孕期血脂指标与妊娠期糖尿病及新生儿脐血C肽的相关性研究

Study of the correlation between serum lipid parameters during pregnancy and gestational diabetes mellitus and neonatal cord-blood C-peptide

目的分析妊娠期糖尿病(GDM)孕妇孕期血脂水平的变化情况,探讨孕期血脂水平与GDM及新生儿体重及脐血C肽之间的关系。方法采用病例对照研究,收集673例孕妇的临床资料,根据其孕中期75 g口服葡萄糖耐量试验(OGTT)结果分为GDM组(150例)、糖耐量正常(NGT)组(523例)。采用Logistic回归分析GDM发生的风险因素。采用Spearman相关性分析GDM孕妇血脂水平与新生儿体重和新生儿脐血C肽之间的相关性。结果在孕早期阶段,与NGT组相比,GDM组甘油三酯水平更高、脂蛋白a[Lp(a)]水平更低;在孕中期阶段,与NGT组相比,GDM组总胆固醇及HDL-C水平更低;在孕晚期阶段,与NGT组相比,GDM组甘油三酯及载脂蛋白A1/载脂蛋白B(ApoA1/B)水平更高、ApoB水平更低(P均<0.05)。年龄(OR=1.111,95%CI=1.065~1.158,P<0.001)和孕早期Lp(a)(OR=0.660,95%CI=0.454~0.960,P=0.030)是GDM发生的独立因素。新生儿出生体重与孕妇年龄呈负相关(r_(s)=-0.253,P=0.013),与产后BMI(r_(s)=0.241,P=0.017)、孕期增重(r_(s)=0.270,P=0.017)、分娩时胎龄(r_(s)=0.34,P=0.001)呈正相关。在孕早期和孕晚期,新生儿出生体重与甘油三酯、ApoB呈正相关,与ApoA1/B呈负相关。新生儿出生体重与孕晚期ApoE呈正相关(r_(s)=0.227,P=0.025)。新生儿脐血C肽水平与孕中期(r_(s)=-0.218,P=0.038)和孕晚期(r_(s)=-0.227,P=0.031)的ApoE水平呈负相关。结论GDM孕妇在妊娠早期就发生脂代谢紊乱。在妊娠期间,监测血脂的变化,维持正常的血脂水平能有效控制妊娠期并发症,减轻不良妊娠结局对母儿的影响。

Objective To analyze the changes of serum lipid levels in pregnant women with gestational diabetes mellitus(GDM)and the relationship between serum lipid levels during pregnancy and GDM,neonatal birth weight and cord-blood C-peptide.Methods In this case-control study,clinical data of 673 pregnant women were collected.According to the results of 75-g oral glucose tolerance test(OGTT)in the second trimester(Tr2),673 pregnant women were divided into the GDM group(n=150)and normal glucose tolerance(NGT)group(n=523).The risk factors of GDM were identified by Logistic regression analysis.The correlation between serum lipid level,neonatal weight and cord-blood C-peptide in GDM pregnant women was analyzed by Spearman correlation.Results During the first trimester(Tr1),triglyceride(TG)level was higher and lipoprotein(a)[Lp(a)]level was lower in the GDM group than those in the NGT group.During Tr2,TC and high-density lipoprotein cholesterol(HDL-C)levels in the GDM group were lower compared with those in the NGT group.In the third trimester(Tr3),TG level and apolipoprotein A1/B(ApoA1/B)ratio were higher and ApoB level was lower in the GDM group than those in the NGT group,with statistical significance(all P<0.05).Age(OR=1.111,95%CI=1.065-1.158,P<0.001)and Lp(a)in Tr1(OR=0.660,95%CI=0.454-0.960,P=0.030)were the independent factors of the incidence of GDM.Neonatal birth weight was negatively correlated with age(r_(s)=-0.253,P=0.013),whereas positively correlated with postpartal body mass index(BMI)(r_(s)=0.241,P=0.017),gestational weight gain(GWG)(r_(s)=0.270,P=0.017)and gestational age at delivery(r_(s)=0.34,P=0.001).In Tr1 and Tr3,neonatal birth weight was positively correlated with TG and ApoB levels,whereas negatively correlated with ApoA1/B ratio.Neonatal birth weight was positively correlated with ApoE level in Tr3(r_(s)=0.227,P=0.025).Neonatal cord-blood C-peptide level was negatively correlated with ApoE levels in Tr2(r_(s)=-0.218,P=0.038)and Tr3(r_(s)=-0.227,P=0.031).Conclusions Pregnant women with GDM develop lipid metabolism disorder in Tr1.During pregnancy,monitoring the changes in blood lipids and maintaining normal blood lipid levels can effectively control the complications during pregnancy and mitigate the effect of adverse pregnancy outcomes on mother and neonate.