孕早期肝酶与妊娠期糖尿病关系的前瞻性队列研究

ASSOCIATIONS OF LIVER ENZYMES WITH GESTATIONAL DIABETES MELLITUS IN EARLY PREGNANCY: A PROSPECTIVE COHORT STUDY

目的探讨孕早期血清肝酶水平与妊娠期糖尿病(GDM)的关联。方法研究对象来自同济母婴健康队列(TMCHC),通过问卷调查了解孕妇的一般情况,于孕6~18w检测血清碱性磷酸酶(ALP)、γ-谷氨酰转移酶(GGT)、谷丙转氨酶(ALT)和谷草转氨酶(AST)的水平,孕24~28w经口服75g葡萄糖耐量试验(OGTT)诊断GDM。采用Logistic回归模型评估ALP和GGT与GDM发病风险的关联。结果本研究共纳入2483名孕妇,其中230人(9.3%)被诊断为GDM。ALP和GGT水平与GDM发生风险呈显著正相关,调整相关混杂因素后,与最低分位相比,ALP最高五分位OR值(95%CI)为2.47(1.57,3.88),ALP每增加一个标准差(SD),GDM风险增加35%;GGT最高五分位OR(95%CI)为1.63(1.04,2.56),GGT每增加一个SD,GDM风险增加20%。以ALP和GGT均低于各自最高五分位为参照,ALP和GGT均位于最高五分位者(ALP≥53.0 U/L且GGT≥19.0 U/L)发生GDM的OR值(95%CI)为2.52(1.63,3.90),仅ALP升高者发生GDM的OR值(95%CI)为1.86(1.27,2.74),仅GGT升高者发生GDM的OR值(95%CI)为1.18(0.77,1.80)。结论孕早期ALP或GGT水平升高均增加GDM的发病风险,两者同时升高GDM的发病风险更大。[营养学报,2020,42(3):224-228]

Objective To explore the associations between serum liver enzymes activity in early pregnancy and subsequent gestational diabetes mellitus(GDM). Methods The basic information of participants enrolled in the Tongji Maternal and Child Health Cohort(TMCHC) study was collected via questionnaires. The serum levels of alkaline phosphatase(ALP), gama-glutamyl transpeptidase(GGT), alanine aminotransferase(ALT), and aspartate aminotransferase(AST) activities at 6-18 weeks of gestation were measured. All the subjects underwent a 75 g oral glucose tolerance test for GDM diagnosis at 24-28 weeks of gestation. Logistic regression models were used to explore the associations of ALP and GGT levels with the risk of GDM. Results A total of 2483 women were enrolled in this study, 230(93%) of whom were diagnosed with GDM. ALP and GGT levels were positively associated with the risk of GDM. After adjustment of confounding factors, compared with the lowest quintile of ALP, OR(95% CI) was 2.47(1.57, 3.88) for the highest quintile, and per SD(standard deviation) increased the risk of GDM by 35%. The adjusted OR(95% CI) was 1.63(1.04, 2.56) for the highest quintile versus the lowest quintile of GGT, and per SD increased the risk of GDM by 20%. Compared with lower than the highest quintile of ALP and GGT, the adjusted ORs(95% CI) were 2.52(1.63, 3.90) for ALP and GGT in the highest quintile(ALP≥53.0 U/L and GGT≥19.0 U/L), 1.86(1.27, 2.74) to only ALP in the highest quintile, and 1.18(0.77, 1.80) to only GGT in the highest quintile. Conclusion In early pregnancy, higher levels of serum ALP or GGT activity can increase the risk of GDM. The combination of elevated ALP and GGT levels can increase the risk of GDM significantly.[ACTA NUTRIMENTA SINICA, 2020,42(3):224-228]