妊娠期糖尿病患者胰岛素抵抗、血尿酸水平及其对妊娠结局的影响研究

Effects of insulin resistance and blood uric acid level on pregnancy outcomes of patients with gestational diabetes mellitus

目的:研究妊娠期糖尿病(GDM)患者胰岛素抵抗、血尿酸水平及其对妊娠结局的影响。方法:选取319例产检GDM孕妇、410名正常孕妇分别作为研究组与对照组。回顾性分析两组临床产检资料,包括血清空腹血糖(FBG)、胰岛素(FINS)、尿酸(UA)、胰岛素分泌指数(HOMA-β)、胰岛素抵抗指数(HOMA-IR)以及不良妊娠结局发生情况,利用Spearman相关性分析法分析上述指标与不良妊娠结局的相关性。结果:研究组孕妇血清FBG、HOMA-IR、UA均高于对照组(P<0.05),FINS、HOMA-β均低于对照组(P<0.05);研究组孕妇妊高症、早产、产后出血、胎膜早破发生率均高于对照组(P<0.05),新生儿Agpar 1 min、5 min得分均低于对照组(P<0.05),新生儿窘迫、黄疸、低血糖发生率均高于对照组(P<0.05);孕妇血清HOMA-IR、UA过高与孕妇胎膜早破、早产、产后出血以及新生儿窘迫、低血糖等呈正相关(P<0.05),与新生儿Agpar得分呈负相关(P<0.05);孕妇血清FINS、HOMA-β过低与上述孕妇、新生儿不良结局呈负相关(P<0.05),但与新生儿Agpar得分呈正相关(P<0.05)。结论:GDM孕妇存在更严重的胰岛素抵抗和更高的血清UA水平,与孕妇、新生儿不良结局密切相关。

Objective:To investigate the effects of insulin resistance and blood uric acid level on pregnancy outcomes of patients with gestational diabetes mellitus(GDM).Methods:319 pregnant women with GDM(study group)and 410 normal pregnant women(control group)who received pregnancy check-ups in the hospital were enrolled in this study,and their clinical data,including serum fasting blood glucose(FBG),fasting insulin(FINS),uric acid(UA),insulin secretion index(HOMA-β),insulin resistance index(HOMA-IR)and the occurrence of adverse pregnancy outcomes were retrospectively analyzed.Spearman correlation analysis of the above indicators and adverse pregnancy outcomes was performed.Results:Serum FBG,HOMA-IR and UA is the study group were significantly higher than thouse in the control group(P<0.05),FINS and HOMA-βwere significantly lower than thouse in the sontrol group(P<0.05).The incidences of pregnancy induced hypertension,premature delivery,postpartum hemorrhage and premature rupture of membranes in the study group were sigifcatly higher than thouse in the control group(P<0.05),neonatal Agpar 1 min and 5 min scores were significantly lower than those in the control group(P<0.05),the incidences of neonatal distress,jaundice,and hypoglycenia were significantly higher than those in the control group(P<0.05).Serum HOMA-IR and UA in pregnant women were positively correlated with premature rupture of membranes,premature delivery,postpartum hemorrhage,neonatal distress,and hypoglycemia(P<0.05),and negatively correlated with neonatal Agpar scores(P<0.05).Meternal serum FINS and HOMA-βwere negatively correlated with the aforementioned adverse materrnal and neonatal outcomes(P<0.05),and positively correlated with neonatal Agpar scores(P<0.05).Conclusion:GDM pregnant women have severer insulin resistance and higher blood UA levels,which are closely related to adverse materrnal and neonatal outcomes.