1 941例妊娠期糖代谢异常孕妇血脂分析

Analysis of plasma lipids in 1 941 pregnant women with gestational diabetes mellitus

目的探讨不同程度糖代谢异常的妊娠期糖尿病(gestational diabetes mellitus,GDM)孕妇血脂水平差异及糖代谢异常指标对血脂的影响。方法收集2012年1月至2016年9月在成都市妇女儿童中心医院及成都市郫都区妇幼保健院进行产前保健并确诊为GDM孕妇1 941例的临床资料。进行血清甘油三酯(triglyceride,TG)、总胆固醇(total cholesterol,TC)、高密度脂蛋白胆固醇(high-density lipoprotein cholesterol,HDL-C)、低密度脂蛋白胆固醇(low-density lipoprotein cholesterol,HDL-C)及糖化血红蛋白(glycosylated hemoglobin A1c,HbA1c)的测定。根据糖耐量筛查(oral glucose tolerance,OGTT)结果将孕妇划分为1项异常组(Group 1)、2项异常组(Group 2)和3项异常组(Group 3)3组。采用单因素方差分析法分析组间血脂水平的差异,采用多重线性回归分析糖代谢指标对血脂的影响。结果 Group 3的年龄、孕前体质量指数、孕期增重及HbA1c均高于Group 1和Group 2(P<0.05)。Group 3 TG水平高于Group 1和Group 2(P<0.05),HDL-C低于Group 1和Group 2(P<0.05)。多重线性回归分析发现OGTT-空腹血糖是影响血脂的主要因素,OGTT-空腹血糖每上升1 mmol/L,TG上升0.26 mmol/L(P<0.05),HDL-C下降0.047 mmol/L(P<0.05)。结论 OGTT筛查结果影响GDM孕妇血脂水平,建议针对GDM孕妇的干预指导应结合血糖、血脂进行综合考虑。

Objective To investigate the differences of plasma lipids in 1 941 pregnant women with gestational diabetes mellitus （GDM） of different degree, and to identify influences which cause the differences. Methods 1 941 pregnant women with GDM who had their antenatal care in Chengdu Women＆Children＇ s Central Hospital and Pidu Health Center For Women and Children from January 2012 to September 2016 were selected. Blood specimens were collected to determine plasma triglyceride（TG）, total cholesterol（TC）, high - density lipoprotein cholesterol （ HDL - C ）, low - density lipoprotein cholesterol （ LDL - C ）, and glycosylated hemoglobin A1 c （HbA1 c）. With acknowledgement of weight before pregnancy and medical history based on questionnaires. Pregnant women with GDM were divided into 3 groups based on the results of OGTT, Group 1 with 1 index higher than the standard, Group 2 with 2 indexes higher, and Group 3 with 3 indexes higher. One - way ANOVA was performed to explore the differences of plasma lipids among groups,while multiple liner regression was performed to determine influences of plasma lipids. Results Age, BMI before pregnancy, weight gain and HbAlc of Group 3 were higher than Group 1 and Group 2（P 〈0. 05）. TG of Group 3 were higher than Group 1 and Group 2 （ P 〈 0. 05）, and HDL - C of Group 3 were lower than Group 1 and Group 2 （ P 〈 0. 05 ）. TG would rise 0. 26 mmol/L andHDL - C would descend 0. 047 mmol/L when fasting blood glucose of OGTT rise 1 mmol/L（ P 〈 0.05 ）. Conclusion Result of OGTT has impact on plasma lipids of pregnant women with GDM. Medical advices given to them should be based on both glucose and plasma lipids.