Association of Triglyceride to High Density Lipoprotein-Cholesterol Ratio In Early Pregnancy with the Risk of Gestational Diabetes Mellitus:Large-sample Retrospective Cohort Study
Association of Triglyceride to High Density Lipoprotein-Cholesterol Ratio In Early Pregnancy with the Risk of Gestational Diabetes Mellitus:Large-sample Retrospective Cohort Study
杨萱瑾 1王亚新 1李旖旎 1张素菡 1马良坤 1孙崟1
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作者信息
1. 国家妇产疾病临床医学研究中心 中国医学科学院北京协和医院妇产科,北京 100730
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摘要
目的 探究妊娠早期甘油三酯(triglyceride,TG)/高密度脂蛋白胆固醇(high density lipoprotein-cholesterol,HDL-C)与妊娠期糖尿病(gestational diabetes mellitus,GDM)发生风险的关系.方法 回顾性收集2020年7月—2022年6月北京协和医院规律产检并分娩的单胎妊娠孕妇临床资料,并根据妊娠24～28周75 g 口服葡萄糖耐量试验结果将孕妇分为GDM组和正常糖耐量组.采用多因素Logistic回归法评估妊娠早期(8～12+6周)TG/HDL-C与GDM的相关性,并以甘油三酯-葡萄糖(triglyceride-glucose,TyG)指数为参照,评估妊娠早期TG/HDL-C预测GDM的临床价值.结果 共入选符合纳入与排除标准的单胎妊娠孕妇1617名,其中GDM组372例(23.01％)、正常糖耐量组1245名(76.99％).多因素Logistic回归分析校正年龄、民族、孕前体质量指数、GDM史等混杂因素后发现,妊娠早期TG/HDL-C最高四分位数孕妇GDM发生风险是最低四分位数孕妇的2.46倍(OR=2.46,95％CI:1.73～3.51),TyG指数最高四分位数孕妇GDM发生风险是最低四分位数孕妇的2.36倍(OR=2.36,95％CI:1.67～3.37).妊娠早期TG/HDL-C预测GDM的效能(曲线下面积:0.607比0.608)、对GDM基础风险模型的改善程度(净重新分类指数:0.240比0.270;综合判别改善指数:0.022比0.024)均与TyG指数较为接近.结论 妊娠早期TG/HDL-C显著升高与GDM发生风险增加具有一定相关性,且其对GDM的预测价值与TyG指数相当.
Abstract
Objective To investigate the association of triglyceride to high density lipoprotein-choles-terol ratio(TG/HDL-C)in early pregnancy with the risk of gestational diabetes mellitus(GDM).Methods Retrospectively collected clinical data of singleton pregnant women who received regular antenatal care and de-livered at Peking Union Medical College Hospital from July 2020 to June 2022.Based on the results of the 75 g oral glucose tolerance test(OGTT)from 24 to 28 weeks,pregnant women were classified into GDM group and normal glucose tolerance(NGT)group.Multiple Logistic regression was used to evaluate the correlation between TG/HDL-C in early pregnancy(8-12+6weeks)and GDM,and triglyceride-glucose(TyG)index was used as a reference to assess the value of TG/HDL-C in early pregnancy in predicting GDM.Results A total of 1617 singleton pregnant women who met the inclusion and exclusion criteria were enrolled,with 372(23.01％)in the GDM group and 1245(76.99％)in the NGT group.After adjusting for confounding factors,such as maternal age,ethnicity,pre-pregnancy BMI,GDM history and family history of diabetes,pregnant women in the highest TG/HDL-C quartile had a 2.46-fold higher risk of developing GDM than those in the low-est TG/HDL-C quartile(OR=2.46,95％CI:1.73-3.51).Pregnant women in the highest TyG index quartile had a 2.36-fold higher risk of developing GDM than those in the lowest TyG index quartile(OR=2.36,95％CI:1.67-3.37).The efficacy of TG/HDL-C in early pregnancy in predicting GDM(area under the curve:0.607 vs.0.608)and the degree of improvement in the basic risk model of GDM(net reclassifica-tion improvement:0.240 vs.0.270;integrated discrimination improvement:0.022 vs.0.024)were both close to the TyG index.Conclusions Higher TG/HDL-C in early pregnancy was independently associated with high-er risk of GDM.Its predictable value was comparable to that of TyG index.
关键词
妊娠早期/TG/HDL-C/妊娠期糖尿病/甘油三酯-葡萄糖指数
Key words
early pregnancy/triglyceride/high density lipoprotein-cholesterol/gestational diabetes mellitus/triglyceride-glucose index
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