摘要
目的 探究妊娠糖尿病(GDM)患者产后糖耐量试验转归和胰岛素抵抗情况及其与不良妊娠结局的相关性.方法 回顾性选取2020年10月至2022年10月在邢台市中心医院产科定期产检并进行分娩的400例GDM患者为研究对象,所有患者均接受糖耐量试验检查及胰岛素抵抗水平检查,并对其妊娠结局进行追踪记录,并根据其妊娠结局进行分组.有88例患者出现妊娠不良结局,纳入不良结局组,其他312例患者纳入良好结局组.比较良好结局组和不良结局组临床资料[年龄、孕前体重指数、孕周、糖尿病家族史、饮酒史、血压、总胆固醇、甘油三酯、低密度脂蛋白胆固醇(LDL-C)、高密度脂蛋白胆固醇(HDL-C)]、产后糖耐量试验转归和胰岛素抵抗情况,并采用Spearman相关系数分析产后6周糖耐量试验结果及胰岛素抵抗指数与其妊娠结局的相关性.结果 良好结局组和不良结局组患者在年龄、孕前体重指数、孕周、糖尿病家族史、饮酒史、收缩压、舒张压、总胆固醇、甘油三酯、LDL-C、HDL-C水平比较,差异均无统计学意义(P＞0.05).产后6周时,不良结局组的空腹血糖、餐后1 h血糖及餐后2 h血糖分别为(5.79±0.87)、(6.55±0.79)、(8.02±0.89)mmol/L,均高于良好结局组[(4.33±0.66)、(5.22±0.98)、(6.48±0.78)mmol/L],差异均有统计学意义(P＜0.05).产后6周时,不良结局组的空腹胰岛素及胰岛素抵抗指数分别为14.55±3.12、5.73±0.65,均高于良好结局组(9.12±2.02、3.11±0.45),差异均有统计学意义(P＜0.05).Spearman相关分析结果显示,产妇产后6周的空腹血糖、餐后1 h血糖、餐后2 h血糖、空腹胰岛素水平及胰岛素抵抗指数均与产妇妊娠不良结局呈正相关(P＜0.05).结论 GDM患者产后的糖耐量和胰岛素抵抗与不良妊娠结局之间存在正相关关系;产后6周时,不良结局患者的血糖和胰岛素抵抗指数高于良好结局患者,可作为未来健康风险的预测指标.
Abstract
Objective To explore the correlation of postpartum glucose tolerance test outcome and insulin resistance with adverse pregnan-cy outcomes in patients with gestational diabetes mellitus(GDM).Methods A total of 400 GDM patients who underwent regular prenatal exami-nation and delivery in the Department of Obstetrics,Xingtai Central Hospital from October 2020 to October 2022 were retrospectively selected as the research objects.All patients received glucose tolerance test and insulin resistance level examination,and their pregnancy outcomes were tracked and recorded,and grouped according to their pregnancy outcomes.Eighty-eight patients had adverse pregnancy outcomes and were in-cluded in the adverse outcome group,and the other 312 patients were included in the good outcome group.The clinical data[age,pre-pregnancy body mass index,gestational age,family history of diabetes,drinking history,blood pressure,total cholesterol,triglyceride,low-density lipopro-tein cholesterol(LDL-C),high-density lipoprotein cholesterol(HDL-C)],postpartum glucose tolerance test outcome and insulin resistance were compared between the good outcome group and the adverse outcome group.The correlation between the results of glucose tolerance test and insulin resistance index at 6 weeks postpartum and the pregnancy outcome was analyzed by Spearman correlation analysis.Results There were no statistically significant differences in age,pre-pregnancy body mass index,gestational age,family history of diabetes,drinking history,systolic blood pressure,diastolic blood pressure,total cholesterol,triglyceride,LDL-C and HDL-C levels between the good outcome group and the ad-verse outcome group(P＞0.05).At 6 weeks after delivery,the fasting blood glucose,1 h postprandial blood glucose and 2 h postprandial blood glucose in the adverse outcome group were(5.79±0.87),(6.55±0.79)and(8.02±0.89)mmol/L,respectively,which were higher than those in the good outcome group[(4.33±0.66),(5.22±0.98)and(6.48±0.78)mmol/L],and the differences were statistically significant(P＜0.05).At 6 weeks after delivery,the fasting insulin and insulin resistance index in the adverse outcome group were 14.55±3.12 and 5.73±0.65,respectively,which were higher than those in the good outcome group(9.12±2.02 and 3.11±0.45),and the differences were statistically significant(P＜0.05).Spearman correlation analysis showed that fasting blood glucose,1 h postprandial blood glucose,2 h post-prandial blood glucose,fasting insulin level and insulin resistance index at 6 weeks after delivery were positively correlated with adverse pregnancy outcomes(P＜0.05).Conclusion There is a positive relationship between postpartum glucose tolerance and insulin resistance and adverse pregnancy outcomes in GDM patients,maternal glucose and insulin resistance index at 6 weeks after delivery were higher than good outcomes,re-lated to the quality of pregnancy outcomes and can be used as predictors of future health risk.
维普
万方数据