-years（n=115,8.3%）,and≥40 years（n=34,2.6%）.The normal values of the fasting,1h and 2h blood glucose were lower than 5.1,10.0 and 8.5 mmol/L.Gestational diabetes mellitus（GDM） was diagnosed when blood glucose of any point was higher than or equal to normal value.Comparison between groups was tested by analysis of variance and LSD test.Logistic regression was used to calculate the risk for GDM in different age groups.Results：（1） The fasting, 1h and 2h blood glucose levels were in Gaussian distribution.The were 5.91,11.91 and 9.67 mmol/L,The97.5 percentile were 6.01,11.92 and 9.95 mmol/L.（2） Fasting plasma glucose of 25,25-,30-,35 and ≥40 years were（4.82±0.51）、（4.89±0.50）、（4.91±0.46）、（5.07±0.55） and（5.20±0.49） mmol/L,The 1h blood glucose were（7.50±1.71）,（8.08±1.81）,（8.34±1.80）,（9.26±2.07） and（9.12±1.67） mmol/L,The 2h blood glucose were（6.41 ±1.20）,（6.83 ±1.32）,（7.16±1.41）,（7.77±1.43） and（7.79±1.17）mmol/L.There was statistical difference in the blood glucose levels at a same time-point test among different age groups（F=7.52,20.31 and 24.23,all P〈0.01）.（3） The total prevalence rate of GDM was 40.2%（554/1 378）;and the prevalence rates were 27.7%（54/195）,38.2%（299/782）,43.7%（110/252）, 57.4%（66/115）and 73.5%（25/34） among the five age groups,respectively,with significant differences（2=45.02,P=0.00）.Compared with the group aged 25 years, the OR（95% CI） of the prevalence among 25-,30-,35-and ≥40 years group were 1.62（1.15-2.28）,2.02（1.36-3.02）,3.5（2.17-5.71） and 7.25（3.18-16.53） respectively.Conclusions：Advanced age is a risk factor for GDM.The risk of GDM increases significantly after 35 years old and pregnancy in women aged35 years can reduce the risk of GDM.