目的探讨孕期血脂各项指标的变化趋势并分析与妊娠期糖尿病(gestational diabetes mellitus,GDM)相关的危险因素。方法采用巢式病例对照研究方法,先从研究队列人群中选择382例病历资料完整的GDM患者作为病例组,经饮食控制后,该病例组中有56例GDM孕妇需加用胰岛素治疗(A1组),326例无需胰岛素治疗(A2组)。以GDM组孕妇的年龄段分布为匹配因素1∶1配对,从糖耐量试验正常的孕妇中选择382例孕妇作为对照组。收集其基本信息、不同孕期阶段血脂水平及其他有关临床数据,采用卡方检验、两样本均数比较的t检验、重复测量方差分析、Logistic回归分析等方法进行数据分析。结果 (1)随着孕期的增加,两组孕妇血脂各项指标均有上升的趋势;在孕早期和孕中期,GDM组低密度脂蛋白平均水平高于对照组(P <0.05),到了孕晚期两组水平较为接近;而整个孕期GDM组的高密度脂蛋白水平均低于正常组孕妇,差异有统计学意义(P <0.05)。(2)Logistic回归分析显示,孕早期高密度脂蛋白≥1.6 mmol/L是GDM的保护因素(OR=0.533,95%CI:0.334～0.849,P=0.008),而孕24周前体重总增长超过10 kg(OR=1.575,95%CI:1.060～2.340,P=0.024)、孕早期空腹血糖超过5.1 mmol/L(OR=2.380,95%CI:1.657～3.419,P=0.001)、有妊娠期糖尿病史(OR=2.949,95%CI:1.179～7.373,P=0.021)、孕早期低密度脂蛋白≥2.5 mmol/L(OR=2.544,95%CI:1.470～4.401,P=0.001)则是GDM的危险因素。其中,有妊娠期糖尿病史的影响程度最大。结论 (1)随着孕周的延长,孕妇体内血脂各项指标均有上升趋势,较高水平的高密度脂蛋白可能是GDM的保护因素。(2)对有妊娠期糖尿病史、孕早期低密度脂蛋白超过2.5 mmol/L、孕早期空腹血糖超过5.1 mmol/L的孕妇应当加强监管,并建议孕妇在24周前将体重增长幅度控制在10 kg以内,以降低其在孕中、后期发生妊娠期糖尿病的可能性。

Objective To explore the trend of blood lipid change during pregnancy and to analyze the risk factors of the gestational diabetes mellitus( GDM). Methods Based on the principle of nested case-control study,382 GDM patients with complete clinical records were selected as the case group from the reserch cohort,then they were divided into two groups after diet control: group A1( 56 patients treated with insulin) and group A2( treated without insulin). Meanwhile,we selected 382 pregnant women with normal glucose tolerance test as the control group with the age of the GDM patients as the matching factor. Pregnant women's general information,blood lipid at various periods and other clinical data were collected. Chi-square test,two sample T-test,ANOVA Of repeated measure and logstic regression were used for statitical analysis. Results(1)Indicators of blood lipid level increased with gestational week in both 2 groups. The level of the low density lipoprotein( LDL) in the GDM group was higher than that in the control group in early and second trimester of pregnancy( P < 0. 05). However,the level of the LDL was similar in 2 groups in the third trimester of pregnancy.Meanwhile,the level of the high density lipoprotein( HDL) in GDM group was lower than that in normal group during the whole pregnancy( P < 0. 05) ．(2)The results of the logistic regression analysis showed that HDL over 1. 6 mmol/L was protective factor of GDM( OR = 0. 533,OR 95% CI: 0. 334-0. 849,P = 0. 008). Body weight gain before 24 thweek being over 10 kg( OR = 1. 575,OR95% CI: 1. 060-2. 340,P = 0. 024),fasting plasma glucose before 13 thweek being over 5. 1 mmol/L( OR = 2. 380,95% CI: 1. 657-3. 419,P = 0. 001),having history of GDM( OR = 2. 949,95% CI: 1. 179-7. 373,P = 0. 021),and LDL before 13 thweek being over2. 5 mmol/L( OR = 2. 544,95% CI: 1. 470-4. 401,P = 0. 001) were risk factors of the GDM,but with history of GDM was the most important among these risk factors. Conclusion(1) Indicators of blood lipid level increased with gestational week. Higher level of HDL might be protective factor of GDM．(2) Pregnant women who has history of GDM,whose LDL before 13 thweek being over 2. 5 mmol/L,or whose fasting plasma glucose before 13 thweek being over 5. 1 mmol/L should be closely monitored. Meanwhile,pregnant women should be recommended to keep body weight gain below 10 kg before 24 thweek in order to decrease the probability of developing GDM in secondary and third trimesters of pregnancy.