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目的探讨妊娠期糖尿病(GDM)孕妇子代新生儿脐静脉血胰岛素和C肽水平对新生儿体格发育的影响。方法纳入2014年7月至2015年1月于我院行剖宫产的GDM孕妇51例和糖耐量正常(NGT)孕妇49例。收集孕妇一般资料,测定孕妇分娩前空腹外周血血糖和血脂水平,测定新生儿脐静脉血血糖、血脂、胰岛素和C肽水平,测量新生儿出生后24 h内的体格发育指标。采用logistic回归和多元线性回归分析新生儿脐静脉血胰岛素和C肽与巨大儿发生风险和新生儿体格发育的相关性。结果 1 GDM组新生儿脐静脉血胰岛素、C肽水平高于NGT组(P<0.05),两组新生儿血糖、甘油三酯(TG)、总胆固醇(TC)、高密度脂蛋白-胆固醇(HDL-C)和低密度脂蛋白-胆固醇(LDL-C)水平差异无统计学意义(P>0.05)。2与NGT组相比,GDM组新生儿巨大儿发生率高,新生儿上臂周径、胸围、腹围、肩宽和总皮褶厚度显著增加(P<0.01,P<0.05),头围/肩宽比值、头围/胸围比值显著下降(P<0.01),但两组新生儿出生体重、身长和头围差异无统计学意义(P>0.05)。3 Logistic回归分析显示,新生儿脐静脉血胰岛素水平、C肽水平与巨大儿发生率呈正相关;多元线性回归分析显示,新生儿脐静脉血胰岛素水平、C肽水平与新生儿出生体重、身长、胸围、腹围、上臂周径、肩宽以及总皮褶厚度均呈正相关,与头围/肩宽比值、头围/胸围比值呈负相关(P<0.01)。结论 GDM孕妇子代脐静脉血胰岛素和C肽水平升高可增加巨大儿发生风险,并与新生儿体格发育各项指标具有显著相关性。
Objective To investigate the effects of neonatal umbilical venous blood insulin and C-peptide on the physical development of neonates during gestational diabetes mellitus (GDM). Methods 51 pregnant women with GDM and 49 pregnant women with normal glucose tolerance (NGT) undergoing cesarean section in our hospital from July 2014 to January 2015 were enrolled. The general data of pregnant women were collected. The levels of fasting blood glucose and blood lipid in pregnant women before delivery were measured. The levels of blood glucose, lipids, insulin and C-peptide in neonates were measured. The physical development indexes of newborns within 24 hours after birth were measured. Logistic regression and multivariate linear regression were used to analyze the correlation between neonatal umbilical venous blood insulin and C-peptide, risk of macrosomia and physical development of neonates. Results The level of insulin and C-peptide in umbilical vein of neonates with GDM was significantly higher than that of NGT (P <0.05). The levels of blood glucose, triglyceride (TG), total cholesterol (TC), high density lipoprotein-cholesterol HDL-C) and low-density lipoprotein-cholesterol (LDL-C) levels were not statistically different (P> 0.05). Compared with NGT group, the incidence of neonatal giant macrosomia in GDM group was significantly higher than that in NGT group (P <0.01, P <0.05), and the ratio of head circumference / circumference, chest circumference, Shoulder width ratio and head / chest ratio decreased significantly (P <0.01). However, there was no significant difference in birth weight, body length and head circumference between the two groups (P> 0.05). 3 Logistic regression analysis showed that neonatal umbilical blood insulin levels, C peptide levels and the incidence of macrosomia were positively correlated; multiple linear regression analysis showed that neonatal umbilical blood insulin levels, C-peptide levels and birth weight, body length, Bust circumference, abdominal circumference, upper arm circumference, shoulder width and total skin fold thickness were positively correlated with the ratios of head circumference / shoulder width to head circumference / chest circumference (P <0.01). Conclusions Increased levels of insulin and C-peptide in the umbilical cord blood of pregnant women with GDM may increase the risk of macrosomia in children and have a significant correlation with the indexes of physical development in neonates.