摘要
目的探讨妊娠期糖尿病(GDM)患者产后糖代谢异常(AGM)转归及其影响因素。方法选择2019年1月至12月,于四川大学华西第二医院孕期被诊断为GDM,并于产后4~12周进行75 g口服葡萄糖耐量试验(OGTT)筛查的1175例单胎妊娠产妇为研究对象。根据其产后糖代谢是否正常,将其分为研究组(n=361,产后AGM者)与对照组(n=814,产后糖代谢正常者)。采用回顾性分析方法,收集受试者一般临床资料及孕期与产后4~12周75 g OGTT结果等,并采用成组t检验或χ^(2)检验进行统计学分析。对GDM患者产后AGM转归相关影响因素进行单因素分析与多因素非条件logistic回归分析,探讨其AGM转归的独立影响因素。本研究遵循的程序符合病例收集医院伦理委员会制定的伦理学标准,得到该伦理委员会批准[审批文号:医学科研2021伦审批第(181)号]。结果①24~28孕周时,1175例GDM患者75 g OGTT结果提示,空腹血糖(FPG)及OGTT 1、2 h血糖指标中,1、2、3项升高者分别为639例(54.4%)、373例(31.7%)与163例(13.9%)。②产后4~12周时,1175例GDM患者75 g OGTT结果提示,产后糖代谢正常者为814例(69.3%),AGM为361例(30.7%),包括空腹血糖受损(IFG)为19例(1.6%),糖耐量受损(IGT)为294例(25.0%),IFG+IGT为23例(2.0%),疑似2型糖尿病(T2DM)患者为25例(2.1%)。③产后AGM转归影响因素的单因素分析结果显示,研究组GDM患者年龄、糖尿病家族史发生率,24~28孕周OGTT 1、2 h血糖值,以及2项血糖指标(OGTT 1、2 h血糖)均升高与3项血糖指标(FPG及OGTT1、2 h血糖)均升高者所占比例,均显著高于对照组,而研究组仅1项血糖指标(FPG或OGTT 1 h血糖)升高者所占比例,则显著低于对照组,2组比较,差异均有统计学意义(P<0.05)。④多因素非条件logistic回归分析结果:模型1将受试者年龄、糖尿病家族史及24~28孕周OGTT 1、2 h血糖值进行多因素logistic回归分析结果显示,糖尿病家族史及24~28孕周OGTT 1、2 h血糖值,均为GDM患者产后AGM转归的独立危险因素(OR=1.693、1.205、1.355,95%CI:1.208~2.373、1.088~1.335、1.204~1.524,P=0.002、<0.001、<0.001)。模型2将受试者年龄、糖尿病家族史、24~28孕周OGTT血糖指标升高项目进行多因素logistic回归分析结果显示,糖尿病家族史及24~28孕周OGTT 2项血糖指标(OGTT 1、2 h血糖)升高与3项血糖指标均升高,均为GDM患者产后AGM转归独立危险因素(OR=1.668、1.421、1.747,95%CI:1.192~2.333、1.035~1.952、1.195~2.553,P=0.003、0.030、0.004);24~28孕周仅FPG或OGTT 1 h血糖升高为其独立保护因素(OR=0.401、0.646,95%CI:0.240~0.670、0.418~0.997,P<0.001、=0.048)。结论对于GDM患者产后AGM转归,临床应关注其年龄、糖尿病家族史、孕期OGTT结果等指标。对GDM高危人群进行上述指标持续监测与规范干预,是健全GDM孕前-孕期-产后全程管理的重要环节。
Objective To explore postpartum abnormal glucose metabolism(AGM)outcomes and its influencing factors of patients with gestational diabetes mellitus(GDM).Methods From January to December 2019,a total of 1175 GDM patients with singleton pregnancy who delivered in West China Second University Hospital,Sichuan University and screened glucose by performing 75 g oral glucose tolerance test(OGTT)from 4 to 12 weeks postpartum were selected as research subjects.According to whether their postpartum glucose metabolism was normal or not,they were divided into study group(n=361,with postpartum AGM)and control group(n=814,with normal postpartum glucose metabolism).Retrospective research methods were used to analyze clinical data during pregnancy,such as general information and 75 g OGTT results during pregnancy and 4-12 weeks postpartum,and so on.Independent-samples t test or chi-square test was used to conduct univariate analysis on influencing factors of postpartum AGM in GDM patients;and with combination of previous research results and clinical experience,as well as the above univariate analysis results,multivariate unconditional logistic regression analysis was further conducted to explore independent influencing factors of postpartum AGM in patients with GDM.This study was approved by the Ethics Committee of West China Second University Hospital,Sichuan University[Approval No.2021(181)].Results①Results of 75 g OGTT at 24-28 gestational weeks showed that there were 639 cases(54.4%),373 cases(31.7%)and 163 caes(13.9%)patients with 1,2 and 3 elevated blood glucose values in FPG and OGTT 1 h and 2 h,respectively.②Results of postpartum glucose from 4 to 12 weeks showed that patients with normal postpartum glucose metabolism accounted for 69.3%(814/1175),while patients with AGM accounted for 30.7%(361/1175),including 19 cases(1.6%)of impaired fasting glucose(IFG),294 cases(25.0%)of impaired glucose tolerance(IGT),23 cases(2.0%)of IFG+IGT,and 25 cases(2.1%)of suspected type 2 diabetes mellitus(T2DM).③Univariate analysis results of influencing factors of postpartum AGM in GDM patients showed that age,incidence of family history of diabetes,values of OGTT 1 h and 2 h glucose at 24-28 gestational weeks,proportions of patients with two glucose values(OGTT 1 h and 2 h glucose)increasing,and three glucose values(FPG,OGTT 1 h and 2 h glucose)increasing were statistically higher than those in control group,while proportion of patients with only one glucose value increasing(FPG or OGTT 1 h glucose)was statistically lower than that in control group,and all differences were statistically significant(P<0.05).④Multivariate unconditional logistic regression analysis:results of model 1 adjusting age,family history of diabetes,and glucose values of 75 g OGTT at 24-28 gestational weeks revealed that family history of diabetes,OGTT 1 h and 2 h glucose values were independent risk factors of postpartum AGM in GDM patients(OR=1.693,1.205,1.355;95%CI:1.208-2.373,1.088-1.335,1.204-1.524;P=0.002,<0.001,<0.001).Results of model 2 adjusting age,family history of diabetes,and increasing glucose items of 75 g OGTT at 24-28 gestational weeks revealed that family history of diabetes,two glucose items increasing(OGTT 1 h and 2 h glucose),and three glucose items increasing were independent risk factors of postpartum AGM in GDM patients(OR=1.668,1.421,1.747;95%CI:1.192-2.333,1.035-1.952,1.195-2.553;P=0.003,0.030,0.004).Only FPG or OGTT 1 h glucose increasing were independent protective factors of postpartum AGM in GDM patients(OR=0.401,0.646;95%CI:0.240-0.670,0.418-0.997;P<0.001,=0.048).Conclusions For postpartum AGM in patients with GDM,clinical attention should be paid to indicators,such as age,family history of diabetes,and OGTT results during pregnancy.Targeting high-risk populations for continuous monitoring and standardized interventions for above indicators are critical steps in managing GDM from pre-pregnancy period to postpartum.
作者
张佳妮
毛赤慧
曹祺
王晓东
Zhang Jiani;Mao Chihui;Cao Qi;Wang Xiaodong(Department of Obstetrics and Gynecology,Key Laboratory of Birth Defects and Related Diseases of Women and Children(Sichuan University),Ministry of Education,West China Second University Hospital,Sichuan University,Chengdu 610041,Sichuan Province,China)
出处
《中华妇幼临床医学杂志（电子版）》
CAS
2022年第1期53-60,共8页
Chinese Journal of Obstetrics & Gynecology and Pediatrics(Electronic Edition)
基金
四川省科技计划重点研发项目(2018SZ0265)。
关键词
糖尿病
妊娠
葡萄糖耐量试验
产后期
葡萄糖代谢障碍
糖尿病
2型
产妇
Diabetes,gestational
Glucose tolerance test
Postpartum period
Glucose metabolism disorders
Diabetes mellitus,type 2
Puerperant
