上海地区孕妇维生素D水平调查及其与妊娠期糖尿病发生的相关性研究及其预测价值探索

doi:10.16150/j.1671-2870.2019.06.006

摘要/Abstract

摘要：

目的：了解上海地区孕妇维生素D水平,分析孕中期血清25羟基维生素D₃[25(OH) D₃]与妊娠期糖尿病（gestational diabetes mellitus, GDM）发生间的相关性,探讨25(OH)D₃ 能否预测GDM的发生。方法：选取2018年在本院产科建卡产检的孕妇作为研究对象,并于孕早期（孕8~12周）检测空腹血糖（fasting blood glucose, FBG）和糖化血红蛋白（hemoglobin A1c, HbA1c）,孕中期（孕13~15周）检测血清25(OH)D₃水平,孕中后期（孕24~28周）检测口服葡萄糖耐量试验（oral glucose tolerance test, OGTT）。回顾性分析以上结果,根据筛查结果将其分GDM组（1 130例）,正常对照组1 102例,并比较2组间的相关指标差异,分析血清25(OH)D₃水平与FBG、HbA1c及OGTT血糖值间的相关性,以及25(OH) D₃对GDM的预测效果。结果：GDM组与对照组间的体质量指数、年龄差异均无统计学意义（P>0.05）,而2组间的各检测指标间差异有统计学意义（P<0.05）。GDM组的血清25(OH)D₃水平低于对照组[（45.10±15.84） nmol/L比(46.77±16.61) nmol/L, P<0.05]。上海地区孕妇的维生素D水平普遍偏低,25(OH)D₃不足率达95%,缺乏率高达60%。同时,血清25(OH)D₃水平与孕早期FBG水平间存在负相关性（r=-0.063, P=0.035）。在OGTT空腹时间点,GDM孕妇FBG正常组与FBG异常组之间比较,25（OH）D₃水平[（45.61±16.74） nmol/L比（43.73±14.12） nmol/L]差异有统计学意义（P<0.05）,而在其他时间点,2组间差异无统计学意义。受试者工作特征曲线分析显示,血清25(OH) D₃预测GDM的曲线下面积小于0.5。结论：上海地区孕妇孕中期的维生素D水平普遍偏低,其血清25（OH）D₃水平与FBG呈负相关,25(OH)D₃可能与空腹糖代谢有关。孕妇孕14~18周的血清25（OH）D₃水平并不适用于预测GDM的发生。

关键词: 妊娠期, 糖尿病, 25羟基维生素D₃

Abstract:

Objective: To investigate the correlation between serum level of 25-vitamin D₃ [25(OH)D₃] and gestational diabetes mellitus (GDM), and to analyze whether 25(OH)D₃ can predict the occurrence of GDM. Methods: The pregnant women registered in our hospital in 2018 were tested for fast blood glucose (FBG) and glycated hemoglobin (HbA1c) in first trimester (8-12 week), serum 25(OH)D₃ in second trimester (13-15 week), and oral glucose tolerance test (OGTT) in second and third trimester (24-28 week). The pregnant women were categorized into gestational diabetes mellitus group (GDM) (1 130 cases) and normal pregnant group (control group) (1 102 cases). Compared the related indices between the two groups, analyzed the correlation between 25(OH)D₃ and each index and the predictive value of 25(OH)D₃ for GDM. Results: There were no significant differences in BMI and age between the two groups (P>0.05). The serum 25(OH)D₃ level in GDM group was lower than that in control group [(45.10±15.84) nmol/L vs (46.77±16.61) nmol/L, P<0.05]. Vitamin D level in pregnant women was generally low: 25(OH)D₃ was inadequate in 95%, and deficient in up to 60%. There was a negative correlation between 25(OH)D₃ and FBG in early pregnancy (r=-0.063, P=0.035). At the fasting time point of OGTT, there was a significant difference in level of 25(OH)D₃ [（45.61±16.74） nmol/L vs （43.73±14.12） nmol/L (P<0.05)] between the two groups having or not having normal FBG, and there was no significant difference in other time points of GOTT between the two groups. The area under ROC curve for serum 25(OH)D₃ to predict GDM was less than 0.5. Conclusions: Vitamin D level in pregnant women is generally low in Shanghai. Level of 25(OH)D₃ is negatively correlated with FBG level, however, serum 25(OH)D₃ in second trimester is not suitable for predicting GDM.

Key words: Gestation period, Diabetes, 25(OH)D₃

中图分类号:

R714.25

姚小艳, 陈君. 上海地区孕妇维生素D水平调查及其与妊娠期糖尿病发生的相关性研究及其预测价值探索[J]. 诊断学理论与实践, 2019, 18(06): 634-639.

YAO Xiaoyan, CHEN Jun. Serum level of 25-vitamin D₃ in pregnant women and its correlation with gestational diabetes mellitus and predictive value for occurrence of GDM[J]. Journal of Diagnostics Concepts & Practice, 2019, 18(06): 634-639.

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组别	BMI（kg/m²）	年龄(岁)
GDM组（n=1 130）	21.5±3.7	31.0±2.5
对照组（n=1 102）	20.9±2.7	30.2±3.6

组别	FBG(mmol/L)	HbA1c(%)	25(OH)D₃(nmol/L)	OGTT(mmol/L)
组别	FBG(mmol/L)	HbA1c(%)	25(OH)D₃(nmol/L)	FBG	1 h PBG	2 h PBG
GDM组	4.74±0.39	5.23±0.38	45.10±15.84	4.82±0.62	9.86±1.43	8.45±1.43
对照组	4.42±0.29	5.04±1.13	46.77±16.61	4.39±0.26	7.08±1.34	6.07±0.98
T值	21.34	5.41	-2.423	21.685	47.41	45.11
P值	<0.001	<0.001	0.010	<0.001	<0.001	<0.001

组别	例数(n)	充足	不足	缺乏	严重缺乏
GDM组	1 130	53(4.7)	332(29.4)	662(58.6)	83（7.3）
对照组	1 102	64(5.8)	357(32.4)	620(56.3)	61（5.5）

相关分析	孕早期 FBG	孕早期 HbAlc	OGTT
相关分析	孕早期 FBG	孕早期 HbAlc	FBG	1 h PBG	2 h PBG
r值	-0.063	-0.01	-0.049	0.40	0.038
P值	0.035	0.830	0.101	0.174	0.205

时间	血糖值（mmol/L）	例数（n）	25（OH）D₃ (nmol/L)	P值
空腹	<5.1	766	45.61±16.74	0.049
	≥5.1	364	43.73±14.12
1 h	<10.0	527	44.50±15.42	0.237
	≥10.0	603	45.62±16.20
2 h	<8.5	455	44.54±15.3	0.334
	≥8.5	675	45.47±16.20