母体血清25-羟维生素D3水平与妊娠期糖尿病发病的相关性

Correlation between maternal serum 25-hydroxyvitamin D3 and the onset of gestational diabetes mellitus

目的分析母体血清25-羟维生素D3水平与妊娠期糖尿病(GDM)发病的相关性。方法选择2015年1月—2017年6月在上海交通大学医学院附属同仁医院产科建立产前检查档案的4 478例孕妇为研究对象,根据孕妇妊娠早期空腹血糖(FBG)水平和口服葡萄糖耐量试验(OGTT)结果分为GDM组(465例)和正常组(4 013名)。分别测定两组孕妇的血清25-羟维生素D3和糖脂代谢产物水平,并分析其与GDM发病的相关性。结果 4 478例孕妇中GDM孕妇占10.38%。GDM组孕妇的维生素D不足发生率为38.71%(180/465),显著高于正常组的14.28%(573/4 013),两组孕妇维生素D不足的总发生率为16.82%(753/4 478);GDM组的25-羟维生素D3水平显著低于正常组(P<0.01)。GDM组孕妇的FBG、三酰甘油(TG)、低密度脂蛋白胆固醇(LDL-C)水平和稳态模型评估的胰岛素抵抗指数(HOMA-IRI)均显著高于正常组(P值均<0.01)。多元线性回归分析结果显示,25-羟维生素D3(OR=0.845,95%CI为0.807~0.878)和TG水平(OR=1.743,95%CI为1.321~1.934)均与孕妇GDM的发病相关(P值分别<0.01、0.05),其中25-羟维生素D3水平是孕妇GDM发病的保护因素,而TG水平是孕妇GDM发病的危险因素。妊娠早期血清25-羟维生素D3水平预测GDM发病的ROC曲线的AUC为0.845,以28.2 nmol/L为参考值,其诊断GDM的灵敏度、特异度、阳性预测值和阴性预测值分别为86.06%、83.60%、56.55%和95.90%。结论 25-羟维生素D3和TG水平可能是GDM发生的相关因素,GDM发病可能与体内25-羟维生素D3水平较低有关。

Objective To determine the relationship between maternal serum 25-hydroxyvitamin D3 and the risk of gestational diabetes mellitus(GDM).Methods A total of 4 478 pregnant women who took prenatal examination in our hospital from January 2015 to June 2017 were recruited in this study.They were divided into GDM group(n=465)and control group(n=4 013)according to the results of fasting blood glucose(FBG)and oral glucose tolerance test(OGTT).Serum 25-hydroxyvitamin D3 concentration and glucose and lipid metabolism were tested.The correlation between serum 25-hydroxyvitamin D3 and the incidence of GDM was determined.Results Among the 4 478 pregnant women,GDM patients accounted for 10.38%.The total incidence of vitamin D deficiency was 16.82%(753/4 478).The incidence of vitamin D deficiency in the GDM group was 38.71%(180/465),which was significantly higher than that in the control group 14.28%(573/4 013).In contrast,the level of 25-hydroxyvitamin D3 in the GDM group was significantly lower than that in the control group(P<0.01).The FBG,triglyceride(TG),low-density lipoprotein cholesterol(LDL-C)levels and HOMA(homeostasis model assessment)steady-state model of insulin resistance index(HOMA-IRI)were significantly higher in the GDM group than those in the control group(all P<0.01).Multiple linear regression analysis demonstrated that 25-hydroxyvitamin D3(OR=0.845,95%CI:0.807-0.878)and TG level(OR=1.743,95%CI:1.321-1.934)were associated with the onset of GDM(P<0.01,0.05).ROC curve showed that AUC was 0.845 when serum 25-hydroxyvitamin D3 was used to predict GDM incidence in early pregnancy.When the reference value was set as 28.2 nmol/L,the sensitivity,specificity,positive predictive value and negative predictive value were 86.06%,83.60%,56.55%and 95.90%,respectively.Conclusion Serum 25-hydroxyvitamin D and TG may be factors associated with GDM.The onset of GDM may be associated with low level of serum 25-hydroxyvitamin D.(Shanghai Med J,2019,42:198-202)