孕前血清丙氨酸氨基转移酶水平与妊娠期糖尿病发病风险相关性

Study of the relationship between the serum alanine aminotransferase level of pregnant women before pregnancy and their risk of gestational diabetes mellitus

目的:探讨孕前血清丙氨酸氨基转移酶(ALT)水平与妊娠期糖尿病(GDM)发病风险关系。方法:采用回顾性队列研究方法,纳入2013年1月-2017年10月在北京市海淀区妇幼保健院建档、产检并分娩且参加过国家免费孕前优生健康检查项目的1398名女性为研究对象,建立以孕前优生健康检查项目为起点,贯穿整个孕期至妊娠期糖尿病(GDM)为终点事件的回顾性备孕妊娠队列,调取研究对象在孕前优生健康检查项目及整个孕期至GDM诊断期间的相关问卷调查和诊疗等信息。采用logistic回归模型评估孕前ALT水平对GDM发病风险的影响,并分析孕前体质指数(BMI)作为效应修饰因子与ALT水平的交互作用。结果:经多因素调整后,与ALT正常组(0-40U/L)相比,孕前血清ALT升高(>40U/L)发生GDM的OR值为2.52(95%CI 1.39-4.58);与ALT<10U/L相比,孕前血清ALT在正常范围内每升高10U/L,GDM风险平均增加31.7%(趋势性检验P<0.001)。分层分析显示,与孕前ALT水平正常且BMI<24kg/m^ 2者相比,ALT水平升高且超重或肥胖者发生GDM的风险增加了6.72倍(OR=7.72,95%CI 3.20~18.60)。交互作用分析显示,孕前超重或肥胖对血清ALT与GDM发病风险间的关联具有正向相加交互作用,相对超额风险度为4.38。结论:孕前血清ALT升高能明显增加其患GDM的风险且血清ALT水平升高与GDM风险增加呈正相关。超重或肥胖对孕前ALT升高所致的GDM风险增加具有协同效应。

Objective:To explore the relationship between the level of serum alanine aminotransferase(ALT)of pregnant women before pregnancy and their risk of gestational diabetes mellitus(GDM).Methods:A retrospective cohort study was conducted from the start of participating National Free Pre-pregnancy Check-up Project(NFPCP)through the entire pregnancy course until the time of GDM diagnosis as end point.People enrolled in this study were 1398 pregnant women who had participated in NFPCP and then established obstetric archives and gave birth at the Obstetrics Clinic of the Maternal and Child Health Hospital of Haidian District in Beijing from January 2013 to October 2017.Relevant information about diagnosis and treatment from baseline to GDM outcomes were collected retrospectively.Multivariable adjusted logistic regression models were used to evaluate the effect of the ALT level of these women before pregnancy on the risks of GDM,and the additive interaction effects between the BMI value of these women before pregnancy as modifiers and their ALT level was analyze.Results:Compared with the normal range(0-40 U/L)of ALT level of women before pregnancy,the odds ratio(OR)of GDM risk in the women with elevated serum ALT(ALT level>40U/L)was 2.52(95%CI 1.39-4.58)after multivariable adjustment.The average risk of GDM increased by 31.7%(P<0.001)for ALT increment of 10U/L within normal range comparing with ALT level<10 U/L.Moreover,the women who were overweight or obesity with elevated serum ALT level before pregnancy had significantly enhanced their risks of GDM about 6.72 times,compared with the women who had BMI value<24 with normal ALT level,with an OR of 7.72(95%CI 3.20-18.60)in the stratification analysis.Finally,in the additive interaction analysis,positive interaction effects were found the BMI value of the women before pregnancy had forward additive interaction for the association between their serum ALT level and their GDM occurrence,which’s relative excess risk due to interaction(RERI)was 4.38.Conclusion:Elevated serum ALT level of pregnant women before pregnancy can significantly increase their risk of GDM,and positive correlation is found between serum ALT level increasing and the risk of GDM.In addition,overweight or obesity has a synergistic effect on the increasing risk of GDM caused by elevated ALT level of pregnant women before pregnancy.