孕前体质指数正常的妊娠期糖尿病孕妇并发脂代谢异常高危因素分析

Analysis of high risk factors of abnormal lipid metabolism of pregnant women with gestational diabetes mellitus and normal pre-pregnancy body mass index

目的:分析孕前体质指数(BMI)正常的妊娠期糖尿病(GDM)孕妇发生脂代谢异常高危因素及预测.方法:选择2018年10月-2020年10月于本院产前检查孕前BMI正常的GDM孕妇167例(观察组)、糖耐量正常孕妇180例(对照组),按照是否发生脂代谢异常将观察组分为脂代谢异常组53例与脂代谢正常组114例,分析GDM孕妇脂代谢异常的发生率及高危因素,探讨孕早期孕妇临床指标对脂代谢异常的预测价值.结果:观察组脂代谢异常发生率(30.5%)高于对照组(6.1%)(P<0.001).脂代谢异常组年龄≥40岁、多胎、多囊卵巢综合征、妊娠期高血压疾病、血糖控制不良的比例,以及GDM3项异常占比、空腹胰岛素、促甲状腺激素、血清转铁蛋白、甘油三酯水平均高于脂代谢正常组(均P<0.05),两组孕次、经产妇、辅助生殖技术受孕占比,以及血清总胆固醇、高密度脂蛋白、低密度脂蛋白水平均无差异(均P>0.05).年龄≥40岁、多囊卵巢综合征、妊娠期高血压疾病、血糖控制不良,以及空腹胰岛素水平、促甲状腺激素、血清转铁蛋白水平异常升高是GDM孕妇发生脂代谢异常的独立危险因素(P<0.05);空腹胰岛素、血清铁蛋白对脂代谢异常具有预测效能(P<0.05),曲线下面积分别为0.861、0.894,截断值空腹胰岛素为12.8 mU/L,血清铁蛋白为447.95mg/dl.结论:孕前BMI正常的GDM孕妇脂代谢异常发生率仍高于正常孕妇,需引起临床重视;孕早期部分临床指标有助于评估脂代谢异常发生风险.

Objective: To analyze the high risk factors of abnormal lipid metabolism of pregnant women with gestational diabetes mellitus(GDM) and normal pre-pregnancy body mass index(BMI), and to study their predictive value. Methods: From October 2018 to October 2020, 167 pregnant women with GDM and normal pre-pregnancy BMI were selected in observation group, and 180 pregnant women with normal glucose tolerance were selected in control group. According to the occurrence of abnormal lipid metabolism, the pregnant women in the observation group were further divided into group A(53 women with abnormal lipid metabolism) and group B(114 women with normal lipid metabolism). The incidence and high risk factors of abnormal lipid metabolism of the pregnant women with GDM were analyzed. The predictive value of clinical indicators of the pregnant women with GDM during the first trimester of pregnancy for their abnormal lipid metabolism was explored. Results: The incidence of abnormal lipid metabolism(30.5%) of the women in the observation group was significantly higher than that(6.1%) of the women in the control group(P<0.001). The proportions of age ≥40 years old, multiple fetus, polycystic ovary syndrome(PCOS), hypertensive disease during pregnancy, poor blood glucose control, and GDM with abnormalities of 3 items, and the levels of fasting insulin, thyroid stimulating hormone, serum transferring, and triglyceride of the women in group A were significantly higher than those of the women in group B(all P<0.05).There were no significant differences in the gravidity,the proportions of parturient women and the women with assisted reproductive technology,and the levels of serum total cholesterol,high density lipoprotein,and low density lipoprotein of the women between the two groups(all P>0.05).Age≥40years old,PCOS,hypertensive disease during pregnancy,poor blood glucose control,and abnormal elevation of the levels of serum fasting insulin,thyroid stimulating hormone,and transferrin of the pregnant women with GDM were the independent risk factors of their abnormal lipid metabolism(P<0.05).The levels of fasting insulin and serum transferrin of the pregnant women with GDM had predictive efficacy for their abnormal lipid metabolism(P<0.05),the area under the curve of which were 0.861and 0.894,and the cut-off values of which were 12.8mU/L and447.95mg/dl.Conclusion:The incidence of abnormal lipid metabolism of the pregnant women with GDM and normal pre-pregnancy BMI is still higher than that of the normal pregnant women,which should be paid more attention to in clinic.Some clinical indicators of the women during the first trimester of pregnancy can help predicting the risk of their abnormal lipid metabolism.