血液流变学指标预测妊娠糖尿病患者妊娠结局的价值

Value of hemorheological parameters in prediction of pregnancy outcomes in patients with gestational diabetes mellitus

目的探讨血液流变学变化对妊娠糖尿病(GDM)患者妊娠结局的预测价值。方法采用回顾性研究,选取2020年1月至12月于黄石市妇幼保健院产科检查并分娩的80例GDM孕妇(GDM组),根据妊娠结局分为妊娠结局良好组(35例)和妊娠结局不良组(45例),选择同期产前检查健康孕妇68例作为对照组。GDM组年龄(30.55±4.23)岁,体重(67.52±6.34)kg,受教育程度:高中及以下30例、大专25例、本科及以上25例;对照组年龄(29.84±3.91)岁,体重(66.08±6.01)kg,受教育程度:高中及以下28例、大专20例、本科及以上20例。比较两组研究对象血液流变学参数的变化,采用χ^(2)检验、t检验进行比较,多变量logistic回归模型分析GDM患者妊娠结局不良的危险因素,受试者操作特征曲线(ROC)评估血液流变学参数预测GDM患者妊娠结局不良的诊断效能。结果GDM组的血浆黏度(PV)、血细胞压积(HCT)、高剪切全血黏度(HWBV)、低剪切全血黏度(LWBV)、红细胞沉降率(ESR)均高于对照组[(1.78±0.32)mPs·s比(1.54±0.33)mPs·s、(45.60±6.56)%比(37.64±5.71)%、(9.41±0.89)mPs·s比(7.61±1.44)mPs·s、(7.93±1.34)mPs·s比(5.36±1.73)mPs·s、(62.05±8.73)mm/h比(49.55±6.81)mm/h],差异均有统计统计学意义(均P<0.05)。妊娠结局良好组PV、HCT、HWBV、LWBV低于妊娠结局不良组[(1.56±0.33)mPs·s比(1.95±0.17)mPs·s、(39.77±2.11)%比(50.14±5.12)%、(8.66±0.88)mPs·s比(10.00±0.16)mPs·s、(6.75±0.74)mPs·s比(8.85±0.95)mPs·s],差异均有统计统计学意义(均P<0.05);两组ESR比较,差异无统计学意义(P>0.05)。血液流变学指标中,PV、HCT、HWBV、LWBV升高是GDM患者不良妊娠结局的潜在风险因素(OR=17.618、1.160、5.697、1.890,均P<0.05),四者联合检测评估不良妊娠结局发生的灵敏度为95.6%、特异度为97.1%、曲线下面积为0.980。结论血液流变学指标在预测GDM患者妊娠结局中具有重要价值,联合检测可显著提高诊断的灵敏度和特异度。

Objective To analyze and explore the value of hemorheological changes in the prediction of pregnancy outcomes in patients with gestational diabetes mellitus(GDM).Methods A retrospective analysis was conducted on 80 patients with GDM(a GDM group)who underwent obstetric examination and delivery at Huangshi Maternal and Child Health Hospital from January to December 2020.The patients were divided into a good pregnancy outcome group(35 cases)and a poor pregnancy outcome group(45 cases)according to the pregnancy outcomes.Sixty-eight healthy pregnant women who underwent prenatal examination during the same period were selected as a control group.The GDM group was(30.55±4.23)years old;their body weight was(67.52±6.34)kg;30 cases'education level was high school or below,25 cases'college,and 25 cases'bachelor's degree or above.The control group was(29.84±3.91)years old;their body weight was(66.08±6.01)kg;28 cases'education level was high school or below,20 cases'college,and 20 cases'bachelor's degree or above.The hemorheological parameters were compared between the two groups byχ^(2) and t tests.The multivariate logistic regression model was used to analyze the risk factors affecting poor pregnancy outcomes in the patients.The diagnostic efficacies of hemorheological parameters in predicting poor pregnancy outcomes in the patients were assessed using the receiver operating characteristic curve(ROC).Results The plasma viscosity(PV),hematocrit(HCT),high shear whole blood viscosity(HWBV),low shear whole blood viscosity(LWBV),and erythrocyte sedimentation rate(ESR)of the GDM group were higher than those of the control group[(1.78±0.32)mPs·s vs.(1.54±0.33)mPs·s,(45.60±6.56)%vs.(37.64±5.71)%,(9.41±0.89)mPs·s vs.(7.61±1.44)mPs·s,(7.93±1.34)mPs·s vs.(5.36±1.73)mPs·s,and(62.05±8.73)mm/h vs.(49.55±6.81)mm/h],with statistical differences(all P<0.05).The PV,HCT,HWBV,and LWBV of the good pregnancy outcome group were lower than those of the poor pregnancy outcome group[(1.56±0.33)mPs·s vs.(1.95±0.17)mPs·s,(39.77±2.11)%vs.(50.14±5.12)%,(8.66±0.88)mPs·s vs.(10.00±0.16)mPs·s,and(6.75±0.74)mPs·s vs.(8.85±0.95)mPs·s],with statistical differences(all P<0.05);there were no statistical differences in the ESR between the two groups(P>0.05).PV,HCT,HWBV,and LWBV were correlated with the occurrence of adverse pregnancy outcomes in the patients and were the potential risk factors for adverse pregnancy outcomes(OR=17.618,1.160,5.697,and 1.890;all P<0.05).The sensitivity,specificity,and area under the curve of the combination of the four indicators for assessing adverse pregnancy outcomes in the patients were 95.6%,97.1%,and 0.980.Conclusion Hemorheological indicators have significant value in predicting the pregnancy outcomes of GDM patients,and combined detection can significantly improve the sensitivity and specificity of the diagnosis.