妊娠期糖尿病视网膜病变的危险因素
| 作者: |
1丁娟,
1王姣,
2韩丽萍,
3张晓雪,
1高姗,
2张孝艳
1 郑州大学第一附属医院质控处，郑州 450052 2 郑州大学第一附属医院妇科，郑州 450052 3 郑州大学第一附属医院体检科，郑州 450052 |
| 通讯: |
丁娟
Email: 1326694329@qq.com |
| DOI: | 10.3978/j.issn.2095-6959.2018.01.016 |
| 基金: | 河南省高等学校重点科研项目(17A320014)。 |
摘要
目的：分析妊娠糖尿病(gestational diabetes mellitus，GDM)视网膜病变的危险因素，为临床防治提供依据。方法：选取郑州大学第一附属医院产前检查的10 172例孕妇，其中103例孕妇(A组)GDM伴糖尿病视网膜病变(diabetic retinopathy，DR)，108例(B组)孕妇GDM不伴DR，101例(C组)正常孕妇。分别在妊娠6个月、9个月和产后6个月检查3组孕妇眼底、糖化血红蛋白(HbAlc)、24 h尿微量白蛋白(24-hour urine microalbumin，24hALB)。结果：单因素方差分析结果显示HbAlc和24hALB水平在妊娠6个月、9个月和产后6个月均为A组>B组>C组(P<0.05)。拟合非条件logistic回归模型的多因素分析结果显示病程≥9个月的患者发生DR的风险是病程<9个月者的5.47倍；HbAlc(界值为6.22%)和24hALB(界值为7.15 mg/L)水平较高的GDM患者，其合并DR的风险较高，OR值分别为5.12和3.43。结论：妊娠会促进DR进展，病程进展、HbAlc及24hALB增高是视网膜病变加重的警示灯。密切监测及控制血糖、HbAlc及24hALB能有效减少或减轻糖尿病孕妇视网膜病变。
关键词：
视网膜病变；糖化血红蛋白；24 h尿微量白蛋白
Risk factors of retinopathy in gestational diabetes mellitus
CorrespondingAuthor: DING Juan Email: 1326694329@qq.com
DOI: 10.3978/j.issn.2095-6959.2018.01.016
Foundation: This work was supported by Colleges and Universities Science and Technology Major Project Foundation of Henan Province, China (17A320014).
Abstract
Objective: To evaluate the risk factors for retinopathy in gestational diabetes mellitus (GDM). Methods: A total of 10 172 pregnant women were screened for GDM at the First Affiliated Hospital of Zhengzhou University, in which 103 women diagnosed with GDM and diabetic retinopathy (DR) were classified into group A, 108 women diagnosed with GDM without DR were classified into group B, and 101 healthy pregnant women were classified into group C. Fundus photography, glycosylated hemoglobin (HbAlc) and 24-hour urine microalbumin (24hALB) examinations at gestational 6 months, 9 months, and postpartum 6 months, were performed on all study participants. Results: One-way ANOVA indicated that HbAlc and 24hALB levels were highest in group A, followed by groups B and C, respectively, at all three time points (P<0.05). The multivariate analysis with unconditional logistic regression model showed that the risk of DR occurrence was 5.47 times higher in patients with GDM ≥9 months as compared to those with GDM <9 months. Patients with higher levels of HbAlc and 24hALB had relatively higher risk of DR, with OR values of 5.12 and 3.43, respectively. Conclusion: Pregnancy could exaggerate the progress of DR. Long-term GDM, and higher levels of HbAlc and 24hALB are indicators for exaggeration of DR. Close surveillance and strict control of blood glucose would help to effectively reduce or alleviate DR in patients with GDM.
Keywords：
gestational diabetes mellitus; diabetic retinopathy; glycosylated hemoglobin; 24-hour urine microalbumin