孕早期血清游离25-羟维生素D对孕前肥胖孕妇妊娠期糖尿病的预测作用

Prediction effect of serum free 25-hydroxy vitamin D in early pregnancy on gestational diabetes mellitus in pregnant women with pre-pregnant obesity

目的探讨孕早期检测血清游离25-羟维生素D(25OHD)水平对预测孕前肥胖孕妇妊娠期糖尿病(GDM)的价值。方法纳入2015年6月至12月在我院首次产检的717例孕前肥胖孕妇为研究对象,统计其一般资料,于孕早期检测并统计孕早期血压、血红蛋白、空腹血糖、糖化血红蛋白、血清总25OHD水平等,同时计算游离25OHD水平。随访至孕24~28周收集75 g葡萄糖耐量试验(OGTT)筛查结果。对血清游离25OHD水平与GDM的关联性进行分析。结果共478例孕妇出现GDM,其孕早期收缩压、舒张压、血红蛋白、空腹血糖均明显高于未出现GDM孕妇,血清游离25OHD水平均明显低于未出现GDM孕妇,差异均有统计学意义(P<0.05);偏相关分析与协方差分析均提示血清游离25OHD与孕24~28周时OGTT试验结果的空腹血糖、餐后2 h血糖呈负相关趋势(P<0.05);受试者工作特征曲线(ROC)显示孕早期血清25OHD水平对预测GDM的曲线下面积为0.730(P<0.05),最佳预测界值为10.25 pmol/L。结论血清游离25OHD水平与孕前肥胖孕妇孕24~28周OGTT试验血糖水平呈负相关,早期检测该指标有助于预测GDM,进而指导疾病治疗。

Objective To investigate the prediction effect of serum free 25-hydroxy vitamin D （25OHD） in early pregnancy on gestational diabetes mellitus （GDM） in pregnant women with pre-pregnant obesity. Methods A total of 717 pregnant women with pre-pregnant obesity, who received the first prenatal examination in our hospital from June to December in 2015, were included in this study. The basic data, blood pressure, hemoglobin, fasting blood glucose, gly- cosylated hemoglobin, serum total 25OHD and serum free 25OHD at early pregnancy were recorded. A follow-up was made until 24 to 28 weeks of pregnancy, and the Glucose tolerance test （OGTT） results were collected. The correlation between serum free 25OHD and GDM was analyzed. Results There were 478 cases with GDM in all. Their systolic blood pressure, diastolic blood pressure, hemoglobin, fasting blood glucose were significantly higher and serum free 25OHD were significantly lower than those in pregnant women without GDM （P〈0.05）. Partial correlation analysis and covariance analysis indicated that serum free 25OHD was negatively correlated with FPG and plasma glucoses of 2 hours later in 24-28 weeks （P〈0.05）. Receiver operating curve （ROC） showed that the area of under curve was 0.730 （P〈0.05） and the best predictive value was 10.25 pmol/L. Conclusion Serum free 25OHD is negatively correlated with blood glucose at 24 to 28 weeks of pregnancy. Early detection of serum free 25OHD is helpful to predict GDM and guide the treatment of disease.