多囊卵巢综合征合并妊娠期糖尿病的影响因素及因素预测价值分析

Analysis of Influencing Factors and Predictive Value of Factors in Polycystic Ovary Syndrome Complicated with Gestational Diabetes Mellitus

目的:分析多囊卵巢综合征(polycystic ovary syndrome,PCOS)合并妊娠期糖尿病(gestational diabetes mellitus,GDM)的影响因素,并分析各因素的预测价值。方法:回顾性选取2018年1月-2021年5月中国人民解放军联勤保障部队第九〇九医院妇产科诊断为PCOS后经规范治疗成功妊娠和分娩的产妇143例。根据是否合并GDM将其分为GDM组(43例)和非GDM组(100例)。检测所有患者临床指标,收集所有患者临床资料。比较两组临床资料及临床指标,并对PCOS合并GDM的影响因素进行Logistic回归分析,并分析不同因素对PCOS合并GDM的预测价值。比较不同因素的预测价值。比较两组不良妊娠结局。结果:143例PCOS患者中43例合并GDM,发生率为30.07%。GDM组GDM家族史占比、稳态模型胰岛素抵抗指数(homeostasis model assessment insulin resistance index,HOMA-IR)、空腹胰岛素(fasting insulin,FINS)、睾酮(testosterone,T)、胱抑素C(Cystatin C,CysC)水平均高于非GDM组,性激素结合蛋白(sex hormone binding protein,SHBG)水平低于非GDM组(P<0.05)。T、HOMA-IR、GDM家族史、CysC均为PCOS合并GDM的独立危险因素,SHBG为PCOS合并GDM的保护因素(P<0.05)。GDM家族史具有较低的AUC(预测价值)。综合指标AUC明显高于单个因素(P<0.05)。GDM组产后出血率高于非GDM组(P<0.05)。两组间早产、胎膜早破、羊水过多、羊水过少发生率比较差异均无统计学意义(P>0.05)。结论:T、HOMA-IR、GDM家族史、CysC均为PCOS患者合并GDM的独立危险因素,SHBG为其保护因素,除GDM家族史外,其他因素均对PCOS合并GDM有较好的预测价值。

Objective:To analyze the influencing factors of polycystic ovary syndrome(PCOS)complicated with gestational diabetes mellitus(GDM),and then to analyze the predictive value of each factors.Method:From January 2018 to May 2021,a total of 143 parturients diagnosed with PCOS and successfully pregnant and delivered via standard treatment in the Department of Gynecology and Obstetrics of the 909th Hospital of Joint Logistics Support Force of the Chinese People’s Liberation Army were retrospectively selected.They were divided into GDM group(43 cases)and non GDM group(100 cases)according to whether GDM was combined or not.The clinical indexes of all patients were detected and the clinical data of all patients were collected.The clinical data and clinical indicators of the two groups were compared,and the influencing factors of PCOS complicated with GDM were analyzed by Logistic regression,and the predictive value of different factors on PCOS complicated with GDM was analyzed.The predictive value of different factors was compared.The adverse pregnancy outcomes of the two groups were compared.Result:Forty-three patients of 143 patients with PCOS were complicated with GDM,with an incidence of 30.07%.The proportion of GDM family history,homeostasis model assessment insulin resistance index(HOMA-IR),fasting insulin(FINS),testosterone(T),and cystatin C(CysC)levels in GDM group were higher than those in non GDM group,the level of sex hormone binding protein(SHBG)was lower than that of non GDM group(P<0.05).T,HOMA-IR,GDM family history and CysC were independent risk factors for PCOS complicated with GDM,and SHBG was the protective factor for PCOS complicated with GDM(P<0.05).GDM family history had a lower AUC(predictive value).The AUC of comprehensive index was significantly higher than that of single factor(P<0.05).The postpartum hemorrhage rate in GDM group was higher than that in non GDM group(P<0.05).There were no significant differences in the incidences of preterm birth,premature rupture of fetal membrane,polyhydramnios and oligohydramnios between the two groups(P>0.05).Conclusion:The T,HOMA-IR,GDM family history and CysC are independent risk factors for PCOS patients complicated with GDM,while SHBG is its protective factor,and except for family history of GDM,other indicators have better predictive value for PCOS patients complicated with GDM.