妊娠期糖尿病孕妇产后糖尿病发生的高危因子分析

High Risk Factors of Gestational Diabetes Mellitus Associated with Development of Postpartum Diabetes

【目的】探讨妊娠期糖尿病(GDM)孕妇产后糖尿病发生的高危因子。【方法】选择2015年1月至2015年12月在北京大学深圳医院规律产检并分娩的单胎妊娠期糖尿病孕妇342例,所有孕妇在孕24~28周均直接行75 g葡萄糖耐量试验(OGTT)。根据空腹、1 h和2 h血糖值,将仅有一项血糖指标异常的记为GDMⅠ(219例),二项异常的为GDMⅡ(81例)和全部异常的为GDMⅢ(42例)。以同期在本院规律产检,血糖值正常并分娩的968例孕妇设为对照组。所有研究对象均排除家族糖尿病史、产科并发症和其他内科并发症等高危因素。所有受试对象于分娩后一年,再次行OGTT试验,分析比较各组孕妇妊娠期各时间点血糖及糖化血红蛋白(Hb A1c)等高危因子与产后糖尿病发生的相关性分析。【结果】复查结果显示,342名GDM孕妇中有27名产后发生2型糖尿病,发病率高于对照组,差异有统计学意义(P<0.05),其中GDMⅢ组中发病率为45.23%,发病率高于其他GDM组(P<0.05);在发生2型糖尿病的GDM孕妇中,与自身妊娠前和同期未发生2型糖尿病的GDM孕妇相比,2 h血糖和Hb A1c值明显增加,且差异具有统计学意义(P<0.05)。Logistic回归分析结果显示,GDMⅢ组别、2 h血糖和Hb A1c值,这三种高危因子均是GDM孕妇发生2型糖尿病的危险因素(P<0.05)。【结论】OGTT血糖全部异常的GDM孕妇产后发生2型糖尿病的发病率明显增加。临床上应对这类孕妇的血糖进行动态的监控,及时发现并纠正2 h血糖和Hb A1c值的异常。

【Objective】To explore the high risk factors of gestational diabetes mellitus（GDM）associated with the development of postpartum diabetes. 【Methods】 Clinical records of 342 singleton GDM women,which underwent obstetric examination in the Peking University Shenzhen hospital between January 1,2015 and December 31,2015,were collected. All patients performed a 75 g oral glucose tolerance test（75 g OGTT）and glycosylated hemoglobin（Hb A1 c）at 24-28 gestational weeks,and were divided into 3 groups：GDM I（219 cases）defined as one abnormal blood glucose of results. GDM Ⅱ（81 cases）：two abnormal blood glucose. GDM Ⅲ（42 cases）：three abnormal blood glucose. 968 cases of healthy pregnant women were selected as the control group. All patients were underwent the followup OGTT and Hb A1 c at 12 mouse postpartum. The characteristics of OGTT and Hb A1 c outcomes were analyzed and compared among groups. 【Results】The follow-up OGTT results showed that twenty-seven（27/342,7.89%）GDM women developed type 2 diabetes. The radio of type 2 diabetes morbidity was higher in the GDM women group than in the control group,which was also higher in GDMⅢ group（45.23%）than in other GDM groups（P 〈0.05）. In the type 2 diabetes GDM women,the value of OGTT-2 h and Hb A1 c were significantly higher in the postpartum stage than in the prenatal perio（P 〈0.05）. Similar data was shown in the type 2 diabetes GDM women group,compared with nondiabetes GDM women group. Logistic analysis showed that the group of GDMⅢ,he value of OGTT-2 h and Hb A1 c were risk factors for the type 2 diabetes morbidity in GDM women（P〈 0.05）.【Conclusions】The current study provides evidence that the GDM women with three abnormal blood glucose have a high risk to develop type 2 diabetes. The blood glucose level of these GDM women should be monitored dynamically,and the abnormal value of OGTT-2 h and Hb A1 c should be detected and corrected in time.