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浙江大学学报(医学版)  2021, Vol. 50 Issue (3): 329-334    DOI: 10.3724/zdxbyxb-2021-0193
专题报道     
糖尿病家族史对妊娠糖尿病孕妇血糖、血脂及妊娠结局的影响
周雨梅1(),谢妮2,张丽霞1,陈丹青1,*()
1.浙江大学医学院附属妇产科医院产科,浙江 杭州 310006
2.浙江省杭州市采荷街道卫生服务中心,浙江 杭州 310018
Impact of family history of diabetes on blood glucose, lipid levels and perinatal outcomes in pregnant women with gestational diabetes mellitus
ZHOU Yumei1(),XIE Ni2,ZHANG Lixia1,CHEN Danqing1,*()
1. Department of Obstetrics, Women’s Hospital, Zhejiang University School of Medicine, Hangzhou 310006, China;
2. Caihe Community Health Service Center, Hangzhou 310018, China
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摘要:

目的:探究糖尿病家族史对妊娠糖尿病(GDM)孕妇血糖、血脂以及妊娠结局的影响。方法:通过1∶4匹配回顾性分析2019年1—12月在浙江大学医学院附属妇产科医院产科分娩的GDM孕妇1265例,其中有糖尿病家族史组253例,无糖尿病家族史组1012例。两组间血脂、血糖水平及妊娠结局(大于胎龄儿、小于胎龄儿、巨大儿、剖宫产、子痫前期、早产、产后出血、胎儿窘迫)差异采用?t?检验和χ2检验,糖尿病家族史与妊娠结局相关性分析采用二元Logistic回归分析。结果:有糖尿病家族史组孕晚期高密度脂蛋白水平低于无糖尿病家族史组(P<0.05),空腹血糖、口服葡萄糖耐量试验(OGTT)1?h血糖、OGTT?2?h血糖及糖化血红蛋白水平较无糖尿病家族史组更高(均P<0.01)。糖尿病家族史是GDM孕妇子痫前期的独立危险因素(OR=3.27,95%CI:1.39~7.68)。结论:有糖尿病家族史的GDM孕妇高密度脂蛋白水平更低、血糖水平更高。糖尿病家族史是GDM孕妇发生子痫前期的独立危险因素。

关键词: 妊娠糖尿病家族史血脂血糖子痫前期危险因素    
Abstract:

Objective: To investigate the impact of family history of diabetes (FHD) on blood glucose, lipid levels and perinatal outcomes in pregnant women with gestational diabetes mellitus (GDM). Methods:A total of 1265 GDM women who gave childbirth in Women’s Hospital, Zhejiang University School of Medicine during January to December 2019 were enrolled in the study, including 253 women with FHD and 1012 women without FHD. The t-test or χ2 test were used to compare the blood lipid, blood glucose levels and perinatal outcomes including large for gestational age infant, small for gestational age infant, macrosomia, cesarean delivery, preeclampsia, preterm labor, postpartum hemorrhage, fetal distress. The correlation between FHD and perinatal outcomes were estimated by Logistic regression analysis. Results: The high density lipoprotein level at third-trimester was significantly lower in GDM women with FHD (P<0.05); and the women with FHD also had higher fasting blood glucose oral glucose tolerance test (OGTT)1?h, OGTT?2?h and glycosylated hemoglobin level (allP<0.01). In GDM women, FHD was an independent risk factor for preeclampsia (OR=3.27, 95%CI: 1.39–7.68).Conclusions: GDM women with FHD have lower high density lipoprotein and higher glucose levels. FHD is an independent risk factor for preeclampsia in GDM women.

Key words: Gestational diabetes mellitus    Family history    Blood lipid    Blood glucose    Preeclampsia    Risk factor
收稿日期: 2021-04-29 出版日期: 2021-08-16
CLC:  R714.256  
基金资助: 国家自然科学基金(81873839);浙江省重点研发计划(2018C03010)
通讯作者: 陈丹青     E-mail: zym1780@zju.edu.cn;chendq@zju.edu.cn
作者简介: 周雨梅,住院医师,主要从事产科学研究;E-mail:zym1780@zju.edu.cn;https://orcid.org/0000-0002-3237-0677
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引用本文:

周雨梅,谢妮,张丽霞,陈丹青. 糖尿病家族史对妊娠糖尿病孕妇血糖、血脂及妊娠结局的影响[J]. 浙江大学学报(医学版), 2021, 50(3): 329-334.

ZHOU Yumei,XIE Ni,ZHANG Lixia,CHEN Danqing. Impact of family history of diabetes on blood glucose, lipid levels and perinatal outcomes in pregnant women with gestational diabetes mellitus. J Zhejiang Univ (Med Sci), 2021, 50(3): 329-334.

链接本文:

http://www.zjujournals.com/med/CN/10.3724/zdxbyxb-2021-0193        http://www.zjujournals.com/med/CN/Y2021/V50/I3/329

组 别

n

年龄(岁)

孕次

产次

孕前BMI(kg/m2

孕期增重(kg)

分娩孕周(周)

初产妇

经产妇

有糖尿病家族史组

253

30.9±3.7

2.0±1.2

176(69.6)

77(30.4)

21.6±3.0

13.5±3.9

38.79±1.52

无糖尿病家族史组

1012

30.5±3.5

1.9±1.1

735(72.6)

277(27.4)

21.3±2.7

13.8±4.1

38.82±1.45

t/χ2

–1.649

–0.507

0.942

–1.647

0.937

0.317

P

>0.05

>0.05

>0.05

>0.05

>0.05

>0.05

表 1  有无糖尿病家族史妊娠糖尿病孕妇一般情况比较

组别

n

孕中期

孕晚期

总胆固醇

甘油三酯

高密度脂蛋白

低密度脂蛋白

总胆固醇

甘油三酯

高密度脂蛋白

低密度脂蛋白

有糖尿病家族史组

253

6.14±1.04

2.43±1.04

2.33±0.55

3.34±0.84

6.50±1.33

4.01±2.23

1.98±0.49

3.45±1.01

无糖尿病家族史组

1012

6.18±1.10

2.32±0.84

2.34±0.51

3.40±0.91

6.59±1.39

3.77±1.99

2.07±0.58

3.54±1.05

t

0.412

–1.685

0.321

0.854

0.967

–1.640

2.209

1.264

P

>0.05

>0.05

>0.05

>0.05

>0.05

>0.05

<0.05

>0.05

表 2  有无糖尿病家族史妊娠糖尿病孕妇孕期血脂水平比较

组别

n

血糖水平(mmol/L)

OGTT异常项数

血糖异常类型

空腹

OGTT?1?h

OGTT?2?h

糖化血红蛋白

一项异常

二项异常

三项异常

空腹血糖异常

服糖后血糖异常

前两者均异常

有糖尿病家族史组

253

4.9±0.6

10.4±1.6

8.9±1.4

5.2±0.6

114(45.1)

99(39.1)

40(15.8)

30(11.9)

162(64.0)

61(24.1)

无糖尿病家族史组

1012

4.8±0.6

9.9±1.4

8.3±1.4

5.1±0.3

692(68.4)

265(26.2)

55(5.4)

165(16.3)

730(72.1)

117(11.6)

t/χ2

–2.697

–4.743

–5.933

–3.680

58.075

27.134

P

<0.01

<0.01

<0.01

<0.01

<0.01

<0.01

表 3  有无糖尿病家族史妊娠糖尿病孕妇孕期血糖水平比较

组别

LGA

SGA

巨大儿

子痫前期

剖宫产

早产

胎儿窘迫

产后出血

有糖尿病家族史组

63(24.9)

6(2.4)

27(10.7)

11(4.3)

128(50.6)

17(6.7)

15(5.9)

3(1.2)

无糖尿病家族史组

201(19.9)

28(2.8)

88(8.7)

15(1.5)

447(44.2)

51(5.0)

64(6.3)

12(1.2)

OR

1.34

0.88

1.25

3.27

1.21

1.28

0.93

0.86

95%CI

0.96~1.89

0.36~2.16

0.78~2.01

1.39~7.68

0.91~1.62

0.72~2.27

0.52~1.67

0.23~3.28

P

>0.05

>0.05

>0.05

<0.01

>0.05

>0.05

>0.05

>0.05

表 4  有无糖尿病家族史妊娠糖尿病孕妇妊娠结局比较
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