2019 年第 11 期 第 14 卷

妊娠期糖尿病患者孕晚期血清铁蛋白水平与胰岛素抵抗程度及母婴结局的相关性分析

Correlation among serum ferritin level at late pregnancy, severity of insulin resistance, maternal and fetal outcomes in patients with gestational diabetes mellitus

作者：叶漾柳冯俏丽符春凤黄敏田晓辉夏丽伟

英文作者：

单位：510630广州，中山大学附属第三医院妇产科（叶漾柳、冯俏丽、符春凤、黄敏、田晓辉）；528415广东省中山市小榄人民医院妇产科（夏丽伟）

英文单位：

关键词：妊娠期糖尿病；铁蛋白；胰岛素抵抗；母婴结局

英文关键词：

• 摘要：

• 【摘要】目的    分析妊娠期糖尿病（GDM）患者孕晚期血清铁蛋白（SF）水平与胰岛素抵抗（IR）程度及母婴结局的相关性。方法    选取2015年8月至2018年4月在中山大学附属第三医院产检并诊断为GDM的初产妇(孕29~34周)90例作为GDM组，同期进行产检的正常初产妇100名作为正常对照组。对比2组孕妇的SF、IR相关指标水平及母婴不良结局发生率的差异，采用Pearson检验分析GDM孕妇SF水平与IR及母婴不良结局的内在联系。结果    GDM组孕妇SF水平明显高于正常对照组孕妇［（48±7）μg/L比（25±4）μg/L］，差异有统计学意义（t＝27.449，P<0.001）。GDM组与正常对照组血清铁、血红蛋白水平差异均无统计学意义（均P＞0.05）。GDM组IR相关指标空腹胰岛素、胰岛素抵抗指数水平高于正常对照组，胰岛β细胞分泌功能指数水平低于正常对照组［（14.3±2.0）mU/L比（9.4±1.1）mU/L、（2.58±0.43）比（1.64±0.29）、（6.7±0.8）比（8.6±1.0）］，差异有统计学意义（t=21.711、17.819、14.056，均P＜0.001）。GDM组母体不良结局羊水过多、胎膜早破、剖宫产、产后出血及胎儿/新生儿不良结局巨大儿、早产儿、新生儿窒息、新生儿低血糖的发生率均高于正常对照组，差异均有统计学意义（均P＜0.05）。相关性分析结果显示，GDM孕妇孕晚期SF水平与空腹胰岛素、胰岛素抵抗指数、母婴不良结局发生率均呈正相关，与胰岛β细胞分泌功能指数呈负相关（均P＜0.05）。结论    GDM孕妇孕晚期SF水平异常增高，SF水平与机体IR程度及母婴不良结局发生率均直接相关，可能在GDM发生及病情进展中具有重要意义。

• 【Abstract】Objective    To analyze the correlation among serum ferritin(SF) level at late pregnancy, insulin resistance(IR), maternal and fetal outcomes in patients with gestational diabetes mellitus(GDM). Methods    From August 2015 to April 2018, 90 primiparous woman (gestational weeks 29-34 weeks) with GDM admitted to the Third Affiliated Hospital, Sun Yat-sen University were enrolled as GDM group; 100 normal pregnant women were enrolled as normal control group. Serum level of SF, indicators of IR and incidence of adverse maternal-fetal outcomes were observed. Relation of serum SF level with IR and adverse maternal-fetal outcomes was analyzed by Pearson test. Results    Serum SF level in GDM group was significantly higher than that in normal control group［（48±7）μg/L vs （25±4）μg/L］(t＝27.449, P<0.001). Serum iron and hemoglobin levels showed no significant differences between groups（all P＞0.05）. Fasting insulin level and insulin resistance index in GDM group were significantly higher and islet β cell secretory function index was significantly lower than those in normal control group［（14.3±2.0）mU/L vs （9.4±1.1）mU/L, （2.58±0.43） vs （1.64±0.29）, （6.7±0.8） vs （8.6±1.0）］（t=21.711, 17.819, 14.056; all P＜0.001）. Incidences of hydramnios, premature rupture of membranes, cesarean section, postpartum hemorrhage, macrosomia, premature delivery, neonatal asphyxia and neonatal hypoglycemia in GDM group were significantly higher than those in normal control group(all P<0.05). Pearson test showed that serum SF level was positively correlated with fasting insulin, insulin resistance index, adverse maternal-fetal outcomes and negatively correlated with insulin β cell secretory function index(all P<0.05). CorrelationsAbnormal increase of serum SF level at late pregnancy is associated with IR and adverse maternal-fetal outcomes in GDM women. SF may play an important role in the occurrence and progression of GDM.