妊娠早期血清游离脂肪酸水平与妊娠期糖尿病的关系

Certain serum free fatty acids during the first trimester of pregnancy associated with gestational diabetes mellitus

目的 探讨妊娠早期血清游离脂肪酸与妊娠期糖尿病(gestational diabetes mellitus,GDM)的关系及其对GDM的筛查价值。方法 依托首都医科大学附属北京妇产医院建立的母子健康队列,根据妊娠24~28周时75 g口服葡萄糖耐量试验(oral glucose tolerance test,OGTT)结果,纳入2018年1月至2018年3月在首都医科大学附属北京妇产医院建档并规律产检的GDM妊娠妇女43例,根据年龄(±3岁)和孕前体质量指数(body mass index,BMI)(±3)进行1∶1匹配同期分娩的无妊娠合并症的血糖正常的女性作为对照组,收集妊娠早期血清,应用气相质谱-色谱法检测血清游离脂肪酸水平,比较两组女性妊娠早期血清游离脂肪酸水平的差异;采用多因素Logistic回归法及受试者工作特征(receiver operating characteristic,ROC)曲线分析妊娠早期血清游离脂肪酸水平对GDM的筛查价值。结果 单因素分析结果显示,GDM组妊娠妇女的妊娠早期血清肉豆蔻酸、棕榈酸、棕榈油酸、硬脂酸水平显著高于对照组;而反亚油酸、亚麻酸水平低于对照组;组间差异均有统计学意义(P<0.05)。多因素Logistic回归分析结果显示,棕榈酸(OR=1.322,95%CI:1.14~1.54)、棕榈油酸(OR=1.524,95%CI:1.17~1.99)水平越高,GDM发生风险越高;而反亚油酸水平越高,GDM发生风险越低(OR=0.902,95%CI:0.857~0.950)。妊娠早期血清游离棕榈酸、棕榈油酸、反亚油酸筛查GDM发生的ROC曲线下面积分别为0.649(95%CI:0.534~0.763)、0.650(95%CI:0.535~0.764)、0.646(95%CI:0.529~0.764)。以棕榈酸20.71μmol/L、棕榈油酸0.87μmol/L、反亚油酸69.5μmol/L为临界值,采取并联试验,筛查GDM的ROC曲线下面积为0.865(95%CI:0.775~0.929);筛查GDM的灵敏度为90.7%,特异度为67.44%,Kappa值为0.58,说明筛查结果与实际结果具有中高度一致性,具有一定临床应用价值。结论 妊娠期糖尿病女性与妊娠早期血清游离脂肪酸水平有关,妊娠早期血清游离棕榈酸、棕榈油酸是GDM发生的可能危险因素,反亚油酸是GDM发生的可能保护性因素,三者联合试验可用于GDM临床筛查。

Objective To explore the relationship between circulating fatty acids in early pregnancy and incident gestational diabetes mellitus(GDM)among Chinese pregnant women.Methods We established a prospective nested case-control study using data from an ongoing cohort,which enrolled women in early pregnancy and followed them up in China.Fourty-three GDM cases were identified and matched on maternal age and pregestational body mass index to 43 pregnant women who did not develop GDM during their pregnancy.Maternal clinical data were collected,including fasting plasma glucose,total cholesterol,triglyceride,low-density lipoprotein cholesterol,high density lipoprotein cholesterol in the first trimester of pregnancy,three point blood glucose of oral glucose tolerance test during the second trimester of pregnancy.Plasma fatty acids were determined by gas chromatography-mass spectrometry.Results(1)Levels of myristic acid,palmitic acid,palmitoleic acid,stearic acid during the first trimester of pregnancy in GDM group were significantly higher than in control group[(4.35±2.50)μmol/L vs(3.08±1.79)μmol/L,(23.28±8.70)μmol/L vs(18.12±6.94)μmol/L,(7.33±4.69)μmol/L vs(5.22±4.45)μmol/L,(12.50±4.39)μmol/L vs(9.41±3.45)μmol/L,respectively].While there were two fatty acids that were significantly lower in GDM group than in control group,which is linolelaidic acid,linolenic acid.Logistic regression indicated that higher levels of palmitic acid(OR=1.32;95%CI:1.14-1.54),palmitoleic acid(OR=1.52;95%CI:1.17-1.99)were associated with higher odds of GDM.However,the level of linolelaidic acid were negatively associated with the incidence of GDM.Conclusion We documented adverse associations of palmitic acid and palmitoleic acid but a protective association of linolelaidic acid with GDM among Chinese pregnant women.