血脂指标比值与妊娠糖尿病的相关性研究

The relationship between lipid ratios and gestational diabetes mellitus

目的比较TG/HDL-C和TC/HDL-C对妊娠糖尿病(GDM)的预测价值。方法根据妊娠24周~28周的75 g葡萄糖耐量试验结果将研究人群分为GDM组(116例)和糖耐量正常(NGT)组(124例),对所有研究者进行体格检查、血脂、血糖等指标的测定,计算TG/HDL-C和TC/HDL-C。结果与NGT组相比,GDM组LDL-C、TG、TC、TC/HDL-C、TG/HDL-C、FBG、FINS、1 h PG、2 h PG和HOMA-IR均明显升高,HDL-C和HOMA-β显著降低(P<0.05);多元逐步回归分析,结果提示,TG、TC/HDL-C、TG/HDL-C、FBG和FINS与HOMA-β密切相关;TC/HDL-C、TG/HDL-C、FBG和FINS与HOMA-IR密切相关;Logistic回归分析提示, TG、TC/HDL-C和TG/HDL-C均是GDM的危险因素(P<0.05);ROC曲线分析提示,TG/HDL-C的曲线下面积最大,即0.827,当截断值取2.27时,对GDM诊断的灵敏度为78.80%、特异度为69.60%。结论血脂指标比值与HOMA-β和HOMA-IR密切相关,是GDM的独立危险因素。

Objective To investigate and compared the Predictive value of TG/HDL-C and TC/HDL-C for gestational diabetes mellitus(GDM). Methods The study population was divided into GDM group(116 cases) and normal glucose tolerance(NGT) group(124 cases) according to the results of 75 g glucose tolerance test from 24 weeks to 28 weeks gestation. Physiology, blood lipids, blood glucose and other indicators were measured for all investigators, and TG/HDL-C and TC/HDL-C were calculated. Results Compared with NGT, patients with GDM had higher LDL-C, TG, TC, TG/HDL-C, TC/HDL-C, FBG, 1 h PG, 2 h PG and HOMA-IR, while with lower HDL-C and HOMA-β, with the differences statistically significant(P<0.05). Multiple regression analysis showed that TG, TC/HDL-C, TG/HDL-C, FBG and FINS were significantly correlated with HOMA-β, while TC/HDL-C, TG/HDL-C, FBG and FINS were significantly correlated with HOMA-IR(P<0.05). According to Logistic analysis, TG(OR=2.016), TC/HDL-C(OR=1.994) and TG/HDL-C(OR=2.762) were risk factors for GDM. TG/HDL-C obtained the highest area under the curve(AUC) of 0.827 determined by ROC curves, suggesting that TG/HDL-C had the greatest diagnostic value of GDM. When the cut off value of TG/HDL-C was set at 2.27, sensitivity was 78.80% and specificity was 69.60%. Conclusion TC/HDL-C and TG/HDL-C are significantly correlated with HOMA-β and HOMA-IR, meanwhile, they are both independent risk factors for GDM.