妊娠期糖尿病患者分娩后糖脂代谢转归失败的高危因素分析

Risk factors of abnormal glycolipid metabolism outcomes after delivery in patients with gestational diabetes mellitus

目的研究妊娠期糖尿病(GDM)患者分娩后糖脂代谢转归失败的高危因素。方法将2016年1月至2018年1月间本院收治的213例GDM的患者纳为研究对象,于患者分娩后随访6~12周,根据糖脂代谢转归情况将其分为转归正常组与异常组,采用多因素Logistic回归模型,分析影响GDM患者产后糖脂代谢转归失败的危险因素。结果糖脂代谢转归异常组108例(50.70%),正常组105例(49.30%)。单因素分析提示两组孕前BMI差异有统计学意义(t=6.921,P<0.05),两组孕中期与产后空腹血糖(FPG)、75g葡萄糖耐量试验餐后2h血糖(2hPBG)、空腹胰岛素(FINS)、胰岛素抵抗指数(HOMA-IR)及三酰甘油(TG)差值差别有统计学意义(t值分别为38.016、43.748、15.087、30.507、16.194,均P<0.05),两组产后BMI、产后腰围及产后喂养方式差别有统计学意义(t值分别为7.872、10.571,χ^2=19.961,均P<0.05)。Logistic回归分析提示,孕中期-产后FPG差值、2hPBG差值、HOMA-IR差值及产后喂养方式有统计学意义,其OR值及95%CI分别为4.14(1.40~12.27)、5.92(2.02~17.32)、1.59(1.15~2.20)、1.49(1.06~2.09)。结论GDM患者产后糖脂代谢转归失败的发生率高,而孕中期-产后FPG、2hPBG及HOMA-IR差值与产后喂养方式均是影响GDM患者产后糖脂代谢转归的独立因素,临床应积极监测患者产后FPG、2hPBG及HOMA-IR状况,并建议患者坚持纯母乳喂养,以降低产后糖脂代谢转归失败率。

Objective To investigate the risk factors of abnormal glycolipid metabolism outcomes after delivery in patients with gestational diabetes mellitus(GDM).Methods Totally 213 GDM patients admitted in Wenzhou Chinese Hospital from January 2016 to January 2018 were included in the study.The patients were followed up for 6-12 weeks,and they were divided into normal group and abnormal group according to postpartum glycolipid metabolism outcomes.Risk factors of abnormal glycolipid metabolism outcomes after delivery in GDM patients were determined by multivariate logistic regression model.Results There were 108 cases(50.70%) in the abnormal group and 105 cases(49.30%) in the normal group.Univariate analysis showed that the difference in BMI between two groups before pregnancy was statistically significant(t=6.921,P<0.05).The midgestational-postpartum FPG,2 hPBG,FINS,HOMA-IR and TG had significant differences between two groups(t value was 38.016,43.748,15.087,30.507 and 16.194,respectively,P<0.05 for all),and the differences in postpartum BMI,postpartum waist circumference and postpartum feeding were significant(t value was 7.872 and 10.571,respectively,χ^2=19.961,P<0.05 for all).Logistic regression analysis indicated that the differences in midgestational-postpartum FPG,2 hPBG,HOMA-IR,and postpartum feeding methods were statistically significant with OR value and 95%CI of 4.14(1.40-12.27),5.92(2.02-17.32),1.59(1.15-2.20),and 1.49(1.06-2.09),respectively.Conclusion GDM patients have high incidence of abnormal glycolipid metabolism outcomes,and the independent factors affecting postpartum glycolipid metabolism are midgestational-postpartum FPG,2 hPBG,HOMA-IR and postpartum feeding mode.In order to reduce the abnormal rate of postpartum glycolipid metabolism,postpartum FPG,2 hPBG and HOMA-IR should be strictly monitored after delivery and exclusive breastfeeding is recommended.