妊娠中期维生素D、铁蛋白与妊娠期糖尿病的关系

Relationship of vitamin D,ferritin and gestational diabetes mellitus in the second trimester of pregnancy

目的研究妊娠糖尿病(GDM)孕妇妊娠中期铁蛋白(SF)和维生素D(VD)水平变化,并探讨VD、SF与GDM之间的关系。方法选取2020年7月至10月河北省人民医院产科门诊孕24~28周行口服葡萄糖耐量试验(OGTT)的170例孕妇作为研究对象,按照OGTT的结果将研究对象分为GDM组(65例)与正常妊娠(NGT)组(105例)。收集两组孕妇的一般临床资料和血清标本,采用己糖激酶法测定OGTT血糖,采用酶联免疫吸附法测定胰岛素(FINS)、SF、VD。比较两组FINS、SF、VD的差异,并对SF、VD水平与GDM进行相关性分析。结果GDM组妊娠中期SF高于NGT组,VD低于NGT组,差异有统计学意义(P<0.05)。根据VD水平分为VD缺乏、VD不足、VD充足三个等级,两组以上三个等级比较,GDM组整体VD水平低于NGT组,差异有统计学意义(P<0.05)。SF水平与VD、胰岛β细胞分泌功能(HOMA-β)呈负相关,与血红蛋白(Hb)呈正相关(P<0.05)。VD与SF及空腹血糖(FPG)呈负相关,与HOMA-β呈正相关(P<0.05)。结论妊娠中期VD和SF与GDM孕妇的糖代谢指标显著相关,可能和GDM的发病有关。妊娠期高水平的SF可能导致GDM,应重视血清SF的监测,对于SF偏高孕妇适当限制铁元素的摄入,进行个体化铁补充,避免增加GDM的发生风险。低水平VD可能导致GDM,孕期适当补充VD,可能是降低GDM发病率的一种简单而又安全有效的措施。

Objective To study the changes of ferritin(SF)and vitamin D(VD)levels in the second trimester of pregnancy of pregnant women with gestational diabetes mellitus(GDM),and to explore the relationship of VD,SF and GDM.Methods A total of 170 pregnant women who underwent oral glucose tolerance test(OGTT)in the Department of Obstetrics of Hebei General Hospital from July to October 2020 were selected as research objects,and they were divided into GDM group(n=65)and normal glucose tolerance(NGT)group(n=105)according to the results of OGTT.The general clinical data and serum samples of pregnant women were collected,OGTT blood glucose was determined by hexokinase method,fasting insulin(FINS),SF and VD were measured by enzyme-linked immunosorbent assay.The differences of FINS,SF and VD between the two groups were compared,and the correlation of the levels of SF,VD and GDM were analyzed.Results In the second trimester of pregnancy,the SF of the GDM group was higher than that of the NGT group,and the VD was lower than that of the NGT group,the differences were statistically significant(P<0.05).According to the VD level,the GDM group was divided into three grades:VD lack,VD deficiency and VD adequacy.The overall VD level of the GDM group was lower than that of the NGT group,the difference was statistically significant(P<0.05).The level of SF was negatively correlated with VD and homeostasis model assessment-β(HOMA-β),and positively correlated with hemoglobin(Hb)(P<0.05).VD was negatively correlated with SF and fasting plasma glucose(FPG),and positively correlated with HOMA-β(P<0.05).Conclusion VD and SF in the second trimester of pregnancy are significantly correlated with the indexes of glucose metabolism in pregnant women with GDM,which may be related to the pathogenesis of GDM.High levels of SF during pregnancy may lead to GDM,attention should be paid to the monitoring of serum SF,iron intake should be properly restricted for pregnant women with high SF and individualized iron supplementation should be carried out to avoid increasing the risk of GDM.Low level of VD may lead to GDM.Proper supplement of VD during pregnancy may be a simple,safe and effective measure to reduce the incidence of GDM.