糖化白蛋白水平对妊娠期糖尿病孕妇新生儿不良事件的影响及预测价值

Analysis of influencing factors of neonatal adverse events in pregnant women with gestational diabetes mellitus

目的分析妊娠末糖化白蛋白(GA)水平对妊娠期糖尿病(GDM)孕妇新生儿不良事件的影响。方法回顾性分析2021年1月—2022年7月于北京积水潭医院产科足月分娩的GDM孕妇360例的资料,根据新生儿有无发生不良事件分为新生儿不良事件组(观察组60例)和无新生儿不良事件组(对照组300例),通过单因素分析和二元Logistic回归分析筛选出GDM孕妇新生儿不良事件可能的影响因素,采用受试者工作特征(ROC)曲线分析GA预测新生儿不良事件的价值。结果观察组妊娠末GA水平高于对照组(t=2.324,P=0.020),孕前体质量指数(BMI)大于对照组(t=2.344,P=0.019),妊娠末空腹血糖(FPG)高于对照组(t=2.518,P=0.012),剖宫产率高于对照组(χ^(2)=5.361,P=0.021)。建立二元Logistic回归方程,结果GA高水平是新生儿不良事件的独立危险因素[OR(95%CI)=1.338(1.070~1.672),P=0.011]。ROC曲线分析显示GA水平预测新生儿不良事件的ROC曲线下面积(AUC)为0.592,95%CI为(0.505~0.679),当截断值为14.5%时,其诊断敏感度为0.267,特异度为0.913。结论GDM孕妇妊娠末GA水平与新生儿不良事件的发生有相关性,临床工作中应该重视该指标的参考价值。

Objective To analyze the effect of glycated albumin(GA)level on neonatal adverse events in pregnant women with gestational diabetes mellitus(GDM).Methods The data of 360 pregnant women with GDM who delivered at full term in the Obstetric Department of Beijing Jishuitan Hospital from January 2021 to July 2022 were retrospectively analyzed.They were divided into a group with neonatal adverse events(case group,60 cases)and a group without neonatal adverse events(control group,300 cases).The pregnancy data of the two groups were compared,and the regression equation was established using binary logistic regression analysis for the possible influencing factors screened by univariate analysis.Results The level of GA at the end of pregnancy was higher than that of control group(t=2.324,P=0.020),the pre-pregnancy body mass index(BMI)of the case group was higher than that of the control group(t=2.344,P=0.019),the fasting blood glucose at the end of pregnancy was higher than that of the control group(4.6±0.5 vs 4.5±0.5,t=2.518,P=0.012),and the rate of cesarean section was higher than that of the control group(χ^(2)=5.361,P=0.021).Binary logistic regression equation was established,and GA[OR(95%CI)=1.338(1.070-1.672)]was an independent risk factor for neonatal adverse events(P=0.011).Conclusion GA level at the end of pregnancy of GDM pregnant women is correlated with the occurrence of neonatal adverse events,and the value of this index should be attached importance in clinical work.