妊娠早期母体肝脏代谢水平与妊娠期糖尿病的相关性

Correlation between gestational diabetes mellitus and hepatic metabolism in early pregnancy

目的探讨妊娠早期肝脏代谢水平与妊娠期糖尿病（GDM）的相关性。方法入选2012年1月至2014年12月在北京大学第三医院自早孕期建档资料齐全的单胎活产孕妇共13272名作为研究对象，于妊娠24～28周行75 g口服葡萄糖耐量试验（OGTT），共3162名孕妇诊断为GDM，以其中无其他合并症者共766例作为GDM组，另按随机数字表随机抽取同期分娩健康孕妇352名作为对照组。除外可能存在肝脏功能异常因素的孕妇。记录年龄、妊娠≤12周肝脏功能、凝血功能、空腹血糖、尿酸等化验结果及同期孕妇身高、体重，并计算体质指数（BMI）等。数据采用单因素分析及Logisitic多因素回归分析。结果 GDM组孕妇年龄明显高于对照组[（32±3）比（30±7）岁，t=-6.089, P〈0.01]，妊娠早期BMI明显高于对照组[（22.1±3.2）比（20.6±2.5） kg/m2, t=-8.346, P〈0.01]。GDM组γ谷氨酰转肽酶（z=10.366）、纤维蛋白原（t=-3.758）明显高于对照组（均P〈0.01），碱性磷酸酶、空腹血糖、尿酸也显著高于对照组（t=-2.215、-9.793、-6.878，均P〈0.05）；而GDM组直接胆红素（z=-3.813）、总胆红素（z=-3.241）和血红蛋白（t=2.069）均明显低于对照组（均P〈0.05）。多因素Logistic回归分析发现，年龄、BMI、γ谷氨酰转肽酶、天冬氨酸转氨酶、总胆红素、纤维蛋白原等指标是GDM的独立危险因素（OR=0.951~1.358，均P〈0.05）。结论妊娠早期肝脏代谢水平γ谷氨酰转肽酶、天冬氨酸转氨酶、碱性磷酸酶、总胆红素、纤维蛋白原等指标与GDM发生密切相关，应予以重视。

Objective To investigate the correlation between gestational diabetes mellitus（GDM） and the hepatic metabolism in the first trimester of pregnancy. Methods This prospective cohort study was conducted in Peking University Third Hospital from January 2012 to December 2014. Pregnant women who visited our hospital during the first trimester were enrolled. Total of 3 126 participants were found with a positive 75 g oral glucose tolerance test （OGTT）;then of them, 766 women without any other complications were selected into the GDM group, while 352 cases of healthy pregnant women were set as the control group. The prevalence of GDM and its association with age, height, weight, body mass index （BMI）, hypertension, family history of diabetes, alanine aminotransferase （ALT）, asparate aminotransferase（AST）, total bilirubin （TB）, direct bilirubin（DB）, gamma？glutamyltransferase（γ？GT）, total bile acid（TBA）, alkaline phosphatase （ALP）, total protein（TP）, albumin（ALB）, fasting plasma glucose（FPG）, prothrombin time（PT）, fibrinogen（FIB）, activated partial thromboplastin time（APTT）, thrombin time（TT）, hemoglobin（Hgb）, uric acid（UA） were studied in the first trimester. Data analyses were conducted by using single factor analysis and Logistic regression analysis. Results The age of pregnant women in group GDM was significantly higher than that in control group （（32±3） vs （30±7） years, t=-6.089, P〈0.01）, and the BMI was significantly higher in group GDM （（22.1 ± 3.2） vs （20.6 ± 2.5） kg/m2, t=-8.346, P〈0.01）. And theγ？GT （z=10.366）, FIB （t=-3.758） were significantly higher in group GDM than those in control group （both P〈0.01）, besides ALP, FPG, UA werenbsp;also markedly higher than those in control group （t=-2.215,-9.793,-6.878, all P〈0.05）. While the DB （z=-3.813）, TB （z=-3.241） and HGB （t=2.069） were remarkably lower than those in control group （all P〈0.05）. It indicated in multivariable logistic regression analysis that age, BMI, AST, γ？GT, TB, FIB were the independent risk factors of GDM（OR=0.951-1.358, all P〈0.05）. Conclusions It suggests that γ？GT, AST, ALP, T？Bil, FIB in the first trimester of pregnancy are useful predictors of impending GDM.