摘要
目的探讨妊娠非糖尿病孕妇妊娠早期甲状腺激素对巨大儿发生的影响及预测价值。方法采用病例对照研究设计,回顾性纳入2015年1月至2015年8月于本院规律产前检查、符合入排标准的非妊娠糖尿病孕妇736例。其中出生新生儿为巨大儿作为巨大儿组,非巨大儿的作为对照组;对两组相关因素进行多因素logistic回归分析,建立logistic回归预测模型,ROC曲线评价预测模型,以曲线下面积(AUC)预测价值。结果①在非妊娠糖尿病孕妇中,与对照组比较,巨大儿组孕妇妊娠早期促甲状腺激素(TSH)更高中位数分别是2.23 U/L和1.54 U/L,P<0.05,75g口服葡萄糖耐量试验(OGTT)中空腹血糖(fasting blood glucose,FPG)更高[(4.49±0.27)mmol/L,(4.36±0.32)mmol/L,P<0.01]、妊娠期体质量增加更多[(16.99±4.45)kg,(14.66±4.86)kg,P<0.01];②妊娠早期TSH(OR=1.445)、75 g OGTT中FPG(OR=5.250)、妊娠期体质量增加(OR=1.106)是非糖尿病孕妇中巨大儿的独立危险因素;③包括妊娠早期TSH、75g OGTT中FPG、妊娠期体质量增加的预测模型的AUC为0.726,模型中各指标预测发生巨大儿的界值分别为2.185 U/L、4.38 mmol/L、14.75 kg。结论①在非糖尿病孕妇中,随着妊娠早期TSH、75g OGTT中FPG、妊娠期体质量增加3项指标是其发生巨大儿的独立危险因素;②当妊娠早期TSH>2.185 U/L、妊娠期体质量增加>14.75 kg、75g OGTT空腹血糖>4.38 mmol/L时,非妊娠糖尿病孕妇发生巨大儿的风险显著增加。
Objective To investigate the effect of thyroid hormone on the occurrence of macrosomia in non-gestational diabetes mellitus population and its predictive value.Methods A case-control study was designed and retrospectively included in the routine birth examination in our hospital from January 1,2015 to August 31,2015.A total of 736 patients met the criteria for admission.According to the weight of newborns,they were divided into macrosomia group and non-macro group.Stepwise multivariate logistic regression analysis was conducted for the two groups of related factors,the logistic regression prediction model was established,and the ROC curve was used to evaluate the prediction model,with the prediction value of AUC.Results①In the non-gestational diabetes mellitus population,the thyroid stimulating hormone(TSH)in the early pregnancy was higher in the macrosomia group than in the control group[2.23(1.04,3.38)uIU/ml vs 1.54(0.83,2.47)uIU/ml,P<0.05],75g oral glucose tolerance test(OGTT)fasting blood glucose(FPG)was higher[(4.49±0.27)mmol/L vs(4.36±0.32)mmol/L,P<0.01],weight gain during pregnancy was more[(16.99±4.45)kg vs(14.66±4.86)kg,P<0.01]in macrosomia group.②Independent risk factors for macrosomia in non-gestational diabetes mellitus population were TSH in early pregnancy(OR=1.445),75g OGTT FPG(OR=5.25),and weight gain during pregnancy(OR=1.106).③The AUC of predictive model established using the TSH in early pregnancy,75g OGTT FPG,and weight gain was 0.726,the cut-off of each indicator for predicting macrosomia was2.185 uIU/ml,4.38mmol/L,14.75 Kg,respectively.Conclusion In non-diabetic pregnant women,TSH in early pregnancy,75g OGTT FPG and weight gain during pregnancy were independent risk factors for macrosomia.When TSH in early pregnancy>2.185 uIU/ml,75 g OGTT FPG>4.38 mmol/L or weight gain during pregnancy>14.75 kg,the risk of macrosomia was significantly increased in non-gestational diabetes mellitus population.
作者
樊艳婷
张秋兰
杜瑞琴
杜红岩
侯庆香
李全民
FAN Yanting;ZHANG Qiulan;DU Ruiqin;DU Hongyan;HOU Qingxiang;LI Quanmin(The Endocrinology Department,PLA Rocket Force Characteristic Medical Center,Beijing 100008,China)
出处
《中国妇产科临床杂志》
CSCD
北大核心
2020年第2期167-171,共5页
Chinese Journal of Clinical Obstetrics and Gynecology
关键词
妊娠
甲状腺激素
巨大儿
妊娠糖尿病
妊娠期体质量增加
出生体质量
pregnancy
thyroid hormone
macrosomia
getational diabetes mellitus
weight gain during pregnancy
birth weight
