[1]张小平,余海珍,赵家宁,等.孕妇妊娠中期糖脂代谢紊乱对不良妊娠结局的影响[J].现代检验医学杂志,2015,30(06):35-38.[doi:10.3969/j.issn.1671-7414.2015.06.010]
　ZHANG Xiao-ping,YU Hai-zhen,ZHAO Jia-ning,et al.Impaction of Glucose and Lipids Metabolic Abnormalities of Pregnant Women in Second Trimester for Adverse Pregnancy Outcomes[J].Journal of Modern Laboratory Medicine,2015,30(06):35-38.[doi:10.3969/j.issn.1671-7414.2015.06.010]
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孕妇妊娠中期糖脂代谢紊乱对不良妊娠结局的影响()
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《现代检验医学杂志》[ISSN:/CN:]

卷:
第30卷
期数:
2015年06期
页码:
35-38
栏目:
论著
出版日期:
2015-12-30

文章信息/Info

Title:
Impaction of Glucose and Lipids Metabolic Abnormalities of Pregnant Women in Second Trimester for Adverse Pregnancy Outcomes
作者:
张小平; 余海珍; 赵家宁; 付超
西安市第四医院检验科，西安710004
Author(s):
ZHANG Xiao-ping; YU Hai-zhen; ZHAO Jia-ning; FU Chao
Department of Clinical　Laboratory，XI’an No.4 Hospitl，Xi’an 710004，China
关键词:
血糖; 三酰甘油; 糖脂代谢紊乱; 妊娠结局
分类号:
R714.2；R446.112
DOI:
10.3969/j.issn.1671-7414.2015.06.010
文献标志码:
A
摘要:
目的探讨孕妇妊娠中期的糖脂代谢异常对不良妊娠结局的影响。方法回顾性分析2013年4月～2014年4月在西安市第四医院产科就诊并分娩的孕妇1　685例，于24～28周检测糖脂等代谢指标并进行常规75　g口服葡萄糖耐量试验的结果。根据国际妊娠并发糖尿病研究组织(IADPSG)推荐的诊断标准分为妊娠糖尿病组(GDM)和糖耐量正常组；根据三酰甘油(TG)水平分为TG增高组(TG≥3.23　mmol/L)和TG正常组(TG＜3.23　mmol/L)，随访并比较妊娠并发症和妊娠结局。统计学分析采用t检验，χ2检验和Logistic回归分析。结果1　685例孕妇中GDM组孕妇占11.69%，TG增高组孕妇占14.01%。①GDM组与糖耐量正常组相比，三酰甘油［(3.61±1.85)　vs　(2.98±1.34)mmol/L，t=5.73］，总胆固醇［(5.07±1.22) vs (4.60±0.99) mmol/L，t=6.03］显著升高，高密度脂蛋白［(1.28±0.61) vs (1.72±0.93) mmol/L，t=-6.47］明显降低，差异均有统计学意义(P值均＜0.01)；GDM组的妊娠高血压(10.66% vs 4.54%)、子痫/子痫前期(7.11% vs 3.29%)、巨大儿(12.18% vs 5.85%)、新生儿窒息(4.57% vs 1.41%)的发生率均显著高于糖耐量正常组，差异均有统计学意义(P值均＜0.05)。②TG增高组与TG正常组相比，BMI(27.3±3.1 kg/m2 vs 20.4±2.3 kg/m2，t=40.59)，空腹血糖［(4.65±0.71) vs (4.27±0.62)mmol/L，t=8.64］，空腹胰岛素［(20.16±10.53) vs (14.35±8.46) mU/L，t=9.86］，稳态模型评估-胰岛素抵抗指数(3.95±1.14 vs 2.72±0.89，t=18.92)明显升高，差异均有统计学意义(P值均＜0.01)。TG增高组的妊娠高血压(10.59% vs 4.42%)、子痫/子痫前期(6.36% vs 3.31%)、巨大儿(11.44% vs 5.80%)、新生儿窒息(4.66% vs 1.31%)的发生率均显著高于TG正常组，差异均有统计学意义(P值均＜0.05)。③Logistic回归分析显示：TG和FPG的异常增高发生妊娠高血压(OR=1.805和1.179，95%CI：1.314～2.249和0.926-1.451)，巨大儿(OR=3.011和2.194，95%CI：2.317～3.526和1.562～2.927)，新生儿窒息(OR=2.529和2.103，95%CI：1.208～5.246和1.591～2.493)，妊娠糖尿病(OR=3.446和2.214，95%CI：1.472～8.254和1.578～3.006)的风险均升高(P值均＜0.05)。结论妊娠中期FPG，TG水平的代谢紊乱，可能造成妊娠不良结局风险增加。
Abstract:
ObjectiveTo discuss the impaction of glucose and lipids metabolic abnormalities of pregnant women in second trimester for adverse pregnancy outcomes．MethodsA retrospective analysis was conducted in Xi’an No.4 Hospital between April 2013 and April 2014，and involved 1 685 women who were at 24～28 weeks of gestation．We collected maternal blood samples and determined glucose and lipids level．Then a 75 g oral glucose tolerance test was performed in 1　685 women．According to IADPSG criteria，women were randomly divided into gestational diabetes mellitus group (GDM) and normal glucose tolerance group．Besides，they were divided into high TG group (TG≥3.23 mmol/L) and TG normal group (TG<3.23 mmol/L) based on the level of triglyceride (TG)．Data were analyzed through t test，Chi-square test and Logistic regression analysis．ResultsThe GDM group accounted for 11.69% and high TG group accounted for 14.01% in 1685 cases of pregnant women．①The levels of average triglyceride［(3.61±1.85)　vs　(2.98±1.34)mmol/L，t=5.73］，total cholesterol ［(5.07±1.22)　vs　(4.60±0.99)mmol/L，t=6.03］ in GDM group increased significantly，while high density lipoprotein (HDL) ［(1.28±0.61) vs (1.72±0.93)mmol/L，t=-6.47］ decreased significantly when compared with normal glucose tolerance group (P<0.01)．The incidence of hypertension of pregnancy (10.66% vs 4.54%)，eclampsi/preeclampsia (7.11% vs 3.29%)，fetal macrosomia (12.18% vs 5.85%)，asphyxia neonatorum (4.57% vs 1.41%) increased significantly in GDM group when compared with normal glucose tolerance group (P<0.05)．②The level of BMI (27.3±3.1 kg/m2vs 20.4±2.3kg/m2，t=40.59)， fasting blood glucose level ［(4.65±0.71) vs (4.27±0.62)mmol/L，t=8.64］，fasting insulin level［(20.16±10.53) vs (14.35±8.46)U/L，t=9.86］，insulin resistance index (3.95±1.14 vs 2.72±0.89，t=18.92) increased significantly in high TG group when compared with normal TG group (P＜0.01)．The incidence of hypertension of pregnancy (10.66% vs 4.54%)，eclampsi/preeclampsia (6.36% vs 3.31%)，fetal macrosomia (11.44% vs 5.80%)，asphyxia neonatorum (4.66% vs 1.31%) increased significantly in high TG group when compared with normal TG group (P<0.05)．③)Logistic regression analysis showed that：the risk of hypertension of pregnancy (OR=1.805 and 1.179，95%CI：1.314～2.249 and 0.926～1.451)，fetal macrosomia (OR=3.011 and 2.194，95%CI：2.317～3.526 and 1.562～2.927)，asphyxia neonatorum (OR=2.529 and 2.103，95%CI：1.208～5.246 and 1.591～2.493)，GDM (OR=3.446 and 2.214，95%CI：1.472～8.254 and 1.578～3.006) were increased when TG and FPG increased abnormally (P＜0.05)．ConclusionThe elevation of FPG and TG of pregnant women in the second trimester may increase the risk of adverse pregnancy outcomes．

参考文献/References:

［1］Lippi G，Albiero A，Montagnana M，et al．Lipid and lipoprotein profile in physiological pregnancy［J］．Clin Lab，2007，53(3/4)：173-177．
[2]International Association of Diabetes and Pregnancy Study Groups Consensus Panel，Metzger BE，Gabbe SG，et al．International association of diabetes and pregnancy study groups recommendations on the diagnosis and dassification of hypergloycemia in pregnancy［J］．Diabetes Care，2010，33(3)：676-682．
[3]牛建民，雷琼，吕莉娟，等．妊娠期代谢综合征诊断标准的评价及其危险因素的分析［J］．中华妇产科杂志，2013，48(2)：92-97． Niu JM，Lei Q，Lü LJ，et al．Evaluation of the diagnostic criteria of gestational metabolic syndrome and analysis of the risk factors［J］．Chinese Journal of Obstetrics and Gynecology，2013，48(2)：92-97．
[4]毕汇文，张新亚，李坚．妊娠期糖尿病与正常妊娠血脂、胰岛素、C肽的对照分析［J］．中国妇幼保健，2008，23(31)：4400-4401． Bi HW，Zhang XY，Li J．The control analysis of serum lipid，insulin， C peptide in gestational diabetes mellitus and normal pregnant［J］．Maternal and Child Health Care of China，2008，23(31)：4400-4401．
[5]赵右更，唐火明，费新娣，等．正常妊娠妇女和妊娠期糖尿病患者血脂代谢的临床观察［J］．中华妇产科杂志，2000，35(6)：365 -366． Zhao YG，Tang HM，Fei XD，et al．Clinical observation of lipids metabolism in normal pregnant women and gestational diabetes mellitus patients［J］．Chinese Journal of Obstetrics and Gynecology，2000，35(6)：365-366．
[6]刘静，周莉，范玲．妊娠期糖尿病血脂与胰岛素抵抗及妊娠结局的研究［J］．医学综述，2012，18(18)：3067-3068，3074． Liu J，Zhou L，Fan L．Gestational diabetes mellitus，blood lipids and insulin resistance and pregnancy outcome［J］．Medical Recapitulate，2012，18(18)：3067-3068，3074．
[7]吴正林，何涛君，侯学荣，等．孕妇在不同糖耐量状态下胰岛β细胞分泌功能和胰岛素抵抗与C肽的关系研究［J］．现代检验医学杂志，2012，27(4)：53-54，57． Wu ZL，He TJ，Hou XR，et al．Study on relationship of islet β-cell function，insulin resistance and fasting C-peptide of pregnant women with different glucose tolerances［J］．J Mod Lab Med，2012，27(4)：53-54，57．
[8]Vrijkotte TG，Krukziener N，Hutten BA，et al．Maternal lipid profile during early pregnancy and pregnancy complications and outcomes：the ABCD study［J］．J Clin Endocrinol Metab，2012，97(11)：3917-3925．
[9]周建军，胡娅莉，王志群，等．妊娠中期母体血脂及尿酸水平对子痫前期、妊娠期糖尿病和巨大儿的预测价值［J］．中华围产医学杂志，2012，15(4)：217-221． Zhou JJ，Hu YL，Wang ZQ，et al．Maternal serum lipid and uric acid levels at 20 weeks of gestation in predicting preeclampsia，gestational diabetes mellitus and macrosomia［J］．Chinese Journal of Perinatal Medicine，2012，15(4)：217-221．
[10]曹泽毅．中华妇产科学［M］．21版．北京：人民卫生出版社，2004：551． Cao ZY．Chinese obstetrics and gynecology［M］．21th Ed.Beijing：People’s Medical Publishing House，2004：551．
[11]Baliutaviciene D，Buinauskiene JB，Petrenko V，et al．Gestational diabetes，obesity，and metabolic syndrome diagnosed during pregnancy［J］．Metab Syndr Relat Disord，2012，10(3)：214-217．
[12]Chatzi L，Plana E，Pappas A，et al．The metabolic syndrome in early pregnancy and risk of gestational diabetes mellitus［J］．Diabetes Metab，2009，35(6)：490-494．
[13]HAPO Study Cooperative Research Group，Metzger BE，Lowe LP，et al．Hyperglycemia and adverse pregnancy outcome［J］．N Engl J Med，2008，358(19)：1991-2002．
[14]雷琼，牛建民，段冬梅，等．妊娠中期脂代谢异常与不良妊娠结局的相关性［J］．中华围产医学杂志，2014，17(8)：527-530． Lei Q，Niu JM，Duan DM，et al．The correlation of the abnormal metabolism of lipid during second-trimester pregnancy and adverse pregnancy outcome［J］．Chinese Journal of Perinatal Medicine，2014，17(8)：527-530．

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备注/Memo

备注/Memo:
作者简介：张小平(1970-)，男，本科，副主任检验师，长期从事临床检验工作，Tel：13759936933，E-mail：xazzxxpp@163.com。
更新日期/Last Update: 1900-01-01