妊娠期糖尿病患者血脂代谢变化及与不良妊娠结局的关系

Changes in lipid metabolism in patients with gestational diabetes mellitus and their relationship with adverse pregnancy outcomes

摘要

目的 探究妊娠期糖尿病(GDM)患者血脂代谢变化及与不良妊娠结局的关系。方法 回顾性分析2023年1月至2025年9月首都医科大学附属北京妇产医院收治的540例GDM患者的临床资料并纳入研究组,并选取同期首都医科大学附属北京妇产医院收治的非GDM的正常孕妇586例作为对照组。比较两组患者的一般资料、孕早期(8~12周)与孕晚期(36~40周)的实验室指标。统计两组不良妊娠结局发生情况。应用二元Logistic回归模型分析GDM患者不良妊娠结局的影响因素,采用受试者工作特征(ROC)曲线分析影响因素对GDM患者不良妊娠结局的预测价值。结果 研究组孕早期、孕晚期的空腹血糖(FBG)、谷丙转氨酶(ALT)、谷草转氨酶(AST)、总胆红素(T-Bil)、总胆固醇(TC)、甘油三酯(TG)、低密度脂蛋白胆固醇(LDL-C)水平均高于对照组(t介于2.316到13.336之间,P<0.05);研究组不良妊娠结局发生率为21.48%(116/540),高于对照组的12.46%(73/586)(χ²=16.385,P<0.05);研究组中妊娠结局不良者孕早期TC、TG、LDL-C水平高于妊娠结局良好者(t介于9.124到13.944之间,P<0.05),妊娠结局不良者孕晚期FBG、TC、LDL-C水平高于妊娠结局良好者(t介于2.123到7.588之间,P<0.05);回归分析显示:孕早期高水平TC、TG、LDL-C均为GDM患者发生不良妊娠结局的危险因素(OR介于2.452到2.646之间,P<0.05);ROC结果显示,孕早期TC、TG、LDL-C以及三者联合预测GDM患者不良妊娠结局的曲线下面积(AUC)分别为0.835、0.780、0.832、0.886,灵敏度分别为83.62%、75.86%、70.69%、70.69%,特异度分别为70.05%、79.95%、79.01%、97.17%,预测效能均较高(P<0.05)。结论 GDM患者孕早期的TC、TG、LDL-C与妊娠结局有一定相关性,有助于预测GDM患者的妊娠结局。

Abstract

Objective To explore the changes in lipid metabolism in patients with gestational diabetes mellitus (GDM) and their relationship with adverse pregnancy outcomes. Methods The clinical data of 540 patients with GDM in Beijing Obstetrics and Gynecology Hospital,Capital Medical University from January 2023 to September 2025 were retrospectively analyzed and the patients were included in the study group,and 586 normal pregnant women without GDM during the same period were selected as the control group.The general data,laboratory indicators [fasting blood glucose (FBG),alanine aminotransferase (ALT),aspartate aminotransferase (AST),total bilirubin (T-Bil),total cholesterol (TC),triglycerides (TG),low-density lipoprotein cholesterol (LDL-C) and high-density lipoprotein cholesterol (HDL-C)] in early pregnancy (8-12 weeks) and late pregnancy (36-40 weeks) were compared between groups.The incidence of adverse pregnancy outcomes in the two groups was statistically analyzed.Binary Logistic regression model was used to analyze the influencing factors of GDM adverse pregnancy outcomes,and receiver operating characteristic (ROC) curve was used to analyze the predictive value of influencing factors on GDM adverse pregnancy outcomes. Results The levels of FBG,ALT,AST,T-Bil,TC,TG and LDL-C in study group in early pregnancy and late pregnancy were higher than those in control group (t ranges from 2.316 to 13.336,P<0.05).Statistics showed that the incidence of adverse pregnancy outcomes in study group with 21.48% (116/540) was higher than 12.46% (73 cases/586 cases) in control group (χ ²=16.385,P<0.05).In study group,the levels of TC,TG and LDL-C in early pregnancy in patients with adverse pregnancy outcomes were higher than those in patients with good pregnancy outcomes (t ranges from 9.124 to 13.944,P<0.05),and the levels of FBG,TC and LDL-C in late pregnancy in patients with adverse pregnancy outcomes were higher than those in patients with good pregnancy outcomes (t ranges from 2.123 to 7.588,P<0.05).Regression analysis showed that high levels of TC,TG and LDL-C in early pregnancy were risk factors of adverse pregnancy outcomes in GDM patients (OR ranges from 2.452 to 2.646,P<0.05).ROC results showed that the areas under the curves (AUCs) of TC,TG,LDL-C and combined prediction of adverse pregnancy outcomes in GDM patients in early pregnancy were 0.835,0.780,0.832 and 0.886,and the sensitivities were 83.62%,75.86%,70.69% and 70.69%,and the specificities were 70.05%,79.95%,79.01% and 97.17% respectively,showing good predictive performance (P<0.05). Conclusion During early pregnancy,TC,TG,and LDL-C levels in patients with GDM are associated with pregnancy outcomes and may help predict adverse pregnancy outcomes in patients with GDM.

关键词

妊娠期糖尿病 / 总胆固醇 / 甘油三酯 / 低密度脂蛋白胆固醇 / 不良妊娠结局

Key words

gestational diabetes mellitus / total cholesterol / triglyceride / low-density lipoprotein cholesterol / adverse pregnancy outcome

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基金资助

首都卫生发展科研专项项目(2024-1Y-001)