孕早期母体上腹部脂肪厚度预测妊娠期糖尿病的价值

The Value of Maternal Upper Abdominal Ad-ipose Thickness in Predicting GDM in Early Pregnancy

摘要: 目的：研究孕早期母体上腹部脂肪厚度预测妊娠期糖尿病(gestational diabetes mellitus, GDM)的价值。方法：选取2021年7月至2022年7月在青岛大学附属威海市立二院建档产检的11~13 W+6的单胎孕妇，无1型、2型糖尿病及其它并发症。于孕妇上腹部剑突下测量上腹部脂肪厚度，包括皮下脂肪厚度(subcutaneous adipose thickness, SAT)和内脏脂肪厚度(visceral adipose thickness, VAT)。所有孕妇均填写调查问卷，记录孕妇的年龄，身高，体重，孕前体重，孕早期增长体重，有无糖尿病家族史等基本信息。根据75 g口服葡萄糖耐量(oral glucose tolerance test, OGTT)结果将所有孕妇分为GDM组和对照组。对两组孕妇的基本信息及脂肪厚度进行比较。利用单因素及多因素逻辑回归方法分析孕早期母体的SAT及VAT与GDM的关系，计算各影响因素的比值比(odds ratio, OR)及95%置信区间(confidence interval, CI)。利用受试者工作特征曲线(receiver operating characteristic, ROC)计算灵敏度、特异度、曲线下面积(area under curve, AUC)及最佳截断值，评价其预测GDM的价值。结果：共有572例孕妇纳入研究，其中对照组499例，GDM组73例。单因素逻辑回归分析显示，SAT及VAT均是GDM的危险因素。OR值及95% CI分别为5.887 (95% CI 3.636~9.531)、4.044 (95% CI 2.4~6.815)。多因素逻辑回归分析显示，SAT及VAT依然是GDM的危险因素。OR值及95% CI分别为8.688 (95% CI 4.555~16.57)、4.255 (95% CI 2.060~8.787)。ROC曲线分析显示SAT及VAT预测GDM的曲线下面积分别为0.746、0.678，两者联合预测GDM的曲线下面积为0.762，SAT及VAT预测GDM的最佳截断值为2.18 cm、1.80 cm。结论：1) 孕早期母体上腹部SAT及VAT与孕中期GDM的发生具有明显的正相关性，是孕中期GDM发生的独立危险因素。2) 增高的SAT及VAT对预测GDM的诊断具有一定的临床意义。

Abstract: Objective: To study the value of maternal upper abdominal adipose thickness in predicting GDM in early pregnancy. Methods: From July 2021 to July 2022, the pregnant women at 11~13 W+6 who were registered in Weihai Municipal Second Hospital Affiliated to Qingdao University were selected, without type 1 diabetes, type 2 diabetes and other complications. We measured the adipose thick-ness in the upper abdomen of pregnant women, including subcutaneous adipose thickness (SAT) and visceral adipose thickness (VAT). All pregnant women filled in the questionnaires, which rec-orded the age, height, weight, weight before pregnancy, weight gained, family history of diabetes and so on. According to the OGTT results, all the pregnant women were divided into two groups, the GDM group and the control group. To compare and analyze the basic information and adipose thickness of the two groups. Single factor regression analysis and multivariate regression analysis was used to analysis the relation between SAT, VAT and GDM. The odds ratio (OR) and 95% confi-dence interval (CI) of each factor were calculated. The ROC curve was used to calculate sensitivity, specificity, area under curve (AUC) and optimal cut-off value, to evaluate the value of SAT and VAT in predicting GDM. Results: A total of 572 pregnant women were included in the study, including 499 in the control group and 73 in the GDM group. Univariate logistic regression analysis showed that SAT and VAT were risk factors for GDM. OR values and 95% CI were 5.887 (95% CI 3.636~9.531) and 4.044 (95% CI 2.4~6.815), respectively. Multivariate logistic regression analysis showed that SAT and VAT were still risk factors for GDM. OR values and 95% CI were 8.688 (95% CI 4.555~16.57) and 4.255 (95% CI 2.060~8.787), respectively. The ROC curve analysis showed that the area under the curve for predicting GDM by SAT and VAT were 0.746 and 0.678, respectively. The area under the curve for jointly predicting GDM by SAT and VAT was 0.762, and the optimal cutoff values for predicting GDM by SAT and VAT were 2.18 cm and 1.80 cm. Conclusions: 1) The adipose thickness of upper abdomen in early pregnancy has a significant positive correlation with the occurrence of GDM, which was independent risk factor of GDM. 2) Increased SAT and VAT have certain clinical significance in predicting the diagnosis of GDM.