妊娠期代谢综合征诊断标准的评价及危险因素分析

摘要

目的 探讨妊娠期多重代谢异常聚集及妊娠期代谢综合征(GMS)的诊断标准,并对GMS相关的危险因素进行分析.方法 收集2008年1月至2011年12月在广东省妇幼保健院定期产科检查并住院分娩的309例单胎妊娠、子痫前期孕妇为子痫前期组,627例妊娠期糖尿病(GDM)孕妇为GDM组,1245例健康孕妇为对照组.记录各组孕妇年龄、孕周、基础血压、入组血压、身高、孕前体质量、孕前体质指数(BMI),检测其空腹血糖(FPG)、空腹胰岛素(FINS)、总胆固醇(TC)、甘油三酯(TG)、高密度脂蛋白(HDL-C)、低密度脂蛋白(LDL-C)和游离脂肪酸(FFA)水平,按本研究应用的GMS诊断标准(具备以下任意3项或全部者):(1)孕前BMI≥25 kg/m2；(2)诊断为GDM;(3)血压≥140/90 mm Hg(1 mm Hg=0.133 kPa)；(4)TG≥3.23 mmol/L.计算各组孕妇的GMS发生率并分析其危险因素.结果(1)子痫前期组及GDM组孕妇年龄、孕周、基础血压、入组时血压、孕前BMI分别与对照组比较,差异均有统计学意义(P＜0.01).(2)子痫前期组孕妇FPG水平为(4.6±1.0)mmol/L、FINS为(10.1±5.6)mU/L、TC为(6.3±1.6)mmol/L、TG为(3.9±1.8)mmol/L、HDL-C为(1.4±0.4)mmol/L、LDL-C为(3.0±1.0)mmol/L、FFA为(0.8±0.4)mmol/L;GDM组以上指标分别为(4.7±0.9)mmol/L、(10.2±5.8)mU/L、(5.7±1.3)mmol/L、(3.2±1.1)mmol/L、(1.4±0.4)mmol/L、(2.7±0.9)mmol/L、(0.6±0.3)mmol/L;对照组以上指标分别为(4.3±0.5)mmol/L、(9.0±4.4)mU/L、(5.7±1.1)mmol/L、(2.8±1.1)mmol/L、(1.5±0.4)mmol/L、(2.9±0.8)mmol/L、(0.6±0.2)mmol/L,子痫前期组和GDM组孕妇以上指标分别与对照组比较,差异均有统计学意义(P＜0.01).(3)子痫前期组孕妇GMS发生率为26.2％(81/309),GDM组孕妇GMS发生率为13.6％(85/627),分别与对照组(发生率为0)比较,差异均有统计学意义(P＜0.01).(4)以GMS为应变量,以孕前BMI、TG、HDL-C为自变量,分析子痫前期组和GDM组孕妇发生GMS的危险因素,结果显示,子痫前期组孕妇发生GMS的风险显著升高(P＜0.01),其危险因素是孕前BMI(OR=1.29,95％ CI为1.13 ～ 1.47)和TG(OR=2.49,95％ CI为1.87 ～3.31)；GDM组孕妇发生GMS的风险也明显升高(P＜0.01),其危险因素是孕前BMI(OR=1.13,95％ CI为1.04 ～1.23)和TG(OR=1.16,95％ CI为1.02 ～ 1.33).子痫前期组及GDM组均显示TG是发生GMS的独立危险因素(P＜0.01及P＜0.05),而两组均显示HDL-C与GMS的发生无显著相关(P＞0.05).结论 按本研究应用的GMS诊断标准,子痫前期及GDM孕妇中存在着孕前体质量超重(和)或肥胖、糖代谢异常、血压升高、脂代谢异常等多重代谢异常的聚集现象；TG是子痫前期及GDM孕妇发生GMS的独立危险因素,而HDL-C与GMS发生无显著相关性.%Objectives To investigate gestational multiple metabolic abnormalities aggregation and diagnostic criteria for gestational metabolic syndrome(GMS),and to analyze the risk factors of GMS.Methods A cohort study recruiting 309 pregnant women with preeclampsia,627 pregnant women with gestational diabetes mellitus(GDM)and 1245 normal pregnant women was performed from January 2008 to December 2011 in Guangdong Women and Children's Hospital.Information regarding age,gestational weeks,basic blood pressure,admission blood pressure,height and body mass index(BMI)before pregnancy was recorded.Biochemical indicators including fasting plasma glucose(FPG),fasting insulin (FINS),total cholesterol(TC),triglyceride(TG),high density lipoprotein(HDL-C),low density lipoprotein(LDL-C),free fatty acids(FFA)were tested.GMS was diagnosed with three or all of the following conditions:(1)overweight and/or obesity before pregnancy(BMI ≥ 25 kg/m2);(2)hypertension with blood pressure ≥ 140/90 mm Hg(1 mm Hg =0.133 kPa);(3)hyperglycemia:diagnosed as GDM;(4)dyslipidemia with TG≥3.23 mmol/L The incidence of GMS of the three groups were calculated and the risk factors were analyzed.Results(1)The age,gestational weeks,basic blood pressure,admission blood pressure,BMI before pregnancy of women with preeclampsia and women with GDM were significantly different compared to normal women,respectively(P ＜ 0.01).(2)Biochemical indicators of women with preeclampsia were as following:FPG(4.6 ± 1.0)mmol/L,FINS(10.1 ± 5.6)mU/L,TC(6.3 ±1.6)mmol/L,TG(3.9 ± 1.8)mmol/L,HDL-C(1.4 ±0.4)mmol/L,LDL-C(3.0 ± 1.0)mmol/L,FFA (0.8 ±0.4)mmol/L.And those in women with GDM were:FPG(4.7 ± 0.9)mmoL/L,FINS(10.2 ± 5.8)mU/L,TC(5.7 ± 1.3)mmol/L,TG(3.2 ± 1.1)mmol/L,HDL-C(1.4 ± 0.4)mmol/L,LDL-C (2.7 ± 0.9)mmol/L,FFA(0.6 ± 0.3)mmol/L In normal pregnant women they were:FPG(4.3 ±0.5)mmol/L,FINS(9.0±4.4)mU/L,TC(5.7 ±1.1)mmol/L,TG(2.8 ±1.1)mmol/L,HDL-C (1.5 ± 0.4)mmol/L,LDL-C(2.9 ± 0.8)mmol/L,FFA(0.6 ± 0.2)mmol/L Statistic differences were found in preeclampsia and GDM women compared to normal women respectively(P ＜ 0.01).(3)The prevalence of GMS in preeclampsia group and in GDM group was 26.2％(81/309)and 13.6％(85/627),statistically different from that of the control group(0)(P ＜0.01).(4)Compared to normal women,women with preeclampsia had higher risk of developing GMS(OR =1.62,95 ％ CI 1.31-2.00,P ＜ 0.01).The risk factors were BMI(OR =1.29,95％ CI 1.13-1.47)and TG(OR =2.49,95％ CI 1.87-3.31).Also,women with GDM had higher risk of developing GMS than normal women(OR =1.27,95％ CI 1.09-1.49,P ＜ 0.01),and the risk factors were BMI(OR =1.13,95 ％ CI 1.04-1.23)and TG(OR =1.16,95 ％ CI 1.02-1.33).TG was the independent risk factor in both preeclampsia women and GDM women(P ＜ 0.01,P ＜ 0.05).HDL-C seemed to have less importance in identifying GMS(P ＞ 0.05).Conclusions According to the GMS diagnostic criteria used in this study,some preeclampsia patients and some GDM women had aggregation of multiple metabolic abnormalities including pre-pregnancy overweight/obesity,hyperglycemia,high blood pressure and dyslipidemia.TG was the independent risk factor for GMS.HDL-C seemed to have less importance in identifying GMS.