摘要
目的分析有糖尿病家族史妊娠期糖尿病(GDM)患者产后发生2型糖尿病(T2DM)的危险因素。方法选择2015年1月至2019年1月在天长市人民医院确诊为GDM且有糖尿病家族史的患者275例,根据产后发生T2DM的情况将患者分为产后正常组和产后发病组。比较两组患者的临床资料,logistic回归分析影响患者产后发生T2DM的独立危险因素,构建列线图预测模型,使用受试者工作特征(ROC)曲线与校准曲线评价模型预测能力,用X-tile软件获取列线图模型的积分截断值,绘制生存曲线并进行内部核验。结果275例GDM患者中,共有68例产后发生T2DM,发病率为24.73%。两组年龄、孕前BMI值、孕期增重、孕期空腹血糖和孕期糖化血红蛋白差异有统计学意义(均P<0.05)。两组妊娠结局差异无统计学意义(均P>0.05)。年龄≥30岁、孕前体重指数(BMI)偏高、孕期增重≥6 kg、孕期空腹血糖>5.8 mmol/L与孕期糖化血红蛋白>5.2%是有糖尿病家族史的GDM患者产后发生T2DM的独立危险因素(均P<0.05)。列线图模型预测产后发生T2DM的C-index值为0.912(95%CI:0.854~0.960),ROC曲线下面积为0.799(95%CI:0.742~0.856),区分度较好;校准曲线提示模型准确度较好。通过列线图模型积分截断值将有糖尿病家族史的GDM患者产后发生T2DM的概率分为低(≤67.24分)、中(>67.24~≤129.82分)和高风险(>129.82分)3组,产后T2DM发病率分别为13.71%、29.29%和59.62%,差异有统计学意义(P<0.05)。结论年龄≥30岁、孕前BMI值偏高、孕期增重≥6 kg、孕期空腹血糖>5.8 mmol/L与孕期糖化血红蛋白>5.2%是糖尿病家族史的GDM患者产后发生T2DM的独立危险因素。
Objective To analyze the risk factors of postpartum type 2 diabetes(T2DM)in patients with family history of diabetes mellitus with gestational diabetes mellitus(GDM).Methods From January 2017 to January 2019,275 patients with GDM and family history of diabetes were selected.According to the occurrence of postpartum T2DM,the patients were divided into postpartum normal group(207 cases)and postpartum disease group(68 cases).The clinical data of the two groups were compared,and the independent risk factors of postpartum T2DM were analyzed by logistic regression,and a line chart prediction model was constructed.Receiver operating characteristic(ROC)curve and calibration curve were used to evaluate the predictive ability of the model.X-tile software was used to obtain the integral truncation value of the line graph model,and survival curve was drawn and internal verification was carried out.Results Of 275 GDM patients,68 had T2DM after delivery,with a incidence rate of 24.73%.There were significant differences between the two groups in age,body mass index(BMI)before pregnancy,weight gain during pregnancy,fasting blood glucose during pregnancy and glycosylated hemoglobin during pregnancy(all P<0.05).There was no significant difference in pregnancy outcome between the two groups(P>0.05).Age≥30 years,high pre-pregnancy BMI,weight gain≥6 kg during pregnancy,fasting blood glucose>5.8 mmol/L during pregnancy,and glycosylated hemoglobin>5.2%during pregnancy were independent risk factors for postpartum T2DM in GDM patients with diabetes family history(all P<0.05).The nomogram model predicted that the C-index value of postpartum T2DM was 0.912(95%CI:0.854-0.960),and the area under the ROC curve was 0.799(95%CI:0.742-0.856),with good discrimination;The calibration curve indicated that the accuracy of the model was good.According to the integral cutoff value of the line chart model,the probability of postpartum T2DM in GDM patients with family history of diabetes was divided into three groups:low(≤67.24 points),medium(>67.
作者
陈德兰
柳美枝
Chen Delan;Liu Meizhi(Department of Obstetrics and Gynecology,Tianchang People′s Hospital,Tianchang 239300,China)
出处
《中国医师杂志》
CAS
2022年第12期1837-1841,1846,共6页
Journal of Chinese Physician
关键词
糖尿病
妊娠
产后期
糖尿病
2型
危险因素
Diabetes,gestational
Postpartum period
Diabetes mellitus,type 2
Risk factors
