妊娠期糖尿病孕妇产后血脂代谢特点及影响因素分析

Analysis of the characteristics of lipid metabolism of pregnant women with gestational diabetes mellitus after delivery and its influencing factors

目的:分析妊娠期糖尿病(GDM)孕妇产后血脂代谢特点及发生产后高脂血症危险因素。方法:选择2018年1月—2019年10月于本院产科就诊并分娩的GDM孕妇164例(GDM组),糖耐量正常孕妇160例(对照组),根据产后6-8周血脂指标情况将GDM组分为高脂血症组与血脂代谢正常组。比较GDM组与对照组产后6-8周血脂代谢指标,分析GDM孕妇产后高脂血症发生危险因素。结果:GDM组分娩时及产后6-8周时总胆固醇(TC)、甘油三酯(TG)、低密度脂蛋白(LDL)均大于对照组,高密度脂蛋白(HDL)小于对照组(P<0.05)。高脂血症组孕妇年龄、血糖控制不良比例、产后体质指数(BMI)均大于血脂代谢正常组(P<0.05),孕期增重、初产妇、胰岛素治疗、分娩孕周、入组时BMI、新生儿出生体重与血脂代谢正常组无差异(P>0.05);孕妇分娩时TC、TG、LDL、口服葡萄糖耐量试验2h(OGTT)水平均大于血脂代谢正常组(P<0.05),HDL、FPG、1h OGTT水平与血脂代谢正常组无差异(P>0.05)。产后BMI、血糖控制不良、分娩时TC、TG及OGTT(2h)异常升高是GDM孕妇发生产后高脂血症的独立危险因素(P<0.05)。结论:GDM孕妇产后6-8周仍存在血脂代谢异常,尤其是肥胖、妊娠期血糖控制不良、分娩时TC、TG及2h OGTT较高者发生产后高脂血症风险增加。

Objective:To analyze the characteristics of postpartum lipid metabolism of pregnant women with gestational diabetes mellitus(GDM),and to study its influencing factors.Methods:164 pregnant women with GDM were selected in study group,and 160 pregnant women with normal glucose tolerance were selected in control group from January 2018 to October 2019.According to blood lipid indexes of the women in postpartum 6-8 weeks,the women in the study groups were further divided into group A(women with hyperlipidemia)and group B(women with normal blood lipid metabolism).The levels of blood lipid metabolism indexes of the women in postpartum 6-8 weeks were compared between the study group and the control group.The risk factors of postpartum hyperlipidemia of the women with GDM were analyzed.Results:The levels of total cholesterol(TC),triglyceride(TG),and low-density lipoprotein(LDL)of the women in the study group at delivery,and in 6 to 8 weeks after delivery were significantly higher than those of the women in the control group,while high density lipoprotein(HDL)level of the women in the study group was significantly lower than that of the women in the control group(P<0.05).The age,the proportion of poor blood glucose control,and the postpartum body mass index(BMI)value of the women in group A were significantly higher than those of the women in group B(P<0.05).There were no significant differences in the value of gestational weight gain,the proportion of primiparas,the insulin treatment rate,the gestational weeks at delivery,and the BMI value at enrollment in this study,and the newborn birth weight of the women between group A and group B(P>0.05).The levels of TC,TG,LDL,and 2 h blood glucose level of oral glucose tolerance test(OGTT)of the women in group A were significantly higher than those of the women in group B(P<0.05),and there were no significant differences in the levels of HDL,FPG,and 1 hblood glucose of OGTT of the women between group A and group B(P>0.05).The postpartum BMI value,the poor blood glucose control,the abnormal increase of the levels of TC and TG during delivery,and 2 hblood glucose level of OGTT during pregnancy were the independent risk factors of postpartum hyperlipidemia of the pregnant women with GDM(P<0.05).Conclusion:In postpartum 6-8 weeks,the women with GDM still has abnormal lipid metabolism,especially for those women with obese,with poor blood glucose control during pregnancy,and with the high levels of TC and TG during delivery,or with the high 2 hblood glucose level of OGTT during pregnancy have the high risk of postpartum hyperlipidemia.