OGTT时间-血糖曲线的曲线下面积与妊娠结局相关性分析

Correlation analysis between the area under the curve of OGTT time-blood glucose curve and pregnancy outcome

目的:探讨口服葡萄糖耐量试验(OGTT)时间-血糖曲线的曲线下面积(AUC)与妊娠期糖尿病(GDM)孕妇妊娠结局的关系。方法:选取2016年1月至12月于昆山市第一人民医院定期产检并分娩的937例GDM孕妇,计算OGTT时间-血糖对应的AUC。根据AUC分为<16.80mmol/(L·h)组和≥16.80mmol/(L·h)组,比较两组的妊娠并发症、胰岛素使用的差异,并对AUC≥16.80mmol/(L·h)组的AUC值及新生儿出生体重进行相关性分析。结果:937例GDM孕妇中,AUC<16.80mmol/(L·h)组603例(64.35%)、AUC≥16.80mmol/(L·h)组334例(35.65%)。AUC≥16.80mmol/(L·h)组的胎膜早破、妊娠期高血压疾病、巨大儿、新生儿窒息发生率及胰岛素使用率明显高于AUC<16.80mmol/(L·h)组,差异均有统计学意义(P<0.05);两组的早产、甲状腺机能减退发生率比较,差异无统计学意义(P>0.05)。AUC≥16.80mmol/(L·h)的GDM孕妇中,AUC与新生儿出生体重明显相关(r=0.120,P=0.033)。结论:GDM孕妇的OGTT时间-血糖的AUC作为评价血糖水平的指标,AUC≥16.80mmol/(L·h)时可增加不良妊娠结局的发生,并且其与新生儿出生体重明显相关。临床上可根据OGTT时间-血糖AUC的不同对孕妇进行分层管理。

Objective： To investigate the relationship between area under the curve（ AUC） of glucose tolerance teat（ OGTT） and pregnancy outcomes in pregnant women with gestational diabetes mellitus（ GDM）. Methods： 937 cases of pregnant women with GDM who underwent prenatal examination in the First People ＇ s Hospital of Kunshan from Jan. 2016 to Dec. were analyzed respectively. According to AUC,women were divided into AUC 16.80 mmol/（ L·h） group（ group A） and AUC≥16.80 mmol/（ L·h） group（ group B）. The differences between the two groups of pregnancy complications,insulin use were analyzed,including the correlation analysis of AUC and neonatal birth weight in AUC≥16.80 mmol/（ L·h） group.Result： Of 937 GDM pregnant women,603 were in group A（ 64.35%） and 334 were in group B（ 35.65%）.In the comparison of pregnancy complications,the incidence of premature rupture of membrane,pregnancy induced hypertension,macrosomia,neonatal asphyxia rate,the use of insulin were significantly higher in Group B than those in Group A（ P〈0.05）. While in premature birth,the hypothyroidism,there was no significant difference（ P〈0.05）. AUC in Group B was significantly associated with neonatal birth weight in GDM pregnant women（ r = 0.120,P =0.033）.Conclusions： As the evaluation index of the blood glucose level,when the OGTT timeblood glucose curve area is more than 16.80 mmol/（ L·h）,the incidence of adverse pregnancy outcome will increase,and it is significantly related to neonatal birth weight. According to the OGTT time-blood glucose curve area,the pregnant women can be divided into different layers.