孕期维生素D、甲状旁腺素水平与糖代谢功能的关联研究

Association of vitamin D and parathyroid hormone levels with glucose metabolism during pregnancy

目的探讨孕期维生素D和甲状旁腺素(PTH)不同状态与糖代谢及妊娠糖尿病(gestational diabetes mellitus,GDM)发生风险之间的关系。方法于2015年3月至2017年12月在合肥市3家医院产科门诊招募4 138名孕21~24周孕妇。进行基线问卷调查并留取清晨空腹静脉血,检测血清25-羟维生素D[25(OH)D]和PTH水平,于孕24~28周行葡萄糖耐量试验。采用多元线性回归模型和logistic回归模型,分析25(OH)D和PTH不同状态孕妇的糖代谢指标差异以及GDM发生风险。结果孕中期25(OH)D平均水平为(39.8±16.6) nmol/L,PTH中位数为10.7(6.9,16.7)ng/L,GDM检出率为20.4%。协方差分析显示,25(OH)D、PTH状态与糖代谢指标间均无统计学关联。PTH高水平且维生素D缺乏孕妇(组3)的餐后1 h血糖(1hPG)水平、血糖曲线下面积(AUCglu)水平和GDM发生风险均显著高于PTH中低水平且维生素D非缺乏孕妇(对照组,均P<0.05)和PTH高水平且维生素D非缺乏孕妇(组2,均P<0.05)。然而,与对照组相比,在PTH中低水平且维生素D缺乏孕妇(组1)和组2孕妇中并未观察到糖代谢指标显著性改变和GDM发生风险显著增高。结论孕期维生素D和PTH水平与糖代谢的相关性存在交互作用,维生素D缺乏且伴有PTH水平升高与糖代谢异常存在相关性。

Objective To explore the relationship between different statuses of vitamin D and parathyroid hormone (PTH) during pregnancy with glucose metabolism and the risk of gestational diabetes mellitus (GDM). Methods A total of 4 138 pregnant women who had antenatal care in 3 hospitals of Hefei from March 2015 to December 2017 were recruited during 21-24 weeks. Baseline questionnaires were performed and serum 25-hydroxyvitamin D [25(OH) D] and PTH levels were measured in fasting venous blood. Glucose tolerance tests were performed during 24 to 28 weeks. Multivariate linear regression model and multivariate logistic regression model were applied to analyze the differences of glucose metabolism index and GDM risk among pregnant women at different statuses of 25(OH)D and PTH. Results The average level of 25(OH)D in the second trimester was (39.8±16.6) nmol/L, with the median PTH 10.7 (6.9, 16.7) ng/L and the detection rate of GDM 20.4%. Covariance analysis showed no statistically significant association of vitamin D and PTH levels with glucose metabolism indexes. Pregnant women with high PTH and vitamin D deficiency had higher 1h postprandial plasma glucose (1hPG), the area under the glucose curve (AUCglu) levels, and GDM risk compared with pregnant women with middle/lower PTH and vitamin D deficiency (control group, all P<0.05), and higher PTH accompanied with vitamin D non-deficiency (Group 2, all P<0.05). However, significant changes in glucose metabolism indicators and GDM risk were not observed in low-level PTH-pregnant women with vitamin D deficiency (group 1) and group 2 pregnant women compared with control group. Conclusion There is an interaction between vitamin D/PTH levels and glucose metabolism during pregnancy. Vitamin D deficiency with elevated PTH level is associated with abnormal glucose metabolism.