孕前甘油三酯葡萄糖指数及孕期增重对妊娠期糖尿病患者分娩巨大儿的预测价值

doi:10.3969/j.issn.1004-583X.2022.08.007

临床荟萃 ›› 2022, Vol. 37 ›› Issue (8): 713-716.doi: 10.3969/j.issn.1004-583X.2022.08.007

孕前甘油三酯葡萄糖指数及孕期增重对妊娠期糖尿病患者分娩巨大儿的预测价值

吴路路¹, 王瑞亚², 苏林¹, 冯静³()

1.河北北方学院研究生院, 河北张家口 075000
2.河北医科大学研究生院,河北石家庄 050011
3.河北省人民医院产科,河北石家庄 050051

收稿日期:2022-07-18 出版日期:2022-08-20 发布日期:2022-09-26
通讯作者: 冯静 E-mail:tiandixuanhuang0@126.com
基金资助:
河北省中医药科研计划项目——滋肾育胎丸治疗复发性流产患者病理性高凝状态的疗效观察(2022386)

Predictive value of progestational triglyceride glucose indexes and gestational weight gain on gestational diabetes mellitus petients with delivery of macrosomia

Wu Lulu¹, Wang Ruiya², Su Lin¹, Feng Jing³()

1. Graduate Faculty of Hebei North University, Zhangjiakou 075000,China
2. Graduate Faculty of Hebei Medical University, Shijiazhuang 050017, China
3. Department of Obstetrics and Gynecology, Hebei General Hospital, Shijiazhuang 050051, China

Received:2022-07-18 Online:2022-08-20 Published:2022-09-26
Contact: Feng Jing E-mail:tiandixuanhuang0@126.com

摘要/Abstract

摘要：

目的分析孕前甘油三酯葡萄糖(TyG)指数及孕期增重与妊娠期糖尿病(GDM)患者分娩巨大儿的关系。方法以2020年06月1日-2022年01月31日就诊于河北省人民医院产科住院分娩且确诊为GDM的孕产妇共476例为研究对象,统计患者各项临床资料。根据新生儿体重,分为巨大儿组(124例)和非巨大儿组(352例)。分析GDM患者分娩巨大儿的独立影响因素,绘制受试者工作特征(ROC)曲线以分析孕前TyG指数及孕期增重对GDM患者分娩巨大儿的预测价值。结果巨大儿组年龄、孕期增重及孕前TyG指数均高于非巨大儿组(P<0.05)。巨大儿组初孕及初产比例均低于非巨大儿组(P<0.05)。多因素Logistic回归分析结果显示,孕期增重、孕前TyG指数是GDM患者分娩巨大儿的独立影响因素(P<0.05)。ROC曲线结果显示:孕期增重(AUC: 0.613, 95%CI:0.554~0.672, P<0.01)、孕前TyG指数(AUC:0.720,95%CI:0.672~0.768,P<0.01)对GDM患者分娩巨大儿有一定预测能力,但二者联合预测能力更高(AUC: 0.746, 95%CI:0.699~0.794,P<0.01),可更好的预测GDM患者分娩巨大儿。结论孕期增重、孕前TyG指数是GDM患者分娩巨大儿的独立危险因素,且对于GDM患者分娩巨大儿具有较好的预测价值。

关键词: 糖尿病, 妊娠, 甘油三酯葡萄糖指数, 巨大儿

Abstract:

Objective To analyze relationship between progestational triglyceride glucose (TyG) index, gestational weight gain and large for gestational age (LGA) in patients with gestational diabetes mellitus (GDM). Methods A total of 476 cases of pregnant women diagnosed with GDM during June 1, 2020 to January 31, 2022 in Obstetrics Department, Hebei General Hospital for institutional delivery were as the study subjects. All clinical data were collected from the two groups which comprised the macrosomia group (n=124) and non-macrosomia group (n=352), grouped based on the newborn weigh. The independent factors influencing macrosomia in GDM patients were analyzed, and receiver operating characteristic (ROC) curve was drawn to evaluate the predictive value of progestational TyG index and gestational weight gain for macrosomia in GDM patients. Results The age, gestational weight gain, and progestational TyG index in the macrosomia group were higher than those in the non-macrosomia group (P<0.05). The proportions of first pregnancy and first birth in the macrosomia group were lower than those in the non-macrosomia group (P<0.05). Multivariate logistic regression analysis showed that gestational weight gain and progestational TyG index were independent factors influencing LGA delivery of GDM patients (P<0.05). ROC curve results showed that gestational weight gain (AUC:0.613, 95%CI: 0.554-0.672, P<0.01) and progestational TyG index(AUC: 0.720, 95%CI: 0.672-0.768, P<0.01) had certain predictive abilities for macrocosm in GDM patients, and the combined predictor of two indices (AUC: 0.746, 95% CI: 0.699-0.794, P<0.01) had a higher ability, and it could predict LGA delivery of GDM patients in a better manner. Conclusion Gestational weight gain and progestational TyG index are independent risk factors for LGA delivery of GDM patients, and with better predictive value.

Key words: diabetes, gestational, triglyceride glucose index, macrosomia

中图分类号:

R714.256

吴路路, 王瑞亚, 苏林, 冯静. 孕前甘油三酯葡萄糖指数及孕期增重对妊娠期糖尿病患者分娩巨大儿的预测价值[J]. 临床荟萃, 2022, 37(8): 713-716.

Wu Lulu, Wang Ruiya, Su Lin, Feng Jing. Predictive value of progestational triglyceride glucose indexes and gestational weight gain on gestational diabetes mellitus petients with delivery of macrosomia[J]. Clinical Focus, 2022, 37(8): 713-716.

导出引用管理器 EndNote|Ris|BibTeX

链接本文: https://huicui.hebmu.edu.cn/CN/10.3969/j.issn.1004-583X.2022.08.007

https://huicui.hebmu.edu.cn/CN/Y2022/V37/I8/713

图/表 4

表1 两组临床资料比较

项目	巨大儿组( $n$ =124)	非巨大儿组( $n$ =352)	χ²/ $Z$ / $t$ 值	$P$ 值
年龄(岁)	32.90±4.10	31.87±4.11	2.385	0.017
分娩孕周(周)	38.38±0.76	38.25±1.44	-0.950	0.342
孕前BMI(kg/m²)	24.56±3.12	24.08±3.43	-1.355	0.176
孕期增重(kg)	13.00(10.00, 18.00)	12.00(8.70, 14.58)	-3.756	<0.01
初孕(例,%)	29.00(23.40)	120.00(34.10)	4.886	0.027
初产(例,%)	47.00(37.90)	173.00(49.10)	4.664	0.031
收缩压(mmHg)	119.46±10.93	118.17±11.89	1.057	0.291
舒张压(mmHg)	77.56±8.86	77.59±9.74	-0.024	0.981
静息心率(次/分)	78.29±16.27	77.93±17.09	0.771	0.441
孕期空腹血糖最高值(mmol/L)	7.82(6.77, 8.79)	7.96 (6.89, 8.93)	-0.810	0.418
孕期糖化血红蛋白(%)	6.14±0.47	6.09±0.57	0.874	0.383
TG(mmol/L)	2.91(2.40, 3.66)	2.72(2.05, 3.58)	-1.844	0.065
TC(mmol/L)	5.91±1.45	6.10±1.26	-1.467	0.143
LDL-C(mmol/L)	3.44±0.77	3.57±0.88	-1.433	0.153
HDL-C(mmol/L)	1.81±0.35	1.87±0.38	-1.713	0.087
孕前TyG指数	2.58±0.32	2.29±0.37	7.757	<0.01

表1 两组临床资料比较

项目	巨大儿组( $n$ =124)	非巨大儿组( $n$ =352)	χ²/ $Z$ / $t$ 值	$P$ 值
年龄(岁)	32.90±4.10	31.87±4.11	2.385	0.017
分娩孕周(周)	38.38±0.76	38.25±1.44	-0.950	0.342
孕前BMI(kg/m²)	24.56±3.12	24.08±3.43	-1.355	0.176
孕期增重(kg)	13.00(10.00, 18.00)	12.00(8.70, 14.58)	-3.756	<0.01
初孕(例,%)	29.00(23.40)	120.00(34.10)	4.886	0.027
初产(例,%)	47.00(37.90)	173.00(49.10)	4.664	0.031
收缩压(mmHg)	119.46±10.93	118.17±11.89	1.057	0.291
舒张压(mmHg)	77.56±8.86	77.59±9.74	-0.024	0.981
静息心率(次/分)	78.29±16.27	77.93±17.09	0.771	0.441
孕期空腹血糖最高值(mmol/L)	7.82(6.77, 8.79)	7.96 (6.89, 8.93)	-0.810	0.418
孕期糖化血红蛋白(%)	6.14±0.47	6.09±0.57	0.874	0.383
TG(mmol/L)	2.91(2.40, 3.66)	2.72(2.05, 3.58)	-1.844	0.065
TC(mmol/L)	5.91±1.45	6.10±1.26	-1.467	0.143
LDL-C(mmol/L)	3.44±0.77	3.57±0.88	-1.433	0.153
HDL-C(mmol/L)	1.81±0.35	1.87±0.38	-1.713	0.087
孕前TyG指数	2.58±0.32	2.29±0.37	7.757	<0.01

表2 多因素Logistic回归分析结果

影响因素	B值	$S E$ 值	Wald χ²值	$O R$ (95% $C I$ )值	$P$ 值
年龄	0.027	0.034	0.655	1.028(0.962,1.098)	0.418
孕期增重	0.094	0.022	19.011	1.099(1.053,1.146)	<0.01
初孕	0.006	0.383	0.001	1.006(0.475, 2.130)	0.988
初产	-0.260	0.363	0.513	0.771(0.378, 1.571)	0.474
孕前TyG指数	2.345	0.351	41.522	10.428(5.238, 20.764)	<0.01

表2 多因素Logistic回归分析结果

影响因素	B值	$S E$ 值	Wald χ²值	$O R$ (95% $C I$ )值	$P$ 值
年龄	0.027	0.034	0.655	1.028(0.962,1.098)	0.418
孕期增重	0.094	0.022	19.011	1.099(1.053,1.146)	<0.01
初孕	0.006	0.383	0.001	1.006(0.475, 2.130)	0.988
初产	-0.260	0.363	0.513	0.771(0.378, 1.571)	0.474
孕前TyG指数	2.345	0.351	41.522	10.428(5.238, 20.764)	<0.01

图1 孕期增重及孕前TyG指数预测GDM患者分娩巨大儿的ROC曲线

表3 孕前TyG指数、孕期增重及联合预测因子与GDM患者分娩巨大儿的ROC分析结果

项目	$S E$ 值	敏感性(%)	特异性(%)	AUC(95% $C I$ )值	$P$ 值
孕前TyG指数	0.024	75.8	59.1	0.720(0.672, 0.768)	<0.01
孕期增重	0.030	33.1	84.4	0.613(0.554, 0.672)	<0.01
联合预测因子	0.024	91.9	45.2	0.746(0.699, 0.794)	<0.01

表3 孕前TyG指数、孕期增重及联合预测因子与GDM患者分娩巨大儿的ROC分析结果

项目	$S E$ 值	敏感性(%)	特异性(%)	AUC(95% $C I$ )值	$P$ 值
孕前TyG指数	0.024	75.8	59.1	0.720(0.672, 0.768)	<0.01
孕期增重	0.030	33.1	84.4	0.613(0.554, 0.672)	<0.01
联合预测因子	0.024	91.9	45.2	0.746(0.699, 0.794)	<0.01

参考文献 15

[1]	Dalfrà MG, Burlina S, Del Vescovo GG, et al. Genetics and epigenetics: New insight on gestational diabetes mellitus[J]. Front Endocrinol (Lausanne), 2020, 11:602477. doi: 10.3389/fendo.2020.602477 URL
[2]	杨洁, 侯杉杉, 赵立峥, 等. 妊娠期糖尿病对孕晚期糖脂水平及巨大儿的影响研究[J]. 中国全科医学, 2021, 24(24):3095-3100. doi: 10.12114/j.issn.1007-9572.2021.00.583
[3]	李融融, 时小东, 陈伟. 新型简化胰岛素抵抗评价指标对糖代谢紊乱预测价值的比较研究[J]. 中华糖尿病杂志, 2022, 14(1):56-62.
[4]	Berger H, Gagnon R, Sermer M. Guideline No.393-diabetes in pregnancy[J]. J Obstet Gynaecol Can, 2019, 41(12):1814-1825. doi: 10.1016/j.jogc.2019.03.008 URL
[5]	American Diabetes Association. 2. Classification and diagnosis of diabetes: Standards of medical care in diabetes-2021[J]. Diabetes Care, 2021, 44(Suppl 1):S15-S33. doi: 10.2337/dc21-S002 pmid: 33298413
[6]	Simental-Mendía LE, Rodríguez-Morán M, Guerrero-Romero F. The product of fasting glucose and triglycerides as surrogate for identifying insulin resistance in apparently healthy subjects[J]. Metab Syndr Relat Disord, 2008, 6(4):299-304. doi: 10.1089/met.2008.0034 URL
[7]	Rosinha PMO, Dantas RAB, Alves MIP, et al. Body mass index and gestational weight gain: Relevance in gestational diabetes and outcomes-A retrospective cohort study[J]. Arch Endocrinol Metab, 2022, 66(2):261-268.
[8]	李丹, 宋灏哲, 黄宗耀, 等. 孕前BMI、孕期随机空腹血糖最高值、孕期增重对28周后妊娠期糖尿病孕妇分娩巨大儿风险的评估价值[J]. 中国医师杂志, 2021, 23(7):1054-1057.
[9]	Sun YY, Juan J, Xu QQ, et al. Increasing insulin resistance predicts adverse pregnancy outcomes in women with gestational diabetes mellitus[J]. J Diabetes, 2020, 12(6):438-446. doi: 10.1111/1753-0407.13013 URL
[10]	Li J, Leng J, Li W, et al. Roles of insulin resistance and beta cell dysfunction in macrosomia among Chinese women with gestational diabetes mellitus[J]. Prim Care Diabetes, 2018, 12(6):565-573. doi: S1751-9918(18)30232-8 pmid: 30115525
[11]	Scholtens DM, Bain JR, Reisetter AC, et al. Metabolic networks and metabolites underlie associations between maternal glucose during pregnancy and newborn size at birth[J]. Diabetes, 2016, 65(7):2039-2050. doi: 10.2337/db15-1748 pmid: 27207545
[12]	商伟静, 黄爱群, 潘晓平. 孕期体重增长与巨大儿发生的随访数据分析研究[J]. 中国妇幼卫生杂志, 2021, 12(3):16-21.
[13]	Kim JA, Kim J, Roh E, et al. Triglyceride and glucose index and the risk of gestational diabetes mellitus: A nationwide population-based cohort study[J]. Diabetes Res Clin Pract, 2021, 171:108533. doi: 10.1016/j.diabres.2020.108533 URL
[14]	Song T, Su G, Chi Y, et al. Triglyceride-glucose index predicts the risk of gestational diabetes mellitus: A systematic review and meta-analysis[J]. Gynecol Endocrinol, 2022, 38(1):10-15. doi: 10.1080/09513590.2021.1940932 URL
[15]	亢云, 张娟娟, 李昭, 等. 西北地区孕妇孕前BMI及孕期增重适宜范围的探讨[J]. 中国妇幼健康研究, 2022, 33(3):47-53.

孕前甘油三酯葡萄糖指数及孕期增重对妊娠期糖尿病患者分娩巨大儿的预测价值

Predictive value of progestational triglyceride glucose indexes and gestational weight gain on gestational diabetes mellitus petients with delivery of macrosomia

RichHTML

PDF (PC)

可视化

摘要/Abstract

引用本文

使用本文

图/表 4

参考文献 15

相关文章 1

编辑推荐

Metrics

本文评价