妊娠期血脂、甲状腺及凝血功能与妊娠期糖尿病发生风险的相关性分析

Association of Gestational Blood Lipids, Thyroid Function and Coagulation Function with the Risk of Gestational Diabetes Mellitus

摘要: 目的：通过系统比较GDM组和非GDM组孕妇妊娠期的血脂、凝血功能、甲状腺功能相关指标，鉴定GDM高危因素并建立预测模型，以期更早识别GDM孕妇。方法：回顾分析2022年1月至2023年12月在海军第九七一医院进行产前检查的797例孕妇，其中GDM组174例(21.8%)，非GDM组623例(78.2%)，比较两组孕妇血脂、凝血功能以及甲状腺功能相关指标的差异，并基于危险因素构建预测模型。结果：GDM组的总胆固醇、甘油三酯、脂蛋白(a)、载脂蛋白B、乳酸脱氢酶、D-二聚体、凝血酶原时间、三碘甲状腺原氨酸、促甲状腺素、BMI均显著高于非GDM组，而凝血酶时间、抗甲状腺球蛋白抗体、甲状腺过氧化物酶抗体显著低于非GDM组，差异均有统计学意义(P均<0.05)。二元Logistic回归分析结果显示：甘油三酯、载脂蛋白B、D-二聚体、三碘甲状腺原氨酸、促甲状腺素的升高为GDM发生的独立危险因素(OR > 1, P < 0.05)。受试者工作曲线(ROC)分析证实：甘油三酯预测AUC为0.791 (95% CI 0.756~0.826)，载脂蛋白B预测AUC为0.589 (95% CI 0.539~0.64)，D-二聚体预测AUC为0.536 (95% CI 0.485~0.587)，三碘甲状腺原氨酸预测AUC为0.547 (95% CI 0.498~0.597)，促甲状腺素预测AUC为0.468 (95% CI 0.421~0.515)。联合ROC分析结果显示AUC为0.825 (95% CI 0.792~0.858)，其敏感度可达87.9%。结论：血脂代谢中甘油三酯、载脂蛋白B，甲状腺功能中三碘甲状腺原氨酸、促甲状腺素，以及凝血功能中D-二聚体共5项指标均为GDM发生的独立危险因素，联合预测模型AUC可达到0.825，其准确性和敏感度明显高于单因素模型。

Abstract: Objective: By systematically comparing the indicators of blood lipids, coagulation and thyroid function-related indices of pregnant women in the GDM group and the non-GDM group during pregnancy, we aim to identify the risk factors of GDM and establish a prediction model, to detect pregnant women with GDM earlier. Methods: We retrospectively collected clinical data of 797 pregnant women who received regular antenatal care at 971 Navy Hospital from January 2022 to December 2023, including 174 (21.8%) in the GDM group and 623 (78.2%) in the non-GDM group. The differences in blood lipids, coagulation function and thyroid function-related indices between the two groups were compared. The prediction model was constructed based on the identified risk factors. Results: Total cholesterol, triglyceride, lipoprotein(a), apolipoprotein B, lactate dehydrogenase, D-dimer, prothrombin time, triiodothyronine, thyrotropin and BMI in the GDM group were significantly higher than those in the non-GDM group, while thrombin time, anti-thyroglobulin antibody and thyroid peroxidase antibody were significantly lower than those in the non-GDM group. The differences were statistically significant (P < 0.05). Logistic regression analysis showed that the increase of triglyceride, apolipoprotein B, D-dimer, triiodothyronine and thyrotropin were independent risk factors for GDM (OR > 1, P < 0.05). Receiver Operating Curve (ROC) analysis revealed that the predictive AUC of triglyceride was 0.791 (95%CI 0.756~0.826), apolipoprotein B was 0.589 (95%CI 0.539~0.64), D-dimer was 0.536 (95%CI 0.485~0.587), triiodothyronine was 0.547 (95%CI 0.498~0.597), and thyrotropin was 0.468 (95%CI 0.421~0.515). Combined ROC analysis showed that the predictive AUC was 0.825 (95%CI 0.792~0.858) and the sensitivity was 87.9%. Conclusions: The five indices including triglyceride and apolipoprotein B in lipid metabolism, triiodothyronine and thyrotropin in thyroid function, and D-dimer in coagulation function were all independent risk factors for the occurrence of GDM. The AUC of the combined prediction model could reach 0.825, and the sensitivity and specificity of which were significantly higher than those of the single-factor model.