妊娠期糖尿病患者血糖处置指数与不良妊娠结局关系的队列研究

Association between disposition index and adverse pregnancy outcomes among patients with gestational diabetes mellitus:a cohort study

目的:探讨妊娠期糖尿病(GDM)患者血糖处置指数(DI)与不良妊娠结局的关系。方法:选取2015年1月至2017年12月在上海交通大学医学院附属第六人民医院妇产科就诊的1912名女性作为研究对象,根据是否患有GDM分为GDM组(434例)和非GDM组(1478例)。所有受试者均在妊娠24~28周间接受75 g口服葡萄糖耐量试验(OGTT),并收集身高、体重等基本信息和完整妊娠资料。根据75 g OGTT结果计算胰岛素敏感性指数(ISI)和0~120 min胰岛素曲线下面积/血糖曲线下面积(AUC INS120/AUC GLU120),两者的乘积即为DI。不良妊娠结局的定义为大于胎龄儿(LGA)、首次剖宫产、子痫前期和早产。组间比较采用t检验、Wilcoxon秩和检验和χ2检验。采用二分类logistic回归分析探究DI与不良妊娠结局风险之间的关系。结果:与非GDM组相比,GDM组患者ISI显著降低(趋势P<0.001),DI亦显著降低(趋势P<0.001)。校正年龄、体重指数、是否合并其他妊娠并发症、行OGTT时的孕周、胎儿性别和产次后,与DI处于最低四分位数(Q1,DI<2.90)组的GDM患者相比,DI处于第二(Q2,DI 2.90~3.02)、第三(Q3,DI 3.03~3.16)、最高(Q4,DI>3.16)四分位数组GDM患者不良妊娠结局风险分别降低55%(95%CI 0.23~0.87)、34%(95%CI 0.35~1.25)和59%(95%CI 0.24~0.71),差异具有统计学意义(趋势P=0.01)。将DI视为连续变量时,DI每增加1个单位,GDM患者发生不良妊娠结局的风险降低60%(95%CI 0.21~0.73)。但是,非GDM女性中DI与不良妊娠结局未见显著关联(OR=0.66,95%CI 0.36~1.18)。结论:GDM患者的DI水平升高与不良妊娠结局风险降低密切相关。

Objective To investigate the relationship between disposition index(DI)and the risk of adverse pregnancy outcomes in women with gestational diabetes mellitus(GDM).Methods A total of 1912 women were prospectively recruited from January 2015 to December 2017 in Department of Gynecology and Obstetrics of the Shanghai Jiao Tong University of Medicine Affiliated Sixth People′s Hospital.According to whether they had GDM,they were divided into GDM group(434 cases)and non-GDM group(1478 cases).All participants received a 75 g oral glucose tolerance test(OGTT)during the 24-28 gestational weeks and completebasal and delivery information was collected.The insulin sensitivity index(ISI)and the area under the insulin curve/area under the blood glucose curve(AUCINS120/AUCGLU120)were calculated from the results of the 75 g OGTT.The DI was calculated as the product of the ISI and AUCINS120/AUCGLU120 and then log transformed.Adverse pregnancy outcomes were defined as large for gestational age(LGA),primary cesarean section,preeclampsia,and preterm birth.Comparison between groups was performed by t test,Wilcoxon rank sum test andχ2 test.Logistic regression analysis was used to explore the relationship between DI and the risk of adverse pregnancy outcomes.Results Women with GDM had a lower ISI even DI than women without GDM.Compared with women with GDM in the lowest quartile(Q1,DI<2.90)of DI,multivariable adjusted(age,body mass index,other pregnancy complications,gestational age at the time of OGTT,fetal sex and parity)odds ratios(OR)of adverse pregnancy outcomes of those in the second(Q2,DI 2.90-3.02),third(Q3,DI 3.03-3.16),and highest(Q4,DI>3.16)quartiles of DI were reduced by 55%(95%CI 0.23-0.87),34%(95%CI 0.35-1.25),and 59%(95%CI 0.24-0.71)(P for trend=0.01),respectively.When DI was considered as a continuous variable,the multivariable adjusted OR of adverse pregnancy outcomes in women with GDM was reduced by 60%(95%CI 0.21-0.73)for each one unit increase in DI.However,DI was not associated with adverse pregnancy outcomes in women without GDM(OR=0.66,95%CI 0.36-1.18).Conclusion Elevated DI levels in women with GDM are closely associated with a reduced risk of adverse pregnancy outcomes.