2069例不同糖耐量状态孕妇的血脂谱及围生结局分析

摘要

在大样本群体中探讨不同糖耐量状态孕妇血脂谱及其围生结局,并寻找巨大儿发生的独立危险因素.50g口服葡萄糖筛查试验(GCT) 1hPG≥7.8mmol/L的孕妇共2069例,按100gOGTT结果分为NGT(n=911)、IGT(n=422)和GDM(n=736)3组,并测定3组HbA1c、TG、TC、LDL-C、HDL-C水平,以上指标均在24～28孕周获得. 结果 (1)不同糖耐量状态的孕妇TG、TC、LDL-C、HDL-C均较非孕参考范围明显升高.从NGT→ IGT→GDM组,TG逐步上升(P＜0.01),HDL-C逐步下降(P＜0.01),TC和LDL-C无统计学差异.(2)经过对血糖的严格干预后,3组的孕期体重增加,新生儿体重无差异,然而巨大儿的发生率在GDM和IGT组仍明显高于NGT组(14.1％,13.1％vs6.6％,P＜0.01).(3)二项分类Logistic回归分析发现OGTT中的FPG(OR=2.98,95％CI 1.63～5.48,P＜0.01)、孕期体重增加(OR= 1.12,95％CI 1.06～1.19,P＜0.01)为巨大儿发生的独立危险因素,而HDL-C为独立保护因素(OR=0.41, 95％CI 0.20～0.86,P＜0.05). 结论 妊娠时,血脂各组分较非孕状态明显升高,从NGT→IGT→GDM,TG逐步上升而HDL-C逐步下降.即使经过血糖的严格干预,巨大儿的发生率并不能降低到NGT组水平.FPG水平和孕重增加是巨大儿发生的独立危险因素,而HDL-C是保护因素.%Objective To explore the spectrum of lipids and the pregnancy outcomes in 2069 pregnant women with NGT,GIGT and GDM, and to search the independent risk factors for macrosomia. Methods We set up a database of 2069 Chinese pregnant women with lh plasma glucose levels≥ 7. 8mmol/L in GCT. They underwent the 100g OGTT during 24th-28th weeks, and the diagnosis was based on ADA criteria. There were 911 cases of NGT, 422 cases of IGT and 736 cases of GDM. Results (1) From NGT→IGT→GDM,the TG levels gradually increased (P＜0.01)Dwhile HDL-C levels decreased (P＜0. 01). Among these three pregnant women groups, the TG, TC, LDL-C and HDL-C level were beyond the reference ranges of non-pregnancy women. (2) After the strict intervention of IGT and GDM, the gestational weight gain in GDM was less than in NGTQ3. 85±5. 68 vs 15. 98+5. 76, P＜0. 01). The neonatal body weight in GDM or IGT was similar with NGT(3. 37±0. 53 or 3. 36±0. 52 vs 3. 30±0. 45, P＞0. 05). However, the incidence of macrosomia in GDM or IGT versus NGT was increased (14.1% or 13.1% vs 6. 6%, P＜0. 01). (3)In binary logistic regression analysis, we found that the FPG in OGTT (QR=2. 98, 95%CI 1. 63-5. 48, P＜0. 01) and the gestational weight gain (QR=1.12, 95%CI 1. 06-1.19, P＜0. 01) were independent risk factors for macrosomia, while the HDL-C level was the protection one (OR = 0.41, 95%CI 0.20-0.86, P＜0.05) . Conclusions Elevations of TG, TC, LDL-C and HDL-C levels occur during pregnancy. However, from NGT→IGT→GDM,the TG level increases while the HDL-C level decreases. After the strict intervention, the incidence of macrosomia in GDM or GIGT versus NGT is increased. The FPG level and the gestational weight gain are independent risk factors for macrosomia, while the HDL-C level is the protective one.