妊娠期糖尿病患者孕晚期血脂检测的临床意义

Clinical significance of serum lipids measurement in patients with gestational diabetes mellitus at late phase

目的探讨妊娠期糖尿病（GDM）患者孕晚期血脂检测的临床意义。方法选择GDM孕妇160例（GDM组）和健康孕妇80例（对照组）,对两组于孕8~12周（孕早期）、32~36周（孕晚期）进行总胆固醇（TC）、三酰甘油（TG）、高密度脂蛋白胆固醇（HDL-C）、低密度脂蛋白胆固醇（LDL-C）、载脂蛋白AI（APOAI）、载脂蛋白B（APOB）和脂蛋白A（LPA）水平检测,并进行组间、组内比较,并比较两组妊娠结局,根据孕晚期检测结果,将GDM患者分为高血脂组和正常血脂组,比较高血脂组和正常血脂组妊娠结局。结果孕早期GDM组TC、TG、LDL-C、APOB均高于对照组（P〈0.05）,孕晚期两组TC、TG、LDL-C、APOAI、APOB、LPA均显著升高（P〈0.05）,GDM组TC、TG、LDL-C、APOB、LPA显著高于对照组（P〈0.05）,HDL-C显著低于对照组（P〈0.05）;GDM组巨大儿、新生儿低血糖、手术产和子痫前期发生率高于对照组（P〈0.05）,GDM患者中高血脂组巨大儿、新生儿低血糖、子痫前期发生率高于正常血脂组（P〈0.05）。结论孕晚期存在高脂血症的GDM患者不良结局发生率高,进行血脂检测有利于对高脂血症做出诊断,从而采取针对性治疗措施,减少妊娠并发症,改善母儿的结局。

Objective To investigate the clinical significance of serum lipids measurement in patients with pregnancy induced diabetes mellitns （GDM）at late phase. Methods A total of 160 pregnant women with GDM （GDM group）and 80 normal pregnant women （control group）were selected as the subjects, total cholesterol （TC）, triglyceride （TG）, high density lipoprotein cholesterol （HDL- C）, low density lipoprotein cholesterol （LDL- C）, apolipoprotein AI （apoAI）, apolipoprotein B （apoB） and lysophosphatidic acid （LPA）levels of pregnant women at 8-12 weeks （early pregnancy）and at 32-36 weeks （late pregnancy） were underwent level detecting, and the indexes above mentioned were compared between the patients in the same group and the two groups, and the pregnancy outcomes were compared, too. According to late pregnancy test results, the GDM patients were divided into hyperlipidemia group and normal blood lipids group, and pregnancy outcomes were compared between the two groups. Results TC, TG, LDL-C, apoB in early pregnancy of the GDM group were higher than those of the control group（P〈0.05）.TC, TG, LDL-C, apoAI, apoB, LPA of the two groups at late pregnancy were significantly increased（P〈 0.05）.TC, TG, LDL-C, apoB and LPA of the GDM group were significantly higher than those of the control group （P〈0.05）, HDL- C was significantly lower than that of the control group （P〈0.05）; The incidence rate of macrosomia, neonatal hypoglycemia, operation and preeclampsia of the GDM group were higher than those of the control group （P〈0.05）. The incidence rate of macrosomia, neonatal hypoglycemia, preeclampsia in GDM patients of the hyperlipidemia group were higher than those of the normal blood lipids group （P〈0.05）. Conclusion The incidence of adverse outcomes of the GDM patients with hyperlipidemia in the late pregnancy are high. Lipid testing is conducive to the diagnosis of hyperlipidemia, and it is necessary to take the measures of treatment, to reduce the complications of pregnancy for the improvement of the outcome of mother and fetus.