摘要
目的探讨孕早期白细胞（WBC）计数、丙氨酸氨基转移酶（ALT）和天门冬氨酸氨基转移酶（AST）水平与妊娠期糖尿病（GDM）发生的相关性。方法纳入GDM孕妇725人,糖耐量正常（NGT）孕妇935人,详细记录受试者孕前体重、身高,于孕8～12周检测WBC、ALT和AST水平,孕24～28周检测血糖、胰岛素水平。比较两组孕妇孕早期WBC计数、ALT和AST水平,回顾性分析孕早期WBC、ALT和AST水平与孕中期血糖和胰岛素水平及GDM发生的相关性。结果 GDM组受试者的WBC计数[9.41（8.15,10.84）×10^9/L比9.04（7.64,10.37）×10^9/L,P=1.0×10^-5]和ALT水平[18.00（12.00,30.00）U/L比16.00（11.00,26.00）U/L,P=0.004]明显高于NGT组,两组受试者的AST水平差异无统计学意义[41.00（26.00,43.00）U/L比41.00（23.00,43.00）U/L,P=0.588]。Logistic回归分析结果显示,校正年龄、孕前BMI、血压和糖尿病家族史后,WBC计数升高能明显增加GDM的发病风险（OR=1.119,P=0.001）,根据ROC曲线得出患GDM的WBC计数最佳临界值为7.965×10^9/L（AUC 0.566,P=1×10^-5）,敏感性为79.4%,特异性为31.3%。多元线性回归分析结果显示,稳态胰岛素评估模型胰岛素抵抗指数与WBC计数成正相关（B=0.051,P=0.022,R2=0.083）;口服50 g糖后1 h血糖（B=0.044,P=0.001,R2=0.044）和空腹真胰岛素（B=0.214,P=0.032,R2=0.066）与孕早期WBC计数成正相关;100 g口服葡萄糖耐量试验（OGTT）后1 h真胰岛素与孕早期AST成正相关（B=0.616,P=1.85×10^-5,R2=0.052）;100 g OGTT后2 h真胰岛素与ALT（B=0.148,P=0.027）和AST（B=0.936,P=3.71×10^-8）成正相关（R2=0.077）;100 g OGTT后3 h真胰岛素与孕早期ALT（B=0.189,P=0.002）和AST（B=0.688,P=7.25×10^-6）成正相关（R2=0.067）。结论孕早期WBC计数升高能明显增加GDM的发病风险,有望成为GDM发病的预测指标之一。
Objective To explore the associations of white blood cell （WBC） count, alanine amin-otransferase （ALT）, and aspartate aminotransferase （AST） in the first trimester of pregnancy with gestational diabetes mellitus （GDM） . Methods Totally 725 GDM women and 935 women who remained euglycemic throughout pregnancy were enrolled in this study. Pre-pregnancy weight/height were recorded. WBC, ALT, and AST levels were detected between 8 and 12 weeks of pregnancy. At 24 to 28 weeks of pregnancy, the glucose and insulin levels were measured. The WBC, ALT, and AST levels were compared between two groups, and the as- sociations of WBC, ALT, and AST levels with the blood glucose and insulin levels were retrospectively ana- lyzed. Meanwhile, the potential associations of those factors with the occurrence of GDM were analzyed. Results WBCcount [9.41 （8.15, 10.84） ×10^9/Lvs. 9.04 （7.64, 10.37） ×10^9/L, P=1.0×10^-5] and ALT levels [ 18.00 （12. 00, 30. 00） U/L vs. 16.00 （11.00, 26.00） U/L, P =0. 004] in the first trimester of pregnancy were significantly increased in GDM subjects than in normal glucose tolerance （NGT） subjects; however, the AST level showed no significant difference between these two groups [41.00 （26. 00, 43.00） U/L vs. 41.00 （23.00, 43.00） U/L, P =0. 588]. Logistic regression analysis illustrated that elevated WBC count was an independent risk factor for GDM after adjustment for age, pre-pregnancy body mass index, blood pres- sure, and family history of diabetes （ OR = 1.119, P = 0. 001 ） . The ROC curve revealed that threshold of WBC count was 7. 965 ×10^9/L （AUC =0. 566, P = 1× 10-5） , which had a sensitivity of 79.4% and a speci- ficity of 31.3%. Multivariate linear regression analysis showed that homeostasis model assessment of insulin re- sistance was positively correlated with WBC count （B = 0. 051, P = 0. 022, R2 = 0. 083 ） ; 1-hour blood glucose after oral 50 grams of sugar （B =0. 044, P =0. 001, R2 =0. 044） and fasting plasma true insulin �
作者
赵丽丽
李伟
平凡
马良坤
聂敏
ZHAO Li-li LI Wei PING Fan MA Liang-kun NIE Min(State Key Laboratory of Endocrinology, Ministry of Health Department of Obstetrics and Gynecology, PUMC Hospital, CAMS and PUMC, Beijing 100730, China)
出处
《中国医学科学院学报》
CAS
CSCD
北大核心
2016年第3期283-287,共5页
Acta Academiae Medicinae Sinicae
基金
国家自然科学基金(81270879)~~
