孕早期GDM患者血清25-OH-D、Hcy、HbA1c水平与胰岛素抵抗关系

Correlation between the levels of serum 25-hydroxyvitamin D,homocysteine and glycosylated hemoglobin of pregnant women with gestational diabetes mellitus during the first trimester of pregnancy and their insulin resistance

目的:探究妊娠期糖尿病(GDM)患者孕早期血清25-羟维生素D(25-OH-D)、同型半胱氨酸(Hcy)和糖化血红蛋白(HbA1c)水平与胰岛素抵抗关系。方法:选择本院2019年12月-2022年12月收治的GDM患者134例为GDM组,同期年龄相近孕周匹配的76例正常孕妇为对照组。比较两组孕8~12周时血脂指标[三酰甘油(TG)、总胆固醇(TC)、高密度脂蛋白胆固醇(HDL-C)、低密度脂蛋白胆固醇(LDL-C)]、25-OH-D、Hcy、HbA1c,胰岛素抵抗指标[空腹胰岛素水平(FINS)、胰岛素抵抗指数(HOMA-IR)、胰岛β细胞功能指数(HOMA-β)],采用多因素logistic回归筛选GDM发生的危险因素,并运用Pearson相关性分析25-OH-D、Hcy、HbA1c与胰岛素抵抗关系。结果:GDM组TG、TC、LDL-C高于对照组,HDL-C低于对照组,25(OH)D(25.89±2.67nmmol/L)低于对照组(34.26±3.19 nmmol/L),Hcy(20.96±3.48μmol/L)、HbA1c(6.19%±0.31%)高于对照组(11.03±2.56μmol/L、5.67%±0.97%),FINS、HOMA-IR高于对照组,HOMA-β低于对照组;多因素分析显示,25(OH)D降低和Hcy、HbA1c、FINS、HOMA-IR上升为GDM发生的独立危险因素;Pearson相关性分析,GDM患者25-OH-D与FINS、HOMA-IR呈负相关,与HOMA-β呈正相关;Hcy及HbA1c与FINS、HOMA-IR均呈正相关,与HOMA-β均呈负相关(均P<0.05)。结论:GDM患者血清25-OH-D、Hcy、HbA1c与胰岛素抵抗密切相关,临床监测25-OH-D、Hcy、HbA1c及胰岛素抵抗情况有利于孕早期GDM防治。

Objective:To explore the correlation between the levels of serum 25-hydroxyvitamin D(25-OH-D),homo-cysteine(Hcy)and glycosylated hemoglobin(HbA1c)of pregnant women with gestational diabetes mellitus(GDM)during the first trimester of pregnancy and their insulin resistance.Methods:134 pregnant women with GDM in hospital were included in study group from December 2019 to December 2022,and 76 normal pregnant women with the sim-ilar age and gestational weeks were selected in control group during the same period.The levels of blood lipids indica-tors,such as triglyceride(TG),total cholesterol(TC),high density lipoprotein cholesterol(HDL-C)and low density lipoprotein cholesterol(LDL-C),the levels of 25-0H-D,Hcy and HbAlc,and the values of insulin resistance indica-tors,such as fasting insulin(FINS),homeostasis model assessment of insulin resistance(HOMA-IR)and homeosta-sis model assessment of isletβcell function index(HOMA-β),of the women during 8-12 gestational weeks were com-pared between the two groups.Multivariate logistic regression was used to screen the risk factors of GDM occurrence.Pearson correlation analysis was adopted to analyze the correlation between the levels of 25-0H-D,Hcy and HbA1c of the pregnant women with GDM and their insulin resistance.Results:The levels of TG,TC and LDL-C of the women in the study group were significantly higher than those of the women in the control group,but the HDL-C level of the women in the study group was significantly lower.The 25(OH)D level(25.89±2.67 nmmol/L)of the women in the study group was significantly lower than that(34.26±3.19 nmmol/L)of the women in the control group.The levels of Hcy(20.96±3.48μmol/L)and HbA1c(6.19%±0.31%)of the women in the study group were significantly higher than those(11.03±2.56pmol/L and 5.67%±0.97%)of the women in the control group,The values of FINS and HO-MA-IR of the women in the study group were significantly higher than those of the women in the control group,but the HOMA-βvalue of the women in the study group was significantly lower.Multivariate analysis showed that the de-crease of 25(OH)D level,and the increases of Hcy,HbAlc and FINS level and HOMA-IR value of the women were the independent risk factors for their GDM occurrence.Pearson correlation analysis showed that the 25-0H-D level of the women with GDM was negatively correlated with their FINS level and HOMA-IR value,and was positively corre-lated with their HOMA-value.The levels of Hcy and HbA1c of the women with GDM were positively correlated with their FINS level and HOMA-IR value,and were negatively correlated with their HOMA-βvalue(all P<0.05).Con-clusion:The levels of the serum 25-0H-D,Hcy and HbA1c of the pregnant women with GDM are closely related to their insulin resistance.Clinical monitoring the levels of 25-0H-D,Hcy and HbA1c and the insulin resistance situation of the pregnant women is beneficial to the prevention and treatment of their GDM during the first trimester of pregnancy.