摘要/Abstract

摘要： 目的 ·探讨妊娠期糖尿病（ gestational diabetes mellitus，GDM）孕妇血脂与 GDM病情及胰岛素抵抗的相关性；分析孕期血脂对妊娠结局的影响。方法 ·选取 2012年 1月—2017年 4月在上海市第六人民医院产检的 GDM孕妇 922例，孕中期 [(14.7±2.8)周]进行血脂检查，在妊娠 24～ 28周行口服 75 g葡萄糖耐量试验（ oral glucose tolerance test，OGTT）及胰岛功能检查。根据孕中期空腹三酰甘油（ triacylglycerol，TAG）水平，分成 3组：T1组（TAG ≤ 1.3 mmol/L，n310），T2组（1.31.79 mmol/L可作为预测孕晚期 GDM病情的血清学指标（ P0.001）。 ② T3组与 T1组、T2组比较，空腹血糖、空腹胰岛素、胰岛素抵抗指数（ HOMA-IR）及修正的胰岛 β细胞功能指数（ MBCI）明显升高，总体胰岛素敏感性指数（ WBSIS）降低（均 P<0.05）；多因素线性回归分析显示，孕前 BMI及孕中期 TAG与 HOMA-IR独立相关（ β0.213，β0.224，均 P0.000）；孕前 BMI与 MBCI独立相关（ β0.811，P0.000）。 ③ T3组的剖宫产率及巨大儿发生率均高于 T1组（均 P<0.05）；校正年龄及孕前 BMI，孕中期血脂不增加分娩巨大儿风险，孕晚期 TAG>4.19 mmol/L、孕中期至孕晚期 TAG水平增加 > 2.38 mmol/L是分娩巨大儿的高危因素（均 P0.001）。结论 ·孕中期 TAG升高（ TAG>1.79 mmol/L）是胰岛素抵抗的独立相关因素，可作为预测 GDM患者病情的一项参考指标；孕中晚期 TAG水平增加 >2.38 mmol/L及孕晚期 TAG高（TAG>4.19 mmol/L）是分娩巨大儿的危险因素。
关键词: 妊娠期糖尿病, 脂代谢, 胰岛素抵抗, 巨大儿
Abstract:
Objective · To investigate the correlation of plasma lipid with gestational diabetes mellitus (GDM) and insulin resistance in women with GDM, and to analyze the effect of plasma lipid on pregnancy outcome. Methods · A total of 922 pregnant women with GDM who underwent prenatal examination in Shanghai Sixth Peoples Hospital January 2012 to April 2017 were selected for plasma lipid examination in the second trimester of pregnancy [(14.7±2.8) weeks]. Oral 75 g glucose tolerance test (OGTT) and islet function examination were performed during 24-28 weeks of pregnancy. According to the fasting triacylglycerol (TAG) level in the second trimester of pregnancy, they were divided into three groups: group T1 (TAG ≤ 1.3 mmol/L, n310), group T2 (1.31.79 mmol/L could be used as an index to predict glucose status in GDM patients (P0.001). ② Compared with group T1 and T2, group T3 showed significantly increased fasting glucose, fasting insulin, HOMA-IR, MBCI, and decreased WBSIS (all P<0.05). Multivariate linear regression analysis showed that BMI before pregnancy and TAG in the second trimester were independently correlated with HOMA-IR (β0.213, β0.224, both P0.000). BMI before pregnancy was independently correlated with MBCI (β0.811, P0.000). ③ The incidences of macrosomia and caesarean in group T3 were significantly higher than those in group T1 (both P<0.05). After adjusting for age and pre-pregnancy BMI, TAG in the second trimester did not increase the risk of macrosomia. TAG>4.19 mmol/L in the third trimester and TAG level in the second trimester to the third one increasing2.38 mmol/L or more, were high risk factors for macrosomia (both P0.001). Conclusion · Increased TAG (TAG>1.79 mmol/L) in the second trimester is an independent and correlated factor of insulin resistance, which may aggravate GDM. Increased TAG levels (TAG increasing>2.38 mmol/L) the second trimester to the third one and high TAG (TAG>4.19 mmol/L) in the third trimester are risk factors for macrosomia.
Key words: gestational diabetes mellitus, lipid metabolism, insulin resistance, macrosomia


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