葡萄糖耐量试验不同时间点血糖水平预测妊娠期糖尿病的妊娠结局

Glucose tolerance test at different time points to predict pregnancy outcomes in gestational diabetes

关键词:  妊娠期糖尿病  葡萄糖耐量试验  血糖  妊娠结局

Key words:  gestational diabetes mellitus  glucose tolerance test  blood glucose  pregnancy outcome

摘要:

目的 分析口服葡萄糖耐量试验(oral glucose tolerance test, OGTT)不同时间点血糖水平预测妊娠期糖尿病(gestational diabets, GDM)的妊娠结局。方法 筛选2016年6月—2017年12月在上海交通大学医学院附属同仁医院产检诊断为GDM的668例孕妇，检测空腹血糖（fasting blood glucose, FBG）及75g OGTT试验。根据血糖水平分为3组： FBG异常为GDM Ⅰ组（n=328）；FBG正常，OGTT 1h或OGTT 2h其中一项血糖异常为GDM Ⅱ组(n=224)；FBG、OGTT 1h、OGTT 2h 3个时间点血糖均异常为GDM Ⅲ组（n=116）。分析3组孕妇的不同时间点血糖水平、空腹胰岛素（FINS）、胰岛素抵抗指数（HOMA-IRI）以及母婴不良结局的发生情况。结果 GDM Ⅲ组孕妇的FBG、OGTT 1h、OGTT 2h血糖水平，及FINS水平、HOMA-IRI均明显高于GDM Ⅰ组与GDM Ⅱ组(均P＜0.05)；而GDM Ⅱ组的以上指标水平均明显高于GDM Ⅰ组(P＜0.05)。GDM Ⅲ组孕妇的妊娠不良结局的发生率明显高于GDM Ⅰ组与GDM Ⅱ组(均P＜0.05)，GDM Ⅱ组的以上新生儿不良结局明显高于GDM Ⅰ组(P＜0.05)。GDM Ⅲ组孕妇的新生儿不良结局的发生率明显高于GDM Ⅰ组与GDM Ⅱ组(均P＜0.05)；而GDM Ⅱ组与GDM Ⅰ组的新生儿不良结局，差异无统计学意义(P＞0.05)。结论 GDM孕妇的OGTT试验时间点异常越多、血糖与胰岛素水平越高提示GDM程度越重，表现为妊娠不良结局、新生儿出现巨大儿发生率可能越高。

Abstract:

Objective To analyze the glucose tolerance test at different time points to predict the pregnancy outcome of gestational diabetes (GDM). Methods From June 2016 to December 2017, 668 GDM pregnant women in hospital were enrolled, and 75g oral glucose tolerance test (OGTT) were performed. They were grouped according to blood glucose levels： 328 cases with fasting blood glucose (FBG) abnormality (GDM Ⅰ group), 224 cases with normal FBG and abnormal OGTT 1h or OGTT 2h (group GDM Ⅱ), and 116 cases with abnormal FBG, OGTT 1h and OGTT 2h (GDM Ⅲ group). Blood glucose levels, fasting insulin (FINS), insulin resistance index (HOMA-IRI), and maternal and infant adverse outcomes were analyzed at different time points in the three groups. Results The FBG, OGTT 1h and OGTT 2h blood glucose levels in the GDM Ⅲ group were significantly higher than those in the GDM I group and the GDM Ⅱ group (all P＜0.05), while the above indicators in the GDM Ⅱ group were higher than in the GDM Ⅰ group. The incidence of adverse pregnancy outcomes in the GDM Ⅲ group was significantly higher than that in the GDM Ⅰ group and the GDM Ⅱ group (all P＜0.05), while the incidence of adverse pregnant outcomes in the GDM Ⅱ group were significantly higher than that in the GDM Ⅰ group (P＜0.05). The incidence of neonatal adverse outcomes in the GDM Ⅲ group was significantly higher than that in the GDM I group and the GDM Ⅱ group (all P＜0.05), while there was no significant difference in neonatal outcomes between groups GDM I and Ⅱ (P＞0.05). Conclusion GDM pregnant women with more abnormal OGTT test time points will have higher the blood glucose and insulin resistance levels and the severer disease, and the incidence of macrosomia in neonates and poor pregnancy outcomes may be increased