妊娠期糖尿病与口服葡萄糖耐量试验血糖正常孕妇胰岛素释放试验及血脂相关性研究

Study on the Relationship between Insulin Release Test and Blood Lipid in Pregnant Women with Gestational Diabetes Mellitus and Normal OGTT Blood Glucose

目的:研究妊娠期糖尿病(GDM)与口服葡萄糖耐量试验(OGTT)血糖正常孕妇的胰岛素释放试验(IRT)与血脂的相关性,探讨妊娠期脂代谢异常与妊娠结局之间的关系。方法:选择2018年10月至2019年7月在上海交通大学附属第一人民医院定期产检孕妇453例,分为GDM组98例,IRT异常组144例,对照组211例。比较3组孕晚期空腹甘油三酯(FTG)、高密度脂蛋白胆固醇(HDL-C)、游离脂肪酸(FFA)、餐后甘油三酯(PTG)以及空腹胰岛素、1小时胰岛素、2小时胰岛素水平,分析FTG、PTG与胰岛素及新生儿出生体质量的相关性,比较各组不良妊娠结局的发生率。结果:GDM组的FTG、PTG及FTG/HDL-C显著高于对照组和IRT异常组,IRT异常组的FTG、PTG显著高于对照组(P<0.05);GDM组的HDL-C显著低于对照组和IRT异常组(P<0.05);3组的FFA差异无统计学意义(P>0.05)。GDM组的空腹胰岛素、2小时胰岛素高于对照组和IRT异常组,与对照组间的差异有统计学意义(P<0.05),与IRT异常组间的差异无统计学意义(P>0.05)。FTG、PTG与新生儿出生体质量均呈正相关性(r>0,P<0.05);GDM组的巨大儿发生率显著高于对照组和IRT异常组(P<0.05);Logistic回归分析结果显示,FTG、PTG均是巨大儿发生的独立危险因素(OR>1,P<0.05)。结论:IRT异常孕妇与GDM孕妇均存在脂代谢异常,而其与巨大儿的发生密切相关。

Objective:To study the relationship between insulin release test(IRT)and blood lipids in pregnant women with gestational diabetes mellitus and pregnant women of normal OGTT,and to explore the relationship between abnormal lipid metabolism and pregnancy outcome.Methods:From October 2018 to July 2019,453 pregnant women,who had regular prenatal check-up in the Shanghai General Hospital Affiliated to Shanghai Jiaotong University,were randomly divided into GDM group(98 cases),abnormal IRT group(144 cases)and control group(211 cases).The fasting triglycerides(FTG),high-density lipoprotein cholesterol(HDL-C),free fatty acids(FFA),postprandial triglycerides(PTG),fasting INS,1-hour insulin and 2-hour insulin were compared among the three groups.Then we analyzed the correlation between FTG,PTG,insulin and neonatal birth weight,and compared the incidence of adverse pregnancy outcomes in each group.Results:The FTG,PTG and FTG/HDL-C in the GDM group were significantly higher than those in the control group and abnormal IRT group,and the FTG and PTG in the abnormal IRT group were significantly higher than the control group(P<0.05).HDL-C in the GDM group was significantly lower than those in the control group and the abnormal IRT group(P<0.05).There was no significant difference of FFA among the three groups(P>0.05).Fasting insulin and 2-hour insulin in GDM group were higher than those in control group and abnormal IRT group,while the difference was statistically signifcant only between GDM group and control group(P<0.05).There was a positive correlation between FTG,PTG and the birth weight of the newborn(r>0,P<0.05).The incidence of macrosomia in the GDM group was significantly higher than that in the control group and the abnormal IRT group(P<0.05).Factors such as age were included in the logistic regression model,and we found that both FTG and PTG were independent risk factors for the occurrence of macrosomia(OR>1,P<0.05).Conclusions:Pregnant women with abnormal IRT and GDM have abnormal lipid metabolism,which is closely related to the occurrence of macrosomia.