孕早期25羟维生素D缺乏对妊娠期糖尿病的预测价值

The predictive value of 25 hydroxy vitamin D deficiency in gestational diabetes during early pregnancy

目的探讨孕早期25羟维生素D缺乏对妊娠期糖尿病(GDM)的预测价值。方法选取2017年3-5月(春季)在丽水市妇幼保健院建卡初期(孕早期)的835名孕妇为研究对象,所选对象均为丽水市本地户籍,测定空腹血糖(FBG)、空腹胰岛素(FINS)、25羟维生素D,并于孕24~28周行葡萄糖耐量试验(OGTT)。分析25羟维生素D水平与GDM的发生率、胰岛素及血糖指标的关系。结果 (1)孕早期25羟维生素D水平为(38.03±12.67)nmol/L,其中145人缺乏,缺乏率82.6%;通过OGTT实验,确诊95例糖尿病孕妇,发生率11.38%;25羟维生素D缺乏组GDM发生率、胰岛素抵抗指数(HOMA-IR)均高于正常组,而胰岛素分泌指数(HOMA-β)低于正常组,差异均有统计学意义(P<0.05)。(2)餐后1、2 h血糖异常值孕妇25羟维生素D水平均低于血糖值正常的孕妇,差异有统计学意义(P<0.05)。(3)25羟维生素D水平与HOMA-IR呈负相关(r=-0.186,P=0.003)。结论孕早期25羟维生素D缺乏增加胰岛素抵抗及糖尿病的发生风险,在妊娠早期检测能有效预测GDM的发生,具有一定的临床价值。

Objective To explore the predictive value of 25 hydroxy vitamin D deficiency in gestational diabetes mellitus（GDM）during early pregnancy. Methods 835 pregnant women in first trimester were selected as the research object from March 2017-May2017（spring） in Lishui maternity and child health care hospital. The selected objects are local household registration of Lishui city.Fasting blood glucose（FBG）,fasting insulin（FINS）,25 hydroxy vitamin D,and oral glucose tolerance test（OGTT） in 24-28 weeks of the subjects were tested. The relationship between 25 hydroxy vitamin D levels and the incidence of GDM,insulin and glycemic index was analyzed. Results（1） The level of 25 hydroxy vitamin D of the subjects was（38. 03 ± 12. 67） nmol/L. Among the835 pregnant women,145 were 25 hydroxy vitamin D deficient,and the deficiency rate was 82. 6%. 95 cases of pregnant women were confirmed as diabetes,with an incidence of 11. 38%. The incidence of GDM and HOMA-IR in 25 hydroxy vitamin D deficiency group were higher than those in the normal group,while HOMA-βwas lower than normal group（P 〈0. 05）.（2） For pregnant women with blood glucose abnormality of 1,2 h after meal,the level of 25 hydroxy vitamin D was lower than the normal pregnant woman（P 〈0. 05）.（3）The level of 25 hydroxy vitamin D was negatively correlated with HOMA-IR（r =-0. 186,P = 0. 003）. Conclusion The deficiency of 25 hydroxy vitamin D can increased the risk of insulin resistance and diabetes mellitus. Early pregnancy tested can effectively predict the occurrence of GDM,and it has certain clinical value.