妊娠期糖尿病患者血脂水平的变化对妊娠结局的影响

Effect of blood lipids levels on pregnancy outcomes in patients with gestational diabetes mellitus

目的探讨妊娠期糖尿病(gestational diabetes mellitus,GDM)孕妇血脂的变化在GDM发病中的作用和与妊娠结局的关系。方法选取2014年于华北理工大学附属医院妇产科分娩的250例患者的临床资料,分为GDM组92例和正常对照组158例,根据GDM组孕妇甘油三酯(triglyceride,TG)是否异常分为血脂异常亚组(33例)和血脂正常亚组(59例)。测定分娩前血脂水平,并对妊娠结局进行对比分析。结果GDM组TG和载脂蛋白B(apolipoprotein B,Apo B)均高于正常对照组,GDM组低密度脂蛋白胆固醇((low density lipoprotein cholesterol,LDL-C)低于正常对照组(P<0.05)。新生儿体重与孕前体质量指数(body mass index,BMI)、孕期增重指数、TG和Apo B均呈明显的正相关(P<0.05)。GDM组剖宫产率、巨大儿发生率和新生儿低血糖发生率均高于正常对照组,差异有统计学意义(P<0.05),胎膜早破、早产和新生儿窒息发生率两组比较差异无统计学意义(P>0.05)。血脂异常亚组中巨大儿的发生率高于血脂正常组(P<0.05),其余妊娠结局两个亚组差异无统计学意义(P>0.05)。结论 GDM患者孕晚期存在高脂血症,与不良妊娠结局有关,TG水平与新生儿体重呈正相关,因此加强孕妇饮食指导和血脂监测有重要的临床意义。

Objective To detect blood lipids levels in patients with gestational diabetes mellitus （GDM） and explore the role in pathogenesis of GDM and the effect on pregnancy outcomes. Methods 250 pregnant women who delivered in Affiliated Hospital of North China University Of Science And Technology were divided into to GDM group （92 cases） and control group （158 cases）. According to the level of triglyceride （ TG）, the GDM group was divided into lipid disorder subgroup and normal lipid subgroup. Blood lipid levels were detected and the pregnancy outcomes were recorded and compared. Results The level of TG and apolipoprotein B （AopB） in GDM group was significantly higher than those in control group （P 〈0. 05 ） , the level of low density lipoprotein cholesterol （ LDL - C） was significantly lower than that in control group （P 〈 0. 05 ）. The birth weight had a significant positive correlation with pre - pregnancy body mass index （ BMI）, the change of BMI during pregnancy, TG and ApoB （ P 〈 0. 05 ）. The rate of cesarean section, incidences of macrosomia, neonatal hypoglycemia in GDM group were significantly higher than those in control group （ P 〈 0. 05）. There was no significant difference in the incidences of premature rupture of membrane, premature delivery and neonatal asphyxia between the two groups（ P 〉0. 05）. The incidence of macrosomia in lipid disorder subgroup was significantly higher than that in normal lipid subgroup in GDM group （ P 〈 0. 05 ）, there was no significant difference in other pregnancy outcomes between two subgroups. Conclusion There was abnormal lipid metabolism in patients with GDM and the birth weight had a significant positive correlation with the level of TG. A dietary guide should be given to the pregnant patients and the monitoring of blood lipids levels is necessary.