摘要
目的研究妊娠早期凝血功能和糖脂代谢指标对妊娠期糖尿病的预测价值。方法选择2020年10月~2021年5月于上海交通大学附属第六人民医院临港院区首次产检建卡的584例孕妇作为观察对象,孕妇妊娠10~13周建卡时收集所有孕妇的临床信息和外周血清标本,检测孕妇的凝血功能、空腹血糖和血脂指标,随访至妊娠24~28周行75g口服葡萄糖耐量试验,检出GDM孕妇142例,非GDM孕妇442例。数据以均数±标准差(x±s)或中位数(四分位数间距)[M(Q1,Q3)]表示,采用t检验、Wilcoxon秩和检验、Logistic回归分析对数据进行统计处理,并采用受试者工作特征曲线(receiver operating characterisitic curve,ROC)计算曲线下面积(area under the curve,AUC)以评价模型对GDM的预测价值。结果与非GDM组比较,GDM组的年龄、孕前体重指数(body mass index,BMI)、空腹血糖(fasting blood glucose,FPG)、纤维蛋白原(fibrinogen,FIB)、D-二聚体(D-dimer measurement,D-Dimer)、总胆固醇(total cholesterol,TC)、甘油三酯(triglycerides,TG)、低密度脂蛋白胆固醇(low-density lipoprotein cholesterol,LDL-C)、sd LDL-C、载脂蛋白B(apolipoprotein B,APOB)、载脂蛋白E(apolipoprotein E,APOE)要高于非GDM组,而PT、INR、APTT、TT低于非GDM组,差异均有统计学意义。采用单因素Logistic回归分析探索GDM的危险因素,孕妇妊娠年龄、孕前BMI、FPG、凝血酶原时间(prothrombin time,PT)、国际标准化比值(international standardized ratio,INR)、活化部分凝血活酶时间(activated partial thromboplastin time,APTT)、FIB、凝血酶时间(thrombin time,TT)、D-二聚体、TC、TG、LDL-C、sdLDL-C、APOB和APOE均为GDM发生的高危因素。多因素Logistic回归提示孕前BMI、FPG、APTT、TT、TG、LDL-C、sdLDL-C、APOB是GDM的预测因素,多因素联合预测GDM的AUC为0.892(0.858~0.927),敏感度和特异性分别为80.71%和86.85%。结论孕早期FPG、APTT、TT、TG、LDL-C、sdLDL-C、APOB联合孕前BMI的预测方法�
Objective To investigate whether first-trimester fasting plasma glucose(FPG),blood coagulation function and lipid metabolism could predict GDM risk.Methods From October 2020 to May 2021,a total of 584 pregnant women who took prenatal care in Shanghai Jiao Tong University Affiliated Sixth People′s Hospital were chosen as the observation subjects.The clinical information and serum samples of all pregnant women were collected at 10-13 weeks of gestation and the blood coagulation function,fasting blood glucose and lipid profiles of the pregnant women were detected.A 75g oral glucose tolerance test was performed up to 24-28 weeks of gestation.142 pregnant women with GDM and 442 pregnant women without GDM were detected.Data were expressed by x±s or median(interquartile range)and were analyzed using student′s t-test,Wilcoxon rank sum test and Logistic regression analysis.The area under the curve(AUC)was calculated by receiver operating characteristic curve(ROC)to analyze the predictive values.Results Compared with non-GDM group,age,pre-pregnancy BMI,FPG,FIB,D-Dimer,TC,TG,LDL-C,sdLDL-C,APOB and APOE in GDM group were significantly higher than those in non-GDM group,while PT,INR,APTT and TT were significantly lower than those in non-GDM group.Univariate Logistic regression analysis was used to explore the risk factors of GDM.Gestational age,pre-pregnancy BMI,FPG,PT,INR,APTT,FIB,TT,D-Dimer,TC,TG,LDL-C,sdLDL-C,APOB and APOE were all risk factors of GDM.Multiple Logistic regression showed that pre-pregnancy BMI,FPG,APTT,TT,TG,LDL-C,sdLDL-C and APOB were predictive factors for GDM.The AUC was 0.892(0.858-0.927).The sensitivity and specificity were 80.71%and 86.85%,respectively.Conclusion FPG,APTT,TT,TG,LDL-C,sdLDL-C,APOB and pre-pregnancy BMI in early pregnancy has important clinical value for the prediction of GDM,which is conducive to the early identification,intervention and treatment of GDM,so as to reduce the morbidity of maternal and infant complications.
作者
陈宇
肖静
黄红玲
CHEN Yu;XIAO Jing;HUANG Hongling(Department of Obstetrics and Gynecology,Shanghai Jiao Tong University Affiliated Sixth People′s Hospital,Shanghai 201306,China)
出处
《医学研究杂志》
2022年第11期133-137,共5页
Journal of Medical Research
基金
上海健康医学院种子基金资助项目(HMSF-17-22-023)。
关键词
妊娠期糖尿病
空腹血糖
血脂
凝血功能
预测
Gestational diabetes mellitus
Fasting plasma glucose
Coagulation function
Lipid metabolism
Prediction
