孕中、晚期多囊卵巢综合征患者发生妊娠期糖尿病的危险因素分析

Risk factors for gestational diabetes mellitus in polycystic ovary syndrome patients at different gestation

目的:探讨多囊卵巢综合征(polycystic ovary syndrome,PCOS)妇女妊娠后不同孕期中发生妊娠期糖尿病(gestational diabetes mellitus,GDM)的危险因素,以深入认识PCOS合并GDM的临床特点。方法:选取孕妇在孕前于重庆市沙坪坝区妇幼保健计划生育服务中心妇产科诊断为PCOS并接受规范治疗,并在2013年3月至2015年3月在该科接受产前检查。根据孕中期(孕24周)、孕晚期(孕32周)口服糖耐量试验结果,分为妊娠期糖尿病组(GDM组)和正常组(非GDM组),其中GDM组孕妇在孕中期和孕晚期分别有20和28例,非GDM组孕妇在孕中期和孕晚期分别有77和69例,比较不同组别间孕妇的基本情况及雄激素、胰岛素水平的差异,并分析其中GDM发生的危险因素。结果:在孕中期,GDM组与非GDM组的孕期增加体质量、胰岛素水平有统计学差异[GDM组孕期增加体质量(5.54±1.32)kg,非GDM组孕期增加体质量(4.08±0.91)kg,t=2.487,P=0.015;GDM组胰岛素为(30.35±8.70)pmol/L,非GDM组胰岛素为(25.47±7.56)pmol/L,t=3.289,P=0.001];在孕晚期,GDM组与非GDM组的孕期增加体质量、糖尿病家族史、睾酮及胰岛素水平有明显差异[GDM组孕期增加体质量(9.83±0.91)kg,非GDM组孕期增加体质量(8.61±1.23)kg,t=2.283,P=0.025;GDM组有糖尿病家族史10例,非GDM组胰岛素有糖尿病家族史9例,χ~2=3.939,P=0.047;GDM组睾酮为(3.49±1.65)nmol/L,非GDM组睾酮为(2.46±1.17)nmol/L,t=2.542,P=0.013;GDM组胰岛素为(33.78±7.01)pmol/L,非GDM组胰岛素为(27.12±6.39)pmol/L,t=4.108,P=0.000]。logistics分析提示,较高的孕期增加体质量、胰岛素水平是PCOS孕妇在孕中期发生GDM的独立危险因素(OR=2.467,95%CI=1.912~3.355,P=0.029;OR=1.565,95%CI=1.287~1.921,P=0.007);较高的孕周增加体质量、睾酮和胰岛素水平是PCOS孕妇在孕晚期发生GDM的独立危险因素(OR=2.640,95%CI=2.392~3.588,P=0.033;OR=1.587,95%CI=1.103~3.307,P=0.045;OR=2.735,95%CI=1.182~4.803,P=0.001)。结论:在孕中、晚期,较高的孕期增加体质量和胰岛素水平都是PCOS孕妇发生GDM的危险因素;较高的睾酮水平仅在孕晚期是PCOS孕妇发生GDM的危险因素。

Objective：To investigate the risk factors for gestational diabetes mellitus（GDM）in polycystic ovary syndrome（PCOS）at different gestation,and to further understand the clinical characteristics of PCOS complicated with GDM. Methods：Pregnant women diagnosed with PCOS in the Obstetrics and Gynecology Department of Maternal and Child Health Care Family Planning Service Center of Shapingba District of Chongqing and received standard treatment and prenatal care services during March 2013 to March 2015 were included. According to the result of oral glucose tolerance test at 24 th week and 32 nd week of gestation,aforementioned pregnant women were divided into GDM group（n=20 at 24 weeks of gestation,n=28 at 32 weeks of gestation）and Non-GDM group（n=77 at 24 weeks of gestation,n =69 at 32 weeks of gestation）. Their basic information and the differences in the level of androgen and insulin in each group were compared,and the risk factors for GDM were analysed. Results：At 24 th week of ges tation,there were significant differences in the weight gain and level of insulin between GDM group and Non-GDM group [the weight gain in GDM group is（5.54±1.32）kg,while in Non-GDM group is（4.08±0.91）kg,t=2.487,P=0.015;the concentration of insulin in GDM group is（30.35±8.70）pmol/L,while in Non-GDM group is（25.47±7.56）pmol/L,t=3.289,P=0.001]. At 32 nd week of gestation,there were significant differences in the weight gain,family history of diabetes,the level of testosterone and insulin between GDM group and Non-GDM group [the weight gain in GDM group is（9.83 ±0.91） kg,while in Non-GDM group is（8.61 ±1.23） kg,t =2.283,P =0.025;patients with family history of diabetes in GDM group are 10 cases,while in Non-GDM group are 9 cases,χ~2=3.939,P=0.047;the concentration of testosterone in GDM group is（3.49±1.65）nmol/L,while in Non-GDM group is（2.46±1.17）nmol/L,t=2.542,P=0.013;the concentration of insulin in GDM group is（33.78±7.01）pmol/L,while in Non-GDM group is（27.12±6.39）pmol/L,t=4.108,P=0.000]. Logistics regression analysis showed that both the higher weight gain and level of insulin were independent risk factors for GDM in PCOS pregnant women（OR=2.467,95%CI=1.912 to 3.355,P=0.029;OR=1.565,95%CI=1.287 to 1.921,P=0.007）at 24 th week of gestation;while the higher weight gain and level of testosterone and insulin were independent risk factors for GDM in PCOS pregnant women（OR=2.640,95%CI=2.392 to 3.588,P=0.033;OR=1.587,95%CI=1.103 to 3.307,P=0.045;OR=2.735,95%CI=1.182 to 4.803,P=0.001）at 32 nd week of gestation. Conclusions：Higher weight gain and level of insulin are risk factors for GDM in PCOS pregnant women at second trimester and third trimester. Furthermore,higher level of testosterone is a risk factor for GDM in PCOS pregnant women at third trimester.