葡萄糖及血脂水平预测妊娠期糖尿病发生风险的临床分析

Clinical analysis of glucose level and blood lipid level in predicting the risk of gestational diabetes mellitus

目的评估孕8～16周孕妇空腹血脂与血浆葡萄糖（FPG）水平预测妊娠期糖尿病（GDM）的价值。方法选取行常规产前检查的孕妇878例，根据糖耐量情况将其分为GDM组（n＝99）与糖耐量正常组（n＝779），收集孕妇的一般资料，检查孕8～16周的血脂指标与FPG指标。采用Logistics回归分析评估GDM的独立危险因素，建立发生GDM风险的预测模型，采用Hosmer-Lemeshow拟合优度检验评估预测模型拟合能力。结果孕8～16周孕妇FPG水平与葡萄糖耐量试验（OGTT）检查空腹（r＝0.447）、服糖后1 h（r＝0.178）、服糖后2 h（r＝0.143）的血糖值呈正相关（均P〈0.05）。孕前体质量指数（BMI）（OR＝1.115，95%CI：1.052～1.172）、孕8～16周FPG（OR＝8.148，95%CI：5.423～12.247）、年龄（OR＝1.057，95%CI：1.014～1.103）、三酰甘油（TG）水平（OR＝1.471，95%CI：1.159～1.869）与孕次〉3次（OR＝1.779，95%CI：1.082～2.931）是孕妇发生GDM的独立危险因素（P〈0.05）。将孕前BMI、孕8～16周、年龄、TG与孕次〉3次等危险因素纳入Logistics回归分析，建立回归方程模型，Hosmer-Lemeshow拟合优度检验显示P＝0.955，该模型预测GDM发生风险的ROC曲线下表面积（AUC）为0.762（95%CI＝0.729～0.793，P＝0.028），cut-off值为0.12，敏感度为68.6%，1-特异度为71.6%。结论将孕8～16周孕妇的实验室指标联合临床指标建立预测模型，可以更好地预测孕妇发生妊娠期糖尿病的风险。

Objective To evaluate the value of fasting plasma lipid levets and fasting plasma glucose （FPG） levels in predicting gestational diabetes mellitus （GDM） in pregnant women between 8 and 16 weeks. Methods A total of 878 pregnant women with routine prenatal examination were selected. According to the glucose tolerance of pregnant women, they were divided into GDM group （ n = 99） and normal glucose tolerance group （n = 779 ）. General data of pregnant women were collected, and the blood lipid index and FPG index were examined at 8 - 16 weeks of gestation. The independent risk factors of GDM were evaluated by Logistic regression analysis, and the prediction model of GDM risk was established. The Hosmer-Lemeshow goodness-of-fit test was used to evaluate the fitting capacity of GDM model. Results FPG levels were positively correlated with blood glucose of OGTF at fasting （ r = 0. 447 ）, after taking glucose for 1 h （r =0. 178） and after taking glucose for 2 h （r =0. 143）, respectively （P 〈 0. 05）. Body mass index （BMI） before pregnancy （ OR = 1. 115, 95% CI： 1. 052 - 1. 172）, FPG in 8-16weeks of gestation （OR =8.148, 95%CI： 5.423 - 12. 247）, age （OR = 1.057, 95%CI： 1. 014 - 1. 103）, triglyceride （TG） （ OR = 1. 471, 95% CI： 1. 159 - 1. 869） and pregnancies 〉 3 times （ OR = 1. 779, 95 % CI： 1. 082 - 2.931 ） were independent risk factors of GDM in pregnant women （ P 〈 0. 05 ）. The regression model was established by BMI, 8 - 16 weeks of gestation, age, TG and pregnancy times 〉 3. The Hosmer-Lemeshow goodness-of-fit test showed P = 0. 955, which predicted the ROC curve under risk of GDM occurrence had a surface area AUC of 0. 762 （ 95% CI = 0. 729 - 0. 793, P = 0.028）, a cut-off value of 0. 12, a sensitivity of 68.6% and a 1-specificity of 71.6%.Conclusions Gestational diabetes mellitus in pregnanc women （GDM） can be predicted by establishing a predictive model combining laboratory indexes and clinical indexes of pregnant women with 8 - 16 weeks gestational diabetes.