早孕期体脂率、脂肪质量指数、血脂谱与妊娠期糖尿病的相关性研究

Association between body fat percentage,fat mass index and lipid profile in the first trimester and gestational diabetes mellitus

目的探讨早孕期体脂率(PBF)、脂肪质量指数(FMI)、血脂谱与妊娠期糖尿病(GDM)的相关性。方法选择2020年5月至2021年5月在中山大学附属第三医院产科门诊建档的1578例孕妇作为研究对象。早孕期采用生物电阻抗法检测PBF、脂肪重,测量身高、体重,同时检测血浆空腹血糖(FPG)、总胆固醇(TC)、甘油三酯(TG)、高密度脂蛋白胆固醇(HDL-C)以及低密度脂蛋白胆固醇(LDL-C)。孕24~28周进行75 g口服葡萄糖耐量试验(OGTT),检测FPG、1 h血糖(1hPG)、2 h血糖(2hPG),将研究对象按照OGTT结果分为GDM组(318例)和对照组(1260例)。组间比较采用独立样本t检验、Mann-Whitney U检验、χ^(2)检验,采用logistic回归模型分析各观察指标与GDM患病的相关性。结果GDM患病率为20.15%(318/1578),GDM组年龄、BMI、PBF、FMI、FPG、TC、TG、LDL-C、75 g OGTT-FPG、1hPG、2hPG、孕次≥3次的比例均高于对照组(P<0.05)。年龄≥25岁的GDM患病率增加183.2%(OR=2.832,95%CI 1.414~5.672,P<0.05);BMI≥24.0 kg/m^(2)的GDM患病率增加123.9%(OR=2.239,95%CI 1.674~2.997,P<0.001);PBF≥25%的GDM患病率增加91.2%(OR=1.912,95%CI 1.462~2.501,P<0.001)。分别按FMI、FPG、TC、TG、HDL-C、LDL-C四分位数分组(Q_(1)、Q_(2)、Q_(3)、Q_(4)组)结果显示,FMI的Q_(4)组比Q_(1)组GDM风险增加97.7%,TC的Q_(3)组、Q_(4)组比Q_(1)组GDM风险增加63.3%、55.7%,TG的Q_(4)组比Q_(1)组GDM风险增加54.8%(均P<0.05)。结论年龄≥25岁、BMI≥24.0 kg/m^(2)、PBF≥25%与GDM密切相关,早孕期PBF、FMI、TC、TG水平可为早期预测GDM提供参考依据。

Objective To investigate the association between body fat percentage(PBF),fat mass index(FMI)and lipid profile in the first trimester with gestational diabetes mellitus(GDM).Methods The retrospective analysis was performed on 1578 pregnant women who received prenatal care in the Third Affiliated Hospital of Sun Yat-sen University from May 2020 to May 2021.All subjects were measured by bioelectrical impedance analysis in the first trimester to obtain PBF and fat mass,height and weight,and at the same time plasma fasting blood glucose(FPG),total cholesterol(TC),triglyceride(TG),high density lipoprotein cholesterol(HDL-C),low-density lipoprotein cholesterol(LDL-C)were measured.75 g oral glucose tolerance test(OGTT)was conducted between 24 and 28 weeks,FPG,1 h plasma glucose(1hPG)and 2 h plasma glucose(2hPG)were detected,and the subjects were divided into GDM group(318 cases)and control group(1260 cases)according to OGTT results.Independent samplet-test,Mann-Whitney U andχ^(2)test were used for comparison between groups,logistic regression model was used to analyze the association between observation index and GDM.Results The prevalence of GDM was 20.15%(318/1578).The age,BMI,PBF,FMI,FPG,TC,TG,LDL-C,75 g OGTT-FPG,1hPG and 2hPG,the proportion of gravidity≥3 times in the GDM group were higher than those in the control group(P<0.05).The risk of GDM in those aged≥25 years increased 183.2%(OR=2.832,95%CI 1.414-5.672,P<0.05),BMI≥24.0 kg/m^(2)was 123.9%(OR=2.239,95%CI 1.674-2.997,P<0.001),and PBF≥25%was 91.2%(OR=1.912,95%CI 1.462-2.501,P<0.001).The pregnant women were grouped according to the quartile of FMI,FPG,TC,TG,HDL-C and LDL-C(Q_(1),Q_(2),Q_(3)and Q_(4)group).The Q_(4)group of FMI increased the risk of GDM by 97.7%compared with the Q_(1)group(P<0.05);the Q_(3)group and Q_(4)group of TC increased the risk of GDM by 63.3%and 55.7%compared with the Q_(1)group(P<0.05);the Q_(4)group of TG increased the risk of GDM by 54.8%compared with the Q_(1)group(P<0.05).Conclusion sAge≥25 years,BMI≥24.0 kg/m^(2)and PBF≥25%are closely related to the incidence of GDM.The levels of PBF,FMI,TC and TG in the first trimester can provide a reference for early prediction of GDM.