孕妇妊娠中期糖脂代谢紊乱对不良妊娠结局的影响

Impaction of Glucose and Lipids Metabolic Abnormalities of Pregnant Women in Second Trimester for Adverse Pregnancy Outcomes

目的探讨孕妇妊娠中期的糖脂代谢异常对不良妊娠结局的影响。方法回顾性分析2013年4月-2014年4月在西安市第四医院产科就诊并分娩的孕妇1685例，于24-28周检测糖脂等代谢指标并进行常规75g口服葡萄糖耐量试验的结果。根据国际妊娠并发糖尿病研究组织（IADPSG）推荐的诊断标准分为妊娠糖尿病组（GDM）和糖耐量正常组；根据三酰甘油（TG）水平分为TG增高组（TG≥3．23mmol／L）和TG正常组（TG〈3．23mmol／L），随访并比较妊娠并发症和妊娠结局。统计学分析采用t检验，χ^2检验和Logistic回归分析。结果l685例孕妇中GDM组孕妇占11．69％，TG增高组孕妇占14．01％。①GDM组与糖耐量正常组相比，三酰甘油[（3．61±1．85）vs（2．98±1．34）mmol／L，t=5．73]，总胆固醇[（5．07±1．22）VS（4．60±0．99）mmol／L，t=6．03]显著升高，高密度脂蛋白[（1．28±0．61）vs（1．72±0．93）mmol／L,t=-6．47]明显降低，差异均有统计学意义（P值均〈0．01）；GDM组的妊娠高血压（10．66% vs 4．54％）、子痫／子痫前期（7．11％ vs 3．29％）、巨大儿（12．18％vs5．85％）、新生儿窒息（4．57％vs1．41％）的发生率均显著高于糖耐量正常组，差异均有统计学意义（P值均〈0．05）。②TG增高组与TG正常组相比，BMI（27．3±3．1kg／m^2 vs 20．4±2．3kg／m^2，t=40．59），空腹血糖[（4．65±0．71）vs（4．27±0．62）mmol／L，t=8．64]，空腹胰岛素[（20．16±10．53）vs（14．35±8．46）mU／L，t=9．86]，稳态模型评估-胰岛素抵抗指数（3．95±1．14 vs 2．72±0．89，t=18．92）明显升高，差异均有统计学意义（P值均〈0．01）。TG增高组的妊娠高血压（10．59％ vs 4．42％）、子痫／子痫前期（6．36％vs3．31％）、巨大儿（11．44％vs5．80％）、新生儿窒息（4．66％vs1.31％）的发生率均显著高于TG正常组，差异均有统计学意义（P值均〈O．05）。③Logistic回归分析显示：TG和FPG的异常增高发生妊娠高血压（OR=1．805和1．179，95％CI：1．314-2．249和0．926—1．451），巨大儿（OR=3．011和2．194，95％CI：2．317-3．526和1．562-2．927），新生儿窒息（OR=2．529和2．103，95％CI：1．208-5．246和1．59l-2．493），妊娠糖尿病（0R=3．446和2．214，95％CI：1．472-8．254和1.578-3．006）的风险均升高（P值均〈0．05）。结论妊娠中期FPG，TG水平的代谢紊乱，可能造成妊娠不良结局风险增加。

Objective To discuss the impaction of glucose and lipids metabolic abnormalities of pregnant women in second trimester for adverse pregnancy outcomes. Methods A retrospective analysis was conducted in Xi＇an No. 4 Hospital between April 2013 and April 2014,and involved 1 685 women who were at 24-28 weeks of gestation. We collected maternal blood samples and determined glucose and lipids level. Then a 75 g oral glucose tolerance test was performed in 1 685 women. Ac-cording to IADPSG criteria,women were randomly divided into gestational diabetes mellitus group （GDM） and normal glu-cose tolerance group. Besides,they were divided into high TG group （TG≥3.23 mmol/L） and TG normal group （TG〈3.23 mmol/L） based on the level of triglyceride （TG）. Data were analyzed through t test,Chi-square test and Logistic regression analysis. Results The GDM group accounted for 11.69%o and high TG group accounted for 14.01% in 1685 cases of preg- nant women. ① The levels of average triglyceride [ （3.61 ± 1.85） vs （2.98 ±1.34） mmol/L, t = 5.73 ], total cholesterol [（5.07±1.22） vs （4.60± 0.99）retool/L, t= 6.03] in GDM group increased significantly, while high density lipoprotein （HDL） [（1.28±0.61） vs （1.72±0.93）mmol/L,t= -6.47] decreased significantly when compared with normal glucose -tolerance group （ P〈 0.01 ）. The incidence of hypertension of pregnancy （ 10.66 % vs 4.54%）, eclampsi/preeclampsia （7.11% vs 3.29%）,fetal macrosomia （12.18% vs 5.85%）,asphyxia neonatorum （4.57% vs 1.41%） increased signifi- cantly in GDM group when compared with normal glucose tolerance group （P%0.05）. ②The level, of BMI （27.3±3. ] kg/ m2vs 20.4±2.3kg/mz ,t=40.59）, fasting blood glucose level [（4.65.1.0.71） vs （4.27.1.0.62）mmol/L,t=8.64] ,fasting insulin level[（20.16±10.53） vs （14.35±8.46）U/L,t=9.86],insulin resistance index （3.95-1-1.14 vs 2.72±0.89,t= 18.92） increased significantly in high TG group when compared with normal TG group （P〈0.01）. The incidence of hyper- tension of pregnancy （ 10.66% vs 4.54%）, eclampsi/preeclampsia （6.36% vs 3.31%）, fetal macrosomia （11.44% vs 5. 80%） ,asphyxia neonatorum （4.66% vs 1.31%） increased significantly in high TG group when compared with normal TG group （P〈0.05）. ③Logistie regression analysis showed that：the risk of hypertension of pregnancy （OR=1. 805 and 1.179,95%CI：1.314-2.249 and 0,926-1. 451）,fetal macrosomia （OR=3.011 and 2. 194,95%CI：2.317-3.526 and 1. 562-2. 927）,asphyxia neonatorum （OR- 2. 529 and 2. 103,95%CI：1. 208-5. 246 and 1. 591-2. 493）,GDM （OR 3. 446 and 2. 214,95%CI：1. 472-8. 254 and 1. 578-3. 006） were increased when TG and FPG increased abnormally （P〈0.05）. Conclusion The elevation of FPG and TG of pregnant women in the second trimester may increase the risk of ad- verse pregnancy outcomes.