孕前体重指数与孕期高血脂相互作用在妊娠期糖尿病发病中的干预分析

Intervention analysis of the interaction between pre pregnancy body mass index and pregnancy hyperlipidemia in the pathogenesis of gestational diabetes mellitus

目的研究孕前体重指数(pBMI)与孕期高血脂相互作用对妊娠期糖尿病(GDM)发病的影响。方法选取2019年1月到2022年5月江西省妇幼保健院收治的100例GDM患者作为研究组,另选取同期于本院产检的100名孕期糖耐量正常孕妇作为对照组。比较两组pBMI情况、血脂水平[甘油三酯(TG)、总胆固醇(TC)、低密度脂蛋白胆固醇(LDL-C)及高密度脂蛋白胆固醇(HDL-C)]及其分类,分析GDM发生与pBMI异常与及孕期高血脂水平交互作用的关系,采用Logistic多因素回归分析GDM发生的影响因素。结果研究组pBMI情况差于对照组,差异有统计学意义(P<0.05)。研究组TG水平高于对照组,HDL-C水平低于对照组,差异有统计学意义(P<0.05);两组TC、LDL-C水平比较差异无统计学意义;研究组血脂水平优于对照组,差异有统计学意义(P<0.05)。最佳预测模型包含pBMI、血脂水平这两个因素(P=0.001),具有良好的一致性与准确性。多因素Logistic回归分析结果显示,高TG水平、高TC水平、高TG水平+高TC水平、超重/肥胖均是发生GDM的影响因素(P<0.05);GDM发生风险最高的因素是超重/肥胖合并高TG水平(OR=14.351),且高TG水平患者中超重/肥胖者发病风险明显高于正常体质量者(OR=2.242)。结论GDM发生的危险因素为pBMI异常及孕期高血脂,两者能够发生交互作用,超重/肥胖孕妇合并高TG水平会增加GDM的发生风险。

Objective To study the influence of the interaction between pre-pregnancy body mass index(pBMI)and pregnancy hyperlipidemia on the onset of gestational diabetes mellitus(GDM).Methods 100 patients with GDM admitted to Jiangxi Maternal and Child Health Hospital from January 2019 to May 2022 were selected as the research group,and 100 pregnant women with normal glucose tolerance during pregnancy were se-lected as the control group.The pBMI status and lipid levels(triglyceride[TG],total cholesterol[TC],low density lipoprotein cholesterol[LDL-C]and high density lipoprotein cholesterol[HDL-C])and their classification were compared between the two groups,the interaction between abnormal pBMI and the level of hyperlipidemia during pregnancy was analyzed,Logistic multivariate regression analysis was used to analyze the influencing factors of GDM.Results The pBMI in the study group was worse than that in the control group,and the difference was statistically significant(P<0.05).The TG level in the study group was higher than that in the control group,and the HDL-C level was lower than that in the control group,the differences were statistically significant(P<0.05);there were no significant differences in the levels of TC and LDL-C between the two groups;the blood lipid level in the study group was better than that in the control group,and the difference was statistically significant(P<0.05).The best pre-diction model included pBMI and lipid level(P=0.001),and had good consistency and accuracy.Multivariate Logistic regression analysis showed that high TG level,high TC level,high TG level+high TC level,overweight/obesity were all influencing factors for the occurrence of GDM(P<0.05).The highest risk factor for GDM was overweight/obesity combined with high TG level(OR=14.351),and the risk of overweight/obesity in the high TG level patients was significantly higher than that in the normal weight patients(OR=2.242).Conclusion The risk factors of GDM are abnor-mal pBMI and hyperlipidemia during pregnancy,which can interact with each other,overweight/obese pregnant women with high TG level will in-crease the risk of GDM.