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目的探讨妊娠早期脂联素水平对妊娠期糖尿病(GDM)发病风险的预测价值。方法检测890例妊娠早期(6~13周)孕妇的血脂联素水平,至妊娠中期(24~28周)行75g口服葡萄糖耐量试验。根据结果分为GDM组(A组,76例)和糖耐量正常对照组(B组,814例),分析妊娠早期脂联素水平与妊娠中期GDM发病风险及血糖调节相关指标之间的相关性。结果 A组妊娠早期和中期脂联素水平均低于B组[(9.67±3.84)μg/ml vs.(11.92±4.59)μg/ml和(9.70±5.18)μg/ml vs.(11.67±4.72)μg/ml](P<0.05)。调整年龄、BMI、体脂百分比、腰围等混杂因素后,妊娠早期脂联素低表达是妊娠中期GDM发病的危险因素[OR=1.14,95%CI(1.04~1.25),P<0.01]。妊娠早期和中期的脂联素水平与妊娠中期的胰岛素抵抗指数、总血糖或胰岛素曲线下面积均呈负相关(r=-0.22、-0.16和-0.22、-0.17,P<0.01),与妊娠中期的胰岛素敏感性指数、胰岛素分泌敏感性指数2均呈正相关(r=0.28、0.21和0.29、0.22,P<0.01)。结论妊娠早期脂联素的水平对妊娠中期GDM发病具有较稳定的预测价值。
Objective To investigate the predictive value of early pregnancy level of adiponectin in the risk of gestational diabetes mellitus (GDM). Methods The level of blood adiponectin in 890 pregnant women during the first trimester of pregnancy (6 ~ 13 weeks) was measured. A 75g oral glucose tolerance test was performed in the second trimester of pregnancy (24 ~ 28 weeks). According to the results, we divided into GDM group (A group, 76 cases) and normal glucose tolerance group (B group, 814 cases), analyzed the correlation between the level of adiponectin in early pregnancy and the risk of GDM and the related indicators of blood glucose regulation . Results The serum levels of adiponectin in group A were lower than those in group B [(9.67 ± 3.84) μg / ml vs. (11.92 ± 4.59) μg / ml and (9.70 ± 5.18) μg / ml vs. (11.67 ± 4.72 ) μg / ml] (P <0.05). After adjusting for age, BMI, body fat percentage, waist circumference and other confounders, low expression of adiponectin in early pregnancy was a risk factor for the incidence of GDM during pregnancy [OR = 1.14,95% CI (1.04-1.25), P <0.01]. The levels of adiponectin in the first trimester and the second trimester were inversely correlated with the insulin resistance index, the total blood glucose or the area under the curve of insulin in the second trimester (r = -0.22, -0.16 and -0.22, -0.17, P <0.01) Mid-term insulin sensitivity index, insulin secretion sensitivity index 2 were positively correlated (r = 0.28,0.21 and 0.29,0.22, P <0.01). Conclusion The levels of adiponectin in early pregnancy have a stable predictive value in the incidence of GDM during the second trimester of pregnancy.