妊娠晚期显性糖尿病的临床特征及围产结局分析

Analysis of the clinical characteristics and perinatal outcomes of dominant diabetes in late pregnancy

目的 研究妊娠晚期显性糖尿病(ODM)的临床特点和围产结局。方法 回顾性分析2015年6月—2020年6月在本院就诊的妊娠晚期ODM患者(ODM组)23例、妊娠期糖尿病患者(GDM组)114例及正常妊娠孕妇(正常组)114例的临床资料。记录并比较三组不良妊娠结局发生率,比较不同妊娠孕妇基本资料和临床特征指标水平。分析ODM发生不良妊娠结局的影响因素,建立预测模型,并分析其准确性。结果 ODM组不良妊娠结局发生率(34.78%)显著高于GDM组(13.16%)和正常组(5.26%)(P<0.05);ODM组患者糖尿病家族史发生率、空腹血糖(FPG)、糖化血红蛋白(HbA1c)、餐后2 h血糖(2 h PBG)、血清胱抑素C(CysC)、同型半胱氨酸(Hcy)、收缩期峰值流速/舒张末期流速(S/D)、阻力指数(RI)及搏动指数(PI)显著高于GDM组和正常组(P<0.05)。Logistic多因素分析结果显示糖尿病家族史、HbA1c、2h PBG、CysC、S/D及PI是不良妊娠结局的独立影响因素(P<0.05)。ROC分析结果显示该模型判断不良妊娠结局的AUC为0.819(P<0.05)。结论 妊娠晚期ODM不良妊娠结局发生率显著高于GDM和正常孕妇,其不良妊娠结局与糖尿病家族史、HbA1c、2hPBG、S/D及PI有关,据此建立预测模型有助于判断不良妊娠结局风险。

Objective To investigate the clinical characteristics and perinatal outcome of overt diabetes mellitus(ODM)in late pregnancy.Methods The clinical data of 23 cases of ODM(ODM group)patients, 114 cases of gestational diabetes mellitus patients(GDM group)and 114 cases of normal pregnancy women(normal group),those were ever hospitalized in our hospital from June 2015 to June 2020,were retrospectively analyzed.The incidence of adverse pregnancy outcomes in the three groups were recorded and compared, and the basic data and clinical characteristics of different pregnant women were compared.To analyze the influencing factors of adverse pregnancy outcome of ODM,establish the prediction model, and analyze its accuracy.Results The incidence of ODM adverse pregnancy outcome in ODM group(34.78%)was significantly higher than that of GDM group(13.16%)and normal group(5.26%)(P<0.05).The indicators such as proportion of family history of diabetes, fasting blood glucose(FPG),glycosylated hemoglobin(HbA1 c),postprandial 2 h blood glucose(2 h PBG),serum cystatin C(CysC),homocysteine(Hcy),systolic peak velocity/end diastolic velocity(S/D),resistance index(RI),and pulsatility index(S/D)in the ODM group were significantly higher than those of GDM group and normal group(P<0.05).The Logistic multivariate analysis results showed family history of diabetes, HbA1 c, 2 h PBG,CysC,S/D and PI were independent influence factors of adverse pregnancy outcome(P<0.05).The ROC analysis results show that the AUC of this model for judging adverse pregnancy outcomes was 0.819(P<0.05).Conclusions The incidence of adverse pregnancy outcomes in late pregnancy in ODM group is significantly higher than that in GDM and normal pregnant women.The adverse pregnancy outcomes are related to family history of diabetes, HbA1 c, 2 hPBG,S/D and PI.Based on this, a predictive model is established to help determine the risk of adverse pregnancy outcomes.