The clinical significance of blood lipid level in patientswith gestational diabetes mellitus in late pregnancy and its impact on neonates
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摘要:目的 研究妊娠期糖尿病(GDM)患者孕晚期血脂水平的临床意义及对新生儿的影响。方法 将GDM患者101例设为GDM组，同期待产的孕晚期糖耐量正常孕妇103例为对照组。评估2组新生儿体质量、巨大儿发生率及产妇体质量增加情况。结果 GDM组孕妇年龄大于对照组，总胆固醇(TC)水平显著高于对照组(P < 0.05)。GDM组新生儿体质量、巨大儿发生率显著高于对照组(P < 0.05)。2组巨大儿体质量无显著差异；出生时、5 min Apgar评分无显著差异(P>0.05)。结论 GDM患者在糖代谢异常的同时还多伴有脂代谢异常。在控制饮食、适当运动及合理应用胰岛素控制血糖的同时，还要监测患者血脂水平，降低胰岛素抵抗程度，改善妊娠结局，以保证母婴健康。Abstract:Objective To study the clinical significance of blood lipid level in patients with gestational diabetes mellitus (GDM) in late pregnancy and its impact on neonates.Methods A total of 101 GDM patients were selected as GDM group, and 103 pregnant women with normal glucose tolerance in the same period were as control group. The neonatal weight, incidence of fetal macrosomia and weight gaining of puerperas in both groups were evaluated.Results Patients in GDM group was older than those in control group, and the total cholesterol (TC) level in GDM group was higher than that in control group (P < 0.05). A higher neonatal weight and incidence of macrosomia was found in GDM group compared with control group (P < 0.05). However, there were no significant differences in weight of fetal macrosomia, and Apgar scores at birth and 5 min after birth in two groups (P>0.05).Conclusion GDM is mostly accompanied with abnormal lipid metabolism during abnormal glucose metabolism process. Therefore, attention should be paid not only to diet control, proper exercise, and rational use of insulin, but also to monitoring of blood lipid, insulin resistance reduction, and improvement of pregnancy outcomes, thus ensuring the maternal and child health.
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Keywords:
- gestational diabetes /
- blood lipids /
- neonatal weight /
- fetal macrosomia /
- pregnancy outcomes
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表 1 2组一般资料、生化指标比较(x±s)
项目 对照组(n=103) GDM组(n=101) 分娩时年龄/岁 26.86±3.24 28.86±3.78* 分娩时孕周/周 39.06±1.51 39.26±0.92 孕前BMI/(kg/m2) 21.30±3.21 22.27±3.45* 孕期增加体质量/kg 11.23±0.45 13.86±0.24* TG/(mmol/L) 2.78±1.54 3.07±1.16 TC/(mmol/L) 5.85±1.12 6.25±1.28* HDL-C/(mmol/L) 1.75±0.44 1.74±0.34 LDL-C/(mmol/L) 3.54±0.75 3.69±0.83 FFA/(mmol/L) 0.54±0.23 0.52±0.20 FBG/(mmol/L) 4.10±0.65 4.63±0.97* HbA1c/% 5.23±0.83 5.74±0.43* TC: 血清总胆固醇; TG: 甘油三酯; HDL-C: 高密度脂蛋白胆固醇; LDL-C: 低密度脂蛋白胆固醇; FFA: 游离脂肪酸; HbA1c: 糖化血红蛋白。与对照组比较, *P < 0.05。 
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表 2 HbA1c与血脂的相关性分析
组别 TG TC HDL-C LDL-C FFA 对照组 r 0.036 0.017 -0.072 0.121 -0.111 p 0.740 0.875 0.502 0.262 0.304 GDM组 r 0.302 0.225 0.124 0.166 0.163 p 0.004 0.033 0.245 0.118 0.126 TC: 血清总胆固醇; TG: 甘油三酯; HDL-C: 高密度脂蛋白胆固醇; LDL-C: 低密度脂蛋白胆固醇; FFA: 游离脂肪酸。
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表 3 2组新生儿体质量、巨大儿情况比较(x±s)
组别 体质量/g 出生时Apgar评分/分 出生5 min Apgar评分/分 巨大儿发生率/% 巨大儿体质量/g 对照组 3 225.45±479.25 10.00±0.00 10.00±0.00 2.25 4 075.00±106.06 GDM组 3 378.78±444.72* 9.91±0.57 9.98±0.15 6.67* 4 425.00±552.95 与对照组比较, *P < 0.05。
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表 4 新生儿体质量与血脂血糖的关系
组别 TG TC HDL-C LDL-C FFA FBG HbA1c 对照组 r 0.182 -0.110 -0.054 -0.188 0.014 -0.030 0.039 p 0.089 0.307 0.619 0.080 0.899 0.781 0.072 GDM组 r 0.183 -0.030 0.003 -0.031 0.108 0.002 0.231 p 0.043 0.782 0.977 0.774 0.311 0.986 0.029 TG: 甘油三酯; TC: 血清总胆固醇; HDL-C: 高密度脂蛋白胆固醇; LDL-C: 低密度脂蛋白胆固醇; FFA: 游离脂肪酸; FBG: 空腹血糖; HbA1c: 糖化血红蛋白。
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