血浆动脉粥样硬化指数与妊娠期糖尿病及妊娠结局的关系

Relationships between atherogenic index of plasma and gestational diabetes mellitus and pregnancy outcomes

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摘要目的探讨血浆动脉粥样硬化指数(AIP)与妊娠期糖尿病(GDM)及妊娠结局的关系。方法选取2020年10月—2021年5月于安徽医科大学第一附属医院内分泌科行75 g口服葡萄糖耐量试验的妊娠24~28周的435例孕妇,分为GDM组(217例)和正常对照组(NGT组,218例)。记录所有研究对象临床资料,比较两组临床指标和AIP,采用Pearson相关性分析和多因素logistic回归分析进一步分析GDM患者妊娠中期AIP水平与不良妊娠结局的关系。结果与NGT组比较,GDM组年龄、妊娠前体质量、妊娠前体质量指数(BMI)、空腹血糖(FBG)、1 h血糖(1 h BG)、2 h血糖(2 h BG)、空腹胰岛素(FINS)、2 h胰岛素(2 h INS)、空腹C肽(FCP)、1 h C肽(1 h CP)、2 h C肽(2 h CP)、胰岛素抵抗指数(HOMA-IR)、血糖曲线下面积(AUC-G)、胰岛素曲线下面积(AUC-I)、三酰甘油(TG)、AIP升高,胰岛β细胞功能指数(HOMA-β)、胰岛素敏感指数(ISI)、高密度脂蛋白胆固醇(HDL-C)降低,差异均有统计学意义(均P<0.05)。Pearson相关分析结果显示:GDM组AIP与孕周、妊娠前体质量、妊娠前BMI、FBG、2 h BG、FINS、1 h INS、2 h INS、FCP、1 h CP、2 h CP、HOMA-IR、HOMA-β、AUC-G、AUC-I、TG均呈正相关(r=0.141,0.213,0.222,0.221,0.229,0.324,0.136,0.185,0.262,0.135,0.227,0.341,0.172,0.180,0.165,0.886,均P<0.05),与ISI、TC、HDL-C、LDL-C均呈负相关(r=-0.341,-0.212,-0.709,-0.346,均P<0.05)。NGT组中,40例发生不良妊娠结局,发生率为18.35%;GDM组中,45例发生不良妊娠结局,发生率为20.74%。多因素logistic回归分析结果显示:AIP、TG是GDM患者不良妊娠结局的独立危险因素(OR=1.016,2.679,均P<0.05)。结论GDM患者AIP水平较正常糖耐量孕妇升高,且与糖脂代谢、胰岛素抵抗密切相关。GDM患者的不良妊娠结局发生率较高,AIP、TG是GDM患者不良妊娠结局的独立危险因素,可考虑针对上述患者采取相关干预措施,以改善患者的妊娠结局。 Objective To explore the relationships between atherogenic index of plasma(AIP)and gestational diabetes mellitus(GDM)and pregnancy outcomes.Methods From October 2020 to May 2021,435 pregnant women of 24-28 gestational weeks receiving 75 g oral glucose tolerance test(OGTT)in Department of Endocrinology,the First Affiliated Hospital of Anhui Medical University were selected and divided into GDM group(217 cases)and normal control group(NGT group,218 cases).The clinical data were recorded,the clinical indexes and AIP in the two groups were compared,Pearson correlation analysis and logistic regression analysis were used to further analyze the relationships between AIP level during the second trimester of pregnancy and adverse pregnancy outcomes in GDM patients.Results Compared with NGT group,age,pre-pregnancy weight,pre-pregnancy body mass index(BMI),fasting blood-glucose(FBG),one-hour blood glucose(1 h BG),two-hour blood glucose(2 h BG),fasting insulin(FINS),two-hour insulin(2 h INS),fasting C peptide(FCP),one-hour C peptide(1 h CP),two-hour C peptide(2 h CP),insulin resistance index(HOMA-IR),area under the curve of blood glucose(AUC-G),area under the curve of insulin(AUC-I),triacylglycerol(TG),and AIP in GDM group increased,HOMA ofβcell(HOMA-β),insulin sensitivity index(ISI),and high density lipoprotein cholesterol(HDL-C)decreased,there were statistically significant differences(P<0.05).Pearson correlation analysis showed that AIP was positively correlated with gestational age,pre-pregnancy weight,pre-pregnancy BMI,FBG,2 h BG,FINS,1 h INS,2 h INS,FCP,1 h CP,2 h CP,HOMA-IR,HOMA-β,AUC-G,AUC-I,and TG in GDM group(r=0.141,0.213,0.222,0.221,0.229,0.324,0.136,0.185,0.262,0.135,0.227,0.341,0.172,0.180,0.165,0.886,P<0.05),AIP was negatively correlated with ISI,TC,HDL-C,and LDL-C(r=-0.341,-0.212,-0.709,-0.346,P<0.05).In NGT group,40 cases were found with adverse pregnancy outcomes,the incidence rate was 18.35%;in GDM group,45 cases were found with adverse pregnancy outcomes,the incidence rate was 20.74%.Multivariate logistic regression analysis showed that AIP and TG were independent risk factors of adverse pregnancy outcomes in GDM patients(OR=1.016,2.679,P<0.05).Conclusion AIP level in GDM patients is higher than that in normal glucose tolerance pregnant women,and it is closely related to glucose metabolism,lipid metabolism,and insulin resistance.GDM patients have a higher incidence rate of adverse pregnancy outcomes.AIP and TG are independent risk factors of adverse pregnancy outcomes in GDM patients.Related interventions may be considered for the above-mentioned patients to improve pregnancy outcomes of the patients.

作者江黎晨任玉梅郑文静王中新胡红琳 JIANG Li-chen;REN Yu-mei;ZHENG Wen-jing;WANG Zhong-xin;HU Hong-lin(Department of Endocrinology,the First Affiliated Hospital of Anhui Medical University,Hefei,Anhui 230000,China;不详)

机构地区安徽医科大学第一附属医院内分泌科安徽医科大学第一附属医院检验科

出处《中国妇幼保健》 CAS 2024年第8期1391-1396,共6页 Maternal and Child Health Care of China

基金安徽省科学技术厅公益性技术应用研究联动计划项目(1704f0804026)。

关键词妊娠期糖尿病动脉粥样硬化指数妊娠结局 Gestational diabetes mellitus Atherogenic index of plasma Pregnancy outcome

分类号 R714.256 [医药卫生—妇产科学]

作者简介通信作者:胡红琳,E-mail:479375436@qq.com。