摘要
目的:分析妊娠期糖尿病(GDM)孕妇血清性激素结合球蛋白(SHBG)及与胰岛素分泌和不良妊娠结局关系。方法:选择2017年1月-2019年10月本院产前检查确诊的GDM孕妇,按照OGTT不同时间点血糖指标分为GDMA组、GDMB组、GDMC组、GDMD组,按照GDM孕妇血清SHBG浓度均数的约数将GDM组进一步分为SHBG≥295组与SHBG<295组,另选OGTT正常孕妇为对照组。检测各组血清SHBG及胰岛素水平,计算胰岛素抵抗相关指标。结果:GDM各组血清SHBG及HOMA-β值均低于对照组,血清FINS、HbA1c、HOMA-IR值均高于对照组(均P<0.05),且GDMA组、GDMB组、GDMC组、GDMD组血清SHBG及HOMA-β值逐渐降低,血清FINS、HbA1c、HOMA-IR值逐渐升高,但GDMB组与GDMC组无差异(P>0.05),其余组间比较均有差异(P<0.05)。GDM各组血清SHBG值与HOMA-IR均存在负相关(P<0.05),与HOMA-β存在正相关(P<0.05);GDM孕妇SHBG<295组FINS、INS30、INS60、INS120、INS180值均高于SHBG≥295组,血糖控制满意比例低于SHBG≥295组,应用胰岛素、胎膜早破发生率高于SHBG≥295组(均P<0.05),两组早产、羊水过多、妊娠期高血压疾病、胎儿窘迫、新生儿窒息发生率无差异(P<0.05);SHBG<295nmol/L是GDM孕妇不良妊娠结局的独立危险因素(P<0.05)。结论:OGTT不同时间点血糖异常的GDM孕妇血清SHBG水平略有差异,低水平SHBG会增加胰岛素抵抗及不良妊娠结局风险。
Objective:To analyze the relationship between the serum sex hormone binding globulin(SHBG)level of pregnant women with abnormal blood glucose levels at different OGTT time points and gestational diabetes mellitus(GDM)and their insulin secretion characteristics and adverse pregnancy outcomes.Methods:The pregnant women with GDM were selected in study group and were divided into group A,group B,group C,and group D according to blood glucose indexes levels at different time points of OGTT from January 2017 to October 2019.These women were also divided in group 1(women with SHBG≥295)and group 2(women with SHBG<295)according to their mean serum SHBG level.The pregnant women with normal OGTT results were selected in the control group.The serum SHBG and insulin levels of the women in these groups were detected,and insulin resistance related indexes of these women were calculated.Results:The serum SHBG level and HOMA-βvalue of the women in the study group were significantly lower than those of the women in the control group,while the serum FINS and HbA1c levels,and HOMA-IR value of the women in the study group were significantly higher(all P<0.05).The serum SHBG level and HOMA-βvalue of the women in group A,group B,group C,and group D had decreased gradually,while the serum FINS and HbA1c levels,and HOMA-IR value of the women in group A,group B,group C,and group D had increased gradually,which had no significant different between group B and group C(P>0.05),but which had significant different between group A and group D(P<0.05).The serum SHBG level of the women with GDM was negatively correlated with their HOMA-IR value(P<0.05),and was positively correlated with their HOMA-βvalue(P<0.05).The values of FINS,INS30,INS60,INS120,and INS180,the rate of insulin application,and the incidence premature rupture of membranes of the women in group 2 were significantly higher than those of the women in group 1,but the proportion of satisfied blood glucose control of the women in group 2 was significantly lower(all P<0.05).There were no significant differences in the incidences of premature delivery,polyhydramnios,hypertension during pregnancy of women,fetal distress,and neonatal asphyxia between group 1 and group 2(P<0.05).The SHBG level<295nmol/L was an independent risk factor of the adverse pregnancy outcomes of the women with GDM(P<0.05).Conclusion:The serum SHBG level of GDM women with abnormal blood glucose at different OGTT time points is slightly different.The low SHBG level of pregnant women may increase the risk of their insulin resistance and adverse pregnancy outcomes.
作者
徐庆丽
燕巍
李志刚
闫淑芬
XU Qingli;YAN Wei;LI Zhigang;YAN Shufen(Zhengzhou Maternal and Child Health Care Hospital,Henan Province,450000;Zhengzhou Central Hospital Affiliated to Zhengzhou University)
出处
《中国计划生育学杂志》
2022年第1期50-54,共5页
Chinese Journal of Family Planning
关键词
妊娠期糖尿病
性激素结合球蛋白
胰岛素
妊娠结局
Gestational diabetes mellitus
Sex hormone binding globulin
Insulin
Pregnancy outcomes
