妊娠期糖尿病患者产后糖代谢转归危险因素分析的前瞻性研究

Risk factors for postpartum glycometabolism in patients with gestational diabetes mellitus:a prospective study

目的探讨妊娠期糖尿病(GDM)患者产后糖代谢转归危险因素,为临床预防2型糖尿病(T2DM)提供思路。方法选取2019年2月至2020年1月慈溪市人民医院妇产科进行定期产检并建立档案的孕妇作为研究对象,建立前瞻性队列研究,收集整理孕前及孕期的临床资料,随访产后6周及6个月,并行75 g口服葡萄糖耐量试验(OGTT),以糖代谢异常为临床终点。采用K-M单因素以及Cox多因素分析GDM患者产后糖代谢异常的危险因素。结果该研究最终招募252例符合研究标准的患者,其中212例最终完成6周随访,149例患者完成6个月随访。产后完成6周随访的212例患者中,糖代谢异常患者87例(41.04%),空腹血糖受损(IFG)3例(1.42%),糖耐量受损(IGT)66例(31.13%),T2DM18例(8.49%);产后完成6个月随访的149例患者中,IFG新增2例,IGT新增11例,T2DM新增3例。孕前超重[体质量指数(BMI)≥24 kg/m2]以及OGTT试验1 h血糖≥10.1 mmol/L是GDM产妇产后糖代谢异常的独立危险因素(OR=2.273,2.462;P=0.039,0.023;95%CI=1.495~3.051,1.684~3.240)。糖代谢正常组Matsuda指数、60 min胰岛素生成指数(IGI60)显著高于糖代谢异常组(t=7.184、2.011,均P<0.05)。结论 GDM患者产后6个月糖代谢异常发生率仍较高,孕前超重(BMI≥24 kg/m2)以及OGTT试验1 h血糖浓度≥10.1 mmol/L是GDM产妇产后糖代谢异常的独立危险因素。

Objective To investigate the risk factors for postpartum glycometabolism in patients with gestational diabetes mellitus(GDM),providing a new idea for clinical prevention of type 2 diabetes mellitus.Methods Pregnant women who underwent regular prenatal examination in Cixi People's Hospital,China between February 2019 and January 2020 were included in this prospective cohort study.The clinical data before and during pregnancy were collected.These pregnant women were followed up for 6 weeks and 6 months postpartum.Oral glucose tolerance test(OGTT)with 75 g of glucose was performed.The clinical end point was abnormal glucose metabolism.Kaplan-Meier(KM)univariate analysis and multivariate Cox regression analyses were used to analyze the risk factors for abnormal glucose metabolism postpartum in patients with GDM.Results A total of 252 eligible patients were included in this study.Among them,212 patients finished 6-week follow-up,and 149 patients finished 6-month follow-up.Among the 212 patients who finished 6-week follow-up postpartum,87(41.04%)patients had abnormal glucose metabolism,3(1.42%)patients had impaired fasting glucose,66(31.13%)had impaired glucose tolerance,and 18(8.49%)patients had type 2 diabetes mellitus.Among the 149 patients who finished 6-month follow-up postpartum,there were 2 new patients with impaired fasting glucose,11 new patients with impaired glucose tolerance,and 3 new patients with type 2 diabetes mellitus.Overweight before pregnancy[body mass index(BMI)≥24 kg/m2]and1-hour OGTT(≥10.1 mmol/L)were the independent risk factors for abnormal glucose metabolism postpartum in pregnant patients with GDM(OR=2.273,2.462;P=0.039,0.023;95%CI=1.495-3.051,1.684-3.240).The Matsuda indexes and 60-minute insulinogenic index in the normal glucose metabolism group were significantly higher than in the abnormal glucose metabolism group(t=7.184 and 2.011,both P<0.05).Conclusion The incidence of abnormal glucose metabolism in patients with GDM at 6 months postpartum remains high.Overweight before pregnancy[body mass index≥24 kg/m2]and 1-hour OGTT(≥10.1 mmol/L)are the independent risk factors for abnormal glucose metabolism postpartum in pregnant patients with GDM.