摘要
目的探讨首次孕检血脂谱和甘油三酯-葡萄糖（TyG）指数与妊娠期糖尿病（GDM）发生风险之间的关系。方法选取2014年6月至2018年2月就诊于中国医科大学附属盛京医院内分泌科门诊的妊娠妇女545例，根据75 g口服葡萄糖耐量试验结果分为正常糖耐量（NGT）组（n=157）和GDM组（n=388）。对两组患者的一般资料和TyG、甘油三酯（TG）、高密度脂蛋白胆固醇（HDL-C）等代谢指标进行比较；组间比较采用独立样本t检验或Mann-Whitney检验，应用Logistic回归对孕期影响GDM发生的相关因素进行分析，受试者工作特征曲线预测孕期发生GDM的各指标的阈值。结果GDM组的TG水平、TyG指数和TG/HDL-C均明显高于NGT组[分别为2.09（1.44，2.94）比1.47（1.02，2.64）mmol/L，1.75（1.38，2.13）比1.16（0.84，1.70），1.30（0.86，1.74）比0.96（0.71，1.44），Z=-2.169、-3.910、-2.283，均P〈0.05]，年龄、孕前体重、孕前最大体重、孕前体质指数（BMI）、超重肥胖的比例、分娩前体重、一级亲属糖尿病家族史、黑棘皮征、既往发生不良妊娠结局的情况也高于NGT组（P〈0.05）。校正年龄、孕前BMI、糖尿病家族史（BMI）、黑棘皮征和既往不良妊娠结局等混杂因素，行Logistic回归分析得出TyG指数（OR=24.138，95%CI：4.167-139.862，P〈0.001）是孕期发生GDM的危险因素，GDM发生风险随着TyG指数的增加而显著增加（OR=10.803，95%CI：10.803-54.244，P=0.004）。ROC曲线示，当TyG指数为1.38时，灵敏度为75.5%，特异度为65.6%,，曲线下面积是0.730（95%CI：0.632-0.827，P〈0.001）；当TG为1.59 mmol/L时，灵敏度为72.6%，特异度为54.3%，曲线下面积是0.623（95%CI：0.513-0.732，P=0.056）。结论当TyG指数〉1.38时，妊娠妇女孕期易发生GDM。
Objective To investigate the association of lipid profiles and triglyceride-glucose （TyG） index at the first visit with the risk of gestational diabetes mellitus （GDM）.Methods Between June 2014 and February 2018, a total of 545 pregnant women were divided into normal glucose tolerance （NGT, n=157） and GDM （n=388） according to 75 g oral glucose tolerance test. The characteristic and metabolic indexes, such as TyGindex, triglyceride （TG）, high density lipoprotein-cholesterol （HDL-C）, were comparedusing Student＇s t-test or Mann-Whitney U test. Logistic regression was used to analyze the risk factors of GDM during pregnancy. Receiver operating characteristic curve predicted the threshold of each indicator affecting the occurrence of GDM.Results The results showed that the level of TG [2.09 （1.44, 2.94） vs 1.47 （1.02, 2.64） mmol/L, Z=-2.169, P=0.030], TyG index [1.75 （1.38, 2.13） vs 1.16 （0.84, 1.70）, Z=-3.910, P〈0.001], and TG/HDL-C [1.30 （0.86, 1.74） vs 0.96（0.71, 1.44）, Z=-2.283, P=0.022] in GDM were significantly higher than NGT. Maternal age, pre-gestational weight, pre-gestational maximum weight, pre-gestational body mass index, proportion of overweight and obesity, prenatal weight, first-degree relatives family history of diabetes, acanthosis, and the incidence of previous adverse pregnancy outcomes were also higher in GDM （P〈0.05）. Adjusted confounding factors, TyG index [odds ratio （OR）=24.138, 95% confidence interval （CI） 4.167-139.862, P〈0.001] was a risk factor for GDM. With the increase of TyG index, the risk of GDM increased significantly （P〈0.05）. ROC curves showed that the cut-off values of TyG index and TG were 1.38 [sensitivity 75.5% and specificity 65.6%; area under the curve （AUC） 0.730, 95% CI： 0.632-0.827, P〈0.001], and 51.59 mmol/L （sensitivity 72.6% and specificity 54.3%; AUC 0.623, 95%CI： 0.513- 0.732, P=0.056）, respectively.Conclusion Pregnant women with TyG index〉1.38 is prone to occur GDM during pregnancy.
作者
唐蕾
杜强
徐诗婷
冯聪
李玲
Tang Lei;Du Qiang;Xu Shiting;Feng Cong;Li Ling(Department of Endocrinology,Shengjing Hospital Affiliated to China Medical University,Shenyang 110004,China)
出处
《中华糖尿病杂志》
CAS
CSCD
北大核心
2018年第10期671-676,共6页
CHINESE JOURNAL OF DIABETES MELLITUS
基金
辽宁省教育厅项目（L2015568）
作者简介
通信作者：李玲，Email：liling8864@hotmail．com
