妊娠期糖尿病患者孕晚期糖化血清白蛋白水平与新生儿呼吸系统疾病关系

Correlation between glycosylated albumin level of pregnant women with gestational diabetes mellitus during the third trimester of pregnancy and their neonatal respiratory diseases

目的:探究妊娠期糖尿病(GDM)患者孕晚期糖化血清白蛋白(GA)水平与新生儿呼吸系统疾病的可能关系。方法:选取2016年6月—2019年9月本院检查分娩的单胎足月产妇1362例,其中GDM孕妇245例,非GDM孕妇1117例。收集两组孕妇基本资料,全自动生化分析仪检测血糖、血脂水平,免疫比浊法检测糖化血红蛋白(HbA1c)水平,酶法检测GA水平。根据GA水平中位数将GDM组分为高GA组(121例)和低GA组(124例),比较两组新生儿情况。采用多因素logistic回归分析影响新生儿发生呼吸系统疾病的危险因素。结果:GDM组孕妇血糖、总胆固醇(TC)、甘油三酯(TG)、高密度脂蛋白胆固醇(HDLC)、低密度脂蛋白胆固醇(LDLC)水平、HbA1c、GA水平均高于非GDM组(P<0.05);新生儿发生呼吸系统疾病GDM组(13.5%)与非GDM组(11.4%例)未见差异;GDM组新生儿出生体重(2805.6±317.3g)、剖宫产占比(29.4)高于非GDM组(2742.7±322.5g、18.6%),出生1 min Apgar评分(8.7±0.4分)低于非GDM组(9.0±0.5分),新生儿发生死亡、巨大儿、小于胎龄儿、新生儿发并发症、高胆红素症比例均高于非GDM组(P<0.05)。GDM组中高GA组新生儿发生呼吸系统疾病(19.0%)高于低GA组(8.1%)(P<0.05),两组新生儿1 min Apgar评分、NRDS、呼吸暂停、窒息、湿肺、肺炎、气胸发病比例无差异(P<0.05);孕晚期HbA1c水平升高、GA水平升高、剖宫产是影响GDM孕妇发生新生儿呼吸系统疾病的危险因素。结论:GDM孕妇孕晚期血清GA水平升高,且是影响新生儿呼吸系统疾病发生的危险因素,监测其水平变化有助于及早干预治疗,对改善新生儿生存质量有一定临床意义。

Objective:To explore the correlation between glycosylated albumin(GA)level of pregnant women with gestational diabetes mellitus(GDM)during the third trimester of pregnancy and their neonatal respiratory diseases.Methods:1362 singleton full-term pregnant women were selected and were divided into study group(245 women with GDM)and control group(1117 women without GDM)from June 2016 to September 2019.The levels of blood glucose and blood lipid were detected by automatic biochemical analyzer,the level of HbA1c was detected by immunoturbidimetric method,and the level of GA was detected by enzyme method.According to the median of serum GA level,the women in the study group was divided into group A(121 women with high level of GA)and group B(124 women with low level of GA).The neonatal situation was compared between group A and group B.Multivariate Logistic regression analysis was used to analyze the risk factors of neonatal respiratory diseases.Results:The levels of blood glucose,total cholesterol(TC),triglyceride(TG),high density lipoprotein cholesterol(HDLC),low density lipoprotein cholesterol(LDLC),HbA1c,and GA of the women in study group were significant higher than those of the women in control group(P<0.05).There was no significant difference in the incidence of neonatal respiratory diseases between the two groups(13.5%vs.11.4%).The neonatal birth weight(2805.6±317.3g)and cesarean section(29.4)of the women in the study group were significant higher than those(2742.7±322.5g and 18.6%)of the women in the control group,but the neonatal Apgar score at 1 min after birth(8.7±0.4 points)in the study group was significant lower than that(9.0±0.5 points)in the control group.The rates of neonatal death,macrosomia,small for gestational age,neonatal complications,and neonatal hyperbilirubin in the study group were significant higher than those in the control group(P<0.05).In the study group,the incidence of neonatal respiratory diseases(19.0%)in group A was significant higher than that(8.1%)in group B(P<0.05),but there were no significant differences in 1 min Apgar score of newborns,and the rates of neonatal NRDS,apnea,asphyxia,wet lung,pneumonia,and pneumothorax between the two groups(P<0.05).Elevated HbA1c and GA levels during the third trimester of pregnancy,and cesarean section of pregnant women with GDM were the risk factors of the occurrence of their neonatal respiratory diseases.Conclusion:The GA level of pregnant women with GDM during the third trimester of pregnancy has elevated,which is a risk factor of their neonatal respiratory diseases.So monitoring the change of GA level is helpful for early intervention of the women with GDM and has certain clinical significance for improving their neonatal quality of life.