摘要
目的探讨影响单纯空腹血糖升高的妊娠期糖尿病（gestational diabetes mellitus，GDM）患者妊娠结局的因素。方法本研究为回顾性研究。研究对象为2012年1月至2015年12月在北京大学第一医院分娩的1 059例单纯空腹血糖升高的GDM孕妇的临床资料。分析这些孕妇的年龄、孕前体重指数、早孕期空腹血糖、口服葡萄糖耐量试验（oral glucose tolerance test，OGTT）各次血糖值、OGTT时间-血糖曲线的曲线下面积（area under the curve，AUC）、糖化血红蛋白、复测空腹血糖（OGTT后1周内），以及胰岛素使用情况等临床指标。根据是否发生不良妊娠结局（包括初次剖宫产、大于胎龄儿、早产、妊娠期高血压疾病、肩难产或产伤、新生儿低血糖及新生儿高胆红素血症），将这些患者分为有或无不良妊娠结局组。采用t或χ2检验，对2组各项临床指标进行单因素分析。对单因素分析差异有统计学意义的变量，再用Logisitc回归模型进行多因素分析。
结果（1）1 059例中，18例（1.7%）需要使用胰岛素控制血糖。591例（55.8%）发生不良妊娠结局。（2）单因素分析结果显示，有不良妊娠结局组年龄≥35岁、孕前体重指数≥25、AUC≥13 mmol/L·h、糖化血红蛋白≥5.5%的比例均高于无不良妊娠结局组[21.7%（128/591）与13.2%（62/468），χ2=12.548；28.9%（171/591）与16.2%（76/468），χ2=23.535；87.5%（517/591）与78.4%（367/468），χ2=15.542；32.9%（155/471）与26.2%（99/377），χ2=4.514；P值均〈0.05]，OGTT服糖后1和2 h的血糖水平高于无不良妊娠结局组[（8.27±1.14）与（8.11±1.19）mmol/L，t=0.367；（7.01±0.85）与（6.88±0.87）mmol/L，t=0.517；P值均〈0.05]。多因素分析结果显示，孕前体重指数〈25及OGTT时间-血糖曲线的AUC〈13 mmol/L·h是不良妊娠结局的保护因素[OR（95%CI）分别为0.498（0.355~0.698）与0.431（0.247~0.752），P值均〈0.01]。结论孕前体重指数〈25及OGTT时间-血糖曲线的AUC〈13 mmol/L·h是单纯空腹血糖升高的GDM患者发生不良妊娠结局的保护因素。临床工作中，可考虑将孕前体重指数〈25及OGTT时间-血糖曲线的AUC〈13 mmol/L·h的单纯空腹血糖升高的GDM患者视为相对低危人群，以减少临床上不必要的过度干预。
ObjectiveTo explore the factors influencing pregnancy outcome of gestational diabetes mellitus （GDM） patients with isolated fasting hyperglycemia.MethodsMedical records of 1 059 GDM patients with isolated fasting hyperglycemia, who gave birth at Peking University First Hospital between January 2012 and December 2015, were retrospectively reviewed. Clinical data, including maternal age, pre-pregnancy body mass index （BMI）, fasting plasma glucose （FPG） in the first trimester, results of oral glucose tolerance tests （OGTT）, area under the curve （AUC） of OGTT, glycosylated hemoglobin （HbA1c）, re-tested FPG （within one week after OGTT） and insulin usage, were analyzed. Patients with or without adverse pregnancy outcome, including first cesarean section, larger for gestational age, preterm birth, hypertensive disorders of pregnancy, dystocia or birth trauma, neonatal hypoglycemia and neonatal hyperbilirubinemia, were respectively divided into two groups. T or Chi-square test was used for univariate analysis. Logistic regression was used for multivariate analysis.ResultsAmong the 1 059 patients, 18 （1.7%） received insulin therapy and 591 had adverse pregnancy outcome （55.8%）. Univariate analysis showed that the percentages of patients whose age≥35 years old, pre-pregnancy BMI≥25, AUC≥13 mmol/L·h or HbA1c≥5.5% were higher in the group with adverse pregnancy outcome than in those without adverse pregnancy outcome [21.7% （128/591） vs 13.2% （62/468）, χ2=12.548; 28.9% （171/591） vs 16.2% （76/468）, χ2=23.535; 87.5% （517/591） vs 78.4% （367/468）, χ2=15.542; 32.9% （155/471） vs 26.2% （99/377）, χ2=4.514; all P〈0.05]. The average values of OGTT-1 h and OGTT-2 h in patients with adverse pregnancy outcome were higher than in those without [（8.27±1.14） vs （8.11±1.19） mmol/L, t=0.367; （7.01±0.85） vs （6.88±0.87） mmol/L, t=0.517; both P〈0.05]. Multivariate analysis showed that pre-pregnancy BMI〈25 and AUC〈13 mmol/L·h were protective factors for adverse pregnancy outcomes [OR （95%CI）： 0.498 （0.355-0.698） and 0.431 （0.247-0.752）, both P〈0.01].ConclusionsPre-pregnancy BMI〈25 and AUC〈13 mmol/L·h are protective factors for adverse pregnancy outcomes in GDM patients with isolated fasting hyperglycemia. Clinical practitioners may regard this group of women as relatively low-risk to avoid unnecessary intervention.
出处
《中华围产医学杂志》
CAS
CSCD
2017年第11期796-800,共5页
Chinese Journal of Perinatal Medicine
关键词
糖尿病
妊娠
血糖
妊娠结局
人体质量指数
葡糖耐量试验
曲线下面积
Diabetes, gestational
Blood glucose
Pregnancy outcome
Body mass index
Glucosetolerance test
Area under curve
