摘要
目的探讨妊娠妇女合并非酒精性脂肪性肝病(NAFLD)对妊娠期糖脂代谢的影响。方法选取复旦大学附属闵行医院2013年1月至2020年6月期间分娩的孕妇进行回顾性分析。通过医院电子病历系统获取孕妇的基本人口学资料、实验室糖脂代谢数据和最终母婴结局的信息。以B超结果作为NAFLD诊断依据,分为NAFLD组和对照组,比较2组孕妇糖脂代谢相关指标及妊娠期糖尿病、妊娠期高血压的发病率,并运用logistic回归模型评价妊娠合并NAFLD与代谢相关妊娠结局的关联。结果本研究共纳入14708名孕妇,平均年龄(29.1±4.7)岁,平均孕前体重指数(21.0±2.8)kg/m2,其中NAFLD孕妇占3.8%(554例)。NAFLD组具有更高的空腹血糖[(4.2±0.5)mmol/L对(4.1±0.5)mmol/L,P<0.01]、糖负荷后1 h[(7.4±1.7)mmol/L对(6.6±1.6)mmol/L,P<0.01]和2 h血糖[(6.2±1.4)mmol/L对(5.7±1.3)mmol/L,P<0.01]、HbA1C[(5.2±0.4)%对(5.1±0.5)%,P<0.01]、三酰甘油[(2.1±1.1)mmol/L对(1.6±0.7)mmol/L,P<0.01]、总胆固醇[(4.8±0.8)mmol/L对(4.7±0.9)mmol/L,P<0.01]、低密度脂蛋白胆固醇[(2.6±0.7)mmol/L对(2.5±0.7)mmol/L,P<0.01]、尿酸[(224.1±51.8)μmol/L对(203.0±45.9)μmol/L,P<0.01]水平。在校正相关混杂因素后,NAFLD组妊娠期糖尿病(OR=1.722,95%CI 1.079~2.747,P=0.023)和妊娠期高血压(OR=3.845,95%CI 2.247~6.582,P<0.001)风险较对照组升高。结论与非NAFLD孕妇相比,NAFLD孕妇妊娠期糖脂代谢紊乱显著,并且妊娠期糖尿病、妊娠期高血压发生率更高。提示应加强对合并NAFLD的妊娠妇女糖脂代谢、血压的监测,预防妊娠期糖尿病及高血压的发生。
ion.According to the ultrasound imaging,all pregnant women were divided into NAFLD group and control group.The difference of glucose and lipid metabolism indexes,incidence of gestational diabetes mellitus,and gestational hypertension between two groups were compared.Logistic regression model was used to examine potential associations between NAFLD and metabolic related adverse pregnancy outcomes.Results A total of 14708 pregnant women with a mean age of(29.1±4.7)years and a mean body mass index of(21.0±2.8)kg/m2 were included in our study.Of those eligible women,554(3.8%)were confirmed by ultrasound as NAFLD.Pregnant women with NAFLD presented higher circulating levels of fasting glucose[(4.2±0.5)mmol/L vs(4.1±0.5)mmol/L,P<0.01],1 h plasma glucose[(7.4±1.7)mmol/L vs(6.6±1.6)mmol/L,P<0.01]and 2 h plasma glucose[(6.2±1.4)mmol/L vs(5.7±1.3)mmol/L,P<0.01]after glucose loading,HbA1C[(5.2±0.4)%vs(5.1±0.5)%,P<0.01],triglyceride[(2.1±1.1)mmol/L vs(1.6±0.7)mmol/L,P<0.01],total cholesterol[(4.8±0.8)mmol/L vs(4.7±0.9)mmol/L,P<0.01],low density lipoprotein-cholesterol[(2.6±0.7)mmol/L vs(2.5±0.7)mmol/L,P<0.01],uric acid[(224.1±51.8)μmol/L vs(203.0±45.9)μmol/L,P<0.01]level.After adjusting for potential confounders,NAFLD significantly increased the risk of gestational diabetes mellitus(OR=1.722,95%CI 1.079-2.747,P=0.023)and gestational hypertension(OR=3.845,95%CI 2.247-6.582,P<0.001).Conclusions Compared to non NAFLD,women with a diagnosis of NAFLD had more significant glucose and lipid metablic aberrations during pregnancy and increased incidence of gestational diabetes and gestational hypertension.Pregnant women with NAFLD should be closely monitored on glucose and lipid metabolism and blood pressure to prevent gestational diabetes mellitus and hypertension.
作者
钱懿灵
张钰
李雪松
宋玉萍
范晓方
杨架林
Yiling Qian;Yu Zhang;Xuesong Li;Yuping Song;Xiaofang Fan;Jialin Yang(Department of Endocrinology,Minhang Hospital Affiliated to Fudan University,Shanghai 201199,China)
出处
《中华内分泌代谢杂志》
CAS
CSCD
北大核心
2021年第12期1056-1060,共5页
Chinese Journal of Endocrinology and Metabolism
基金
国家自然科学基金(82070889、81900788)。
关键词
非酒精性脂肪性肝病
糖脂代谢
妊娠期糖尿病
妊娠期高血压
Nonalcoholic fatty liver disease
Glucose and lipid metabolism
Gestational diabetes mellitus
Gestational hypertension
