复发性流产患者体质指数、胰岛素水平与糖代谢状态的特征研究

Study on the characteristics of body mass index,insulin level and glucose metabolism status in patients with recurrent spontaneous abortion

目的分析复发性流产患者临床与生化指标及其分布特征,同时探讨复发性流产(RSA)与肥胖、胰岛素抵抗(IR)以及糖代谢异常的关系。方法选择876例复发性流产妇女作为病例组(RSA组),另外选取同时期因男方因素行辅助生殖技术助孕的妇女1397例作为对照组,回顾性分析其临床资料,比较两组的体质指数(BMI)、空腹胰岛素(FINS)、空腹血糖(FPG)水平。同时将BMI水平分为4个区间,比较不同区间下两组胰岛素和血糖的分布特征。再筛选出差异有统计学意义的变量进行Logistic回归分析。结果RSA组空腹血糖、空腹胰岛素、HOMA-IR水平明显高于对照组,差异有统计学意义(P<0.01);RSA组空腹血糖受损(IFG)、IR检出率高于对照组,差异有统计学意义(P<0.05)。RSA组BMI及糖代谢均异常的检出率高于对照组,差异有统计学意义(P<0.05)。RSA组在超重和肥胖患者中糖代谢异常检出率高于对照组,差异有统计学意义(P<0.05);RSA组在正常体质量患者中IR检出率高于对照组,差异有统计学意义(P<0.01)。多因素分析显示,IR是RSA发生的危险因素。结论复发性流产与IR、糖代谢异常有关,超重或肥胖的复发性流产患者更易发生糖代谢紊乱,应重视正常体质量复发性流产妇女的内分泌代谢状态。

Objective To analyze the clinical and biochemical indicators and their distribution characteristics of recurrent spontaneous abortion(RSA)patients to explore the relationship between RSA and obesity,insulin resistance and abnormal glucose metabolism.Methods 876 women who suffered from RSA were recruited as the case group(RSA group),and 1397 women who underwent assisted reproductive technology due to male factors in the same period were selected as the control group.The clinical data were collected,and the body mass index(BMI),fasting insulin(FINS),fasting plasma glucose(FPG)levels of the two groups were analyzed.At the same time,the BMI level was divided into 4 intervals,and the distribution characteristics of insulin and blood glucose in the two groups under different intervals were compared.Then the variables with statistically significant differences were selected for Logistic regression analysis.Results The FPG,FINS and HOMA-IR indexes of the RSA group were higher than those of the control group(P<0.01);The detection rates of impaired fasting blood glucose(IFG)and insulin resistance(IR)in the RSA group were higher than those in the control group(P<0.05).The occurrence rate of abnormal BMI and glucose metabolism in the RSA group was higher than that in the control group(P<0.05).The generation rate of abnormal glucose metabolism in overweight and obese patients in the RSA group was higher than that in the control group(P<0.05);the detection rate of IR in normal weight patients in the RSA group was higher than that in the control group(P<0.01).Multivariate analysis showed that IR was a risk factor for RSA.Conclusion The occurrence of RSA is related to IR and abnormal glucose metabolism.Overweight or obese patients with RSA are more likely to have glucose metabolism disorders,and attention should be paid to the endocrine metabolism status of women with RSA of normal weight.