2019 年第 11 期 第 14 卷

血清25-羟维生素D对妊娠期糖尿病的预测价值

Predictive value of serum 25-hydroxyvitamin D level for gestational diabetes mellitus

作者：张艳梅宋晓平黄莺

英文作者：

单位：830001乌鲁木齐，新疆维吾尔自治区人民医院产科

英文单位：

关键词：妊娠期糖尿病；25-羟维生素D；空腹血糖；糖化血红蛋白

英文关键词：

• 摘要：

• 【摘要】目的    探讨妊娠不同时期血清25-羟维生素D［25-(OH)D］水平在妊娠期糖尿病（GDM）预测中的临床价值。方法    选取2017年6月至2018年1月新疆维吾尔自治区人民医院产科门诊行孕前检查的160名女性进行前瞻性研究，根据妊娠24周时糖耐量检查结果分为GDM组（48例）及对照组(112例)。比较2组研究对象妊娠前一般资料、血糖和血脂水平以及妊娠不同时期血清25-(OH)D水平，并通过绘制受试者工作特征曲线分析25-(OH)D水平对GDM的预测价值。结果    2组研究对象妊娠前年龄、孕次、产次、体重指数、血糖和血脂水平比较差异均无统计学意义（均P＞0.05）。对照组妊娠前血清25-(OH)D水平高于GDM组，对照组和GDM组妊娠早期和妊娠中期血清25-(OH)D水平均低于妊娠前［(25±5)、（20±4）μg/L比（29±6）μg/L，(20±4)、（12±3）μg/L比（26±4）μg/L］，且GDM组均显著低于对照组，差异均有统计学意义（均P＜0.05）。受试者工作特征曲线分析显示，妊娠中期血清25-(OH)D水平预测GDM的曲线下面积大于妊娠早期和妊娠前（0.891比0.718、0.613），差异均有统计学意义（均P＜0.001），孕中期25-(OH)D预测GDM的最佳截点为14.18 μg/L。结论    随着妊娠的进展，孕妇血清25-(OH)D水平逐渐下降，GDM患者血清25-(OH)D水平明显低于对照组，妊娠中期较低的25-(OH)D水平与GDM的发生有着较高的相关性。

• 【Abstract】Objective    To investigate the clinical value of serum 25-hydroxyvitamin D［25-(OH)D］ level at different stages of pregnancy in predicting gestational diabetes mellitus(GDM). Methods    A prospective study was conducted among 160 pregnant women admitted to People′s Hospital of Xinjiang Uygur Autonomous Region from June 2017 to January 2018. According to the results of glucose tolerance test at 24 weeks of pregnancy, they were divided into GDM group(48 cases) and control group(112 cases). Pre-pregnancy general data, blood glucose, blood lipid and serum 25-(OH)D levels at different periods of pregnancy were recorded. The predictive value of serum 25-(OH)D level for GDM was analyzed by receiver operating characteristic（ROC） curve. Results    There were no significant differences in age, previous times of pregnancy and delivery, body mass index, blood glucose and blood lipid levels between groups(all P>0.05). Serum level of 25-(OH)D in control group before pregnancy was higher than that in GDM group; 25-(OH)D level significantly decreased at early pregnancy and the second trimester of pregnancy compared to those before pregnancy in both control group and GDM group［(25±5),(20±4)μg/L vs (29±6)μg/L; (20±4),(12±3)μg/L vs (26±4)μg/L］, and the levels in GDM group were significantly lower than those in control group（all P＜0.05）. ROC curve analysis showed that serum 25-(OH)D level at the second trimester of pregnancy had a higher predictive value for GDM than the levels at early pregnancy and before pregnancy（area under the curve: 0.891 vs 0.718, 0.613, both P<0.001); the optimal cut-off point value was 14.18 μg/L. Conclusions    Serum 25-(OH)D level gradually decreased during pregnancy. GDM patients have reduction in the content of serum 25-(OH)D. Low level of serum 25-(OH)D is associated with the occurrence of GDM.