产妇孕早期肝脏功能水平对GDM的预测价值

Predictive value of liver function in early pregnancy of pregnant women with GDM

目的研究妊娠期糖尿病(GDM)与孕早期肝脏功能的相关性并评价其水平对GDM的预测价值。方法分娩产妇1 207例为研究对象,根据24~28周OGTT结果,按照GDM诊断标准,将产妇分为GDM组(n=261)及正常组(n=946)。回顾性分析产妇孕早期肝脏功能水平等相关临床资料,对可能与GDM有关的单因素进行分析,利用多因素Logistic回归分析GDM的独立危险因素,建立利用各独立危险因素预测诊断GDM的ROC曲线。结果对与GDM相关的危险因素进行多因素Logistic回归分析,结果显示产妇孕早期年龄(OR=1.272,P=0.003)、体重指数(BMI)(OR=1.733,P=0.025)以及反映肝脏功能水平的指标γ-谷氨酰转肽酶(γ-GT)(OR=1.343,P=0.005)、纤维蛋白原(FIB)(OR=1.256,P=0.029)、空腹血糖(FPG)(OR=2.273,P=0.002)是GDM的独立危险因素,天冬氨酸转氨酶(AST)(OR=0.852,P=0.015)、总胆红素(T-Bil)(OR=0.953,P=0.036)是GDM的保护因素。肝脏水平指标预测GDM发生的ROC曲线下面积(AUC)分别为:AST:0.559,γ-GT:0.896,T-Bil:0.553,FIB:0.620,FPG:0.742。其中γ-GT的诊断切点为13.32 U/L,此时敏感度为0.912,特异度为0.700。结论反映肝脏功能水平的指标低水平AST、高水平γ-GT、低水平T-Bil、高水平FIB、高水平FPG是GDM发生的独立危险因素,孕早期利用γ-GT预测GDM的发生具有一定价值。

Objective To investigate the correlation between gestational diabetes mellitus（ GDM） and liver function in early pregnancy,and to evaluate its predictive value in pregnant women with GDM. Methods A total of 1207 pregnant women who delivered in our hospital were collected in the study. They were divided into GDM group and control group according to GDM diagnostic criteria. The liver function and the other related clinical data in early pregnancy were retrospectively analyzed. Moreover the single factor that might be related with GDM was analyzed. Multivariate logistic regression was used to analyze the independent risk factors of GDM. The ROC curves of GDM were established by using every independent risk factor. Results The multivariate logistic regression analysis of GDM-related risk factors showed that maternal age in early pregnancy（ OR = 1. 272,P 〈 0. 01）,body mass index（ BMI）（ OR = 1. 733,P 〈 0. 05） and the indexes related with liver function including gamma Glutamyltransferase（ γ-GT）（ OR = 1. 343,P 〈 0. 01）,fibrinogen（ FIB）（ OR = 1. 256,P 〈 0. 05）,fasting plasma glucose（ FPG）（ OR = 2. 273,P 〈 0. 01） were independent risk factors of GDM. However aspartate aminotransferase（ AST）（ OR = 0. 852,P 〈 0. 05） and total bilirubin（ T-Bil）（ OR = 0. 953,P 〈 0. 05） were protective factors of GDM. The area under the ROC curve（ AUC） to predict the incidence of GDM was respectively： AST： 0. 559,γ-GT：0. 896,T-Bil： 0. 553,FIB： 0. 620,FPG： 0. 742. The diagnostic point of γ-GT was 13. 32 U/L,the sensitivity was 0. 912 and the specificity was 0. 700. Conclusion High levels of γ-GT,FIB and FPG,low levels of AST and T-Bil are independent risk factors of GDM. The detection of γ-GT in early pregnancy has a certain value in predicting the incidence of GDM.