1、92022 年第 9 卷第 11 期实用妇科内分泌电子杂志论 著妊娠期糖尿病妇女产后1年心脏代谢指数与糖代谢的相关性分析伍冬梅，王烈林，唐超燕，党超志，罗瑞琼，张萍（玉林市第一人民医院 内分泌科，广西 玉林 537000）【摘要】目的 探讨妊娠期糖尿病（GDM）患者产后1年心脏代谢指数（CMI）与糖代谢异常的关系。方法 选择在本院产科就诊并生产的102例GDM患者为研究对象，产后随访1年。根据75 g葡萄糖耐量试验（OGTT）结果分为糖代谢异常组和糖代谢正常组，比较两组的各项临床指标。进一步按CMI水平，将GDM患者按三分位数法分为Q1组、Q2组、Q3组，比较三组的各项临床指标及糖代谢异常患病
2、率，采用Pearson相关性分析，分析CMI与临床指标的相关性，并采用Logistic多因素回归分析GDM患者产后糖代谢异常的影响因素。结果 与糖代谢正常组比较，糖代谢异常组产后1年的腰围、收缩压、舒张压、内脏脂肪面积、甘油三酯、糖化血红蛋白、空腹血糖及胰岛素水平、2 h血糖及胰岛素水平、稳态模式胰岛素抵抗指数（HOMA-IR）、CMI、体质量指数（BMI）等水平均较高，差异有统计学意义（P0.05）；两组的年龄、皮下脂肪面积、胆固醇、高密度脂蛋白、低密度脂蛋白水平比较，差异无统计学意义（P0.05）。依据患者CMI水平三分位分组，随着CMI水平的升高，其腰围、臀围、腰臀比、收缩压、内脏脂肪面
3、积、皮下脂肪面积、甘油三酯、0 h胰岛素、0 h及2 h血糖、HOMA-IR、BMI等水平均呈升高趋势，高密度脂蛋白呈递减趋势，差异有统计学意义（P0.05）；三组的年龄、胆固醇、低密度脂蛋白、糖化血红蛋白、2 h胰岛素水平比较，差异无统计学意义（P0.05）。Q1组、Q2组、Q3组的糖代谢异常率分别为14.7%、34.7%、54.5%，三组比较，差异有统计学意义（P0.05）。Pearson相关性分析显示，CMI与腰围、收缩压、内脏脂肪、皮下脂肪、甘油三酯、空腹胰岛素、OGTT 2 h胰岛素、空腹血糖、OGTT 2 h血糖、HOMA-IR、BMI呈正相关（P0.05），与高密度脂蛋白呈负相关
4、（P0.05）。Logistic回归分析显示CMI升高是GDM患者产后糖代谢异常的危险因素（OR=15.821，95%CI：1.402，178.423，P=0.025）。结论 CMI可在一定程度上反映GDM患者产后的糖代谢紊乱情况。【关键词】妊娠期糖尿病；心脏代谢指数；糖代谢异常Correlation analysis between cardiac metabolic index and glucose metabolism in women with gestational diabetes mellitus at 1 year after deliveryWu Dongmei,Wang
5、Lielin,Tang Chaoyan,Dang Chaozhi,Luo Ruiqiong,Zhang Ping(Department of Endocrinology,Yulin First Peoples Hospital,Yulin 537000,China)【Abstract】Objective To investigate the relationship between cardiac metabolic index(CMI)and abnormal glucose metabolism in patients with gestational diabetes mellitus(
6、GDM)1 year after delivery.Methods A total of 102 GDM patients who gave birth in the Obstetrics Department of our hospital were selected as the research objects and followed up for 1 year after delivery.According to the results of 75 g oral glucose tolerance test(OGTT),the patients were divided into
7、abnormal glucose metabolism group and normal glucose metabolism group.The clinical indicators of the two groups were compared.Further according to CMI level,GDM patients were divided into Q1 group,Q2 group and Q3 group according to the quantile method.The clinical indicators and the prevalence of ab
8、normal glucose metabolism were compared among the three groups.Pearson correlation analysis was used to analyze the correlation between CMI and clinical indicators,and Logistic multivariate regression was used to analyze the influencing factors of postpartum glucose metabolism abnormalities in GDM p
9、atients.Results Compared with the normal glucose metabolism group,the waist circumference,systolic blood pressure,diastolic blood pressure,visceral fat area,triglyceride,glycosylated DOI：10.3969/j.issn.2095-8803.2022.11.003基金项目：玉林市科学研究与技术开发计划（编号201934047）通信作者：张萍，E-mail：102022 Vol.9 No.11Electronic J
10、ournal of Practical Gynecological Endocrinology论 著hemoglobin,fasting blood glucose and insulin levels,2 h blood glucose and insulin levels,homeostasis model assessment-insulin resistance(HOMA-IR),CMI and body mass index(BMI)in the abnormal glucose metabolism group were higher at 1 year after deliver
11、y,and the differences were statistically significant(P0.05);there were no significant differences in age,subcutaneous fat area,cholesterol,high density lipoprotein and low density lipoprotein levels between the two groups(P0.05).The patients were grouped according to the third of CMI level.With the
12、increase of CMI level,the waist circumference,hip circumference,waist-hip ratio,systolic blood pressure,visceral fat area,subcutaneous fat area,triglyceride,0 h insulin,0 h and 2 h blood glucose,HOMA-IR,and BMI showed an increasing trend,while high-density lipoprotein showed a decreasing trend,and t
13、he differences were statistically significant(P0.05);there were no significant differences in age,cholesterol,low density lipoprotein,glycosylated hemoglobin and 2 h insulin levels among the three groups(P0.05).The abnormal rates of glucose metabolism in Q1 group,Q2 group and Q3 group were 14.7%,34.
14、7%and 54.5%,respectively,and the differences among the three groups were statistically significant(P0.05).Pearson correlation analysis showed that CMI was positively correlated with waist circumference,systolic blood pressure,visceral fat,subcutaneous fat,triglyceride,fasting insulin,OGTT 2 h insuli
15、n,fasting blood glucose,OGTT 2 h blood glucose,HOMA-IR,BMI(P0.05),and negatively correlated with high-density lipoprotein(P0.05).Logistic regression analysis showed that increased CMI was a risk factor for abnormal glucose metabolism in postpartum GDM patients(OR=15.821,95%CI:1.402,178.423,P=0.025).
16、Conclusion CMI can partly reflect the disorder of glucose metabolism in postpartum GDM patients to some extent.【Key words】Gestational diabetes mellitus；Cardiometabolic index；Glucose metabolism abnormalities妊娠期糖尿病（GDM）是指妊娠期间首次发现和发生的糖耐量异常，是一种较常见的妊娠并发症。近年来，GDM的发病率逐年上升。GDM患者的围产期不良结局发生率及远期并发症发生率均增加，且其妊娠期胰岛素抵抗增加也会提升产后发生2型糖尿病的风险。因此，针对GDM患者的产后糖代谢转归和随访尤为重要。心脏代谢指数（CMI）是由Wakabayashi等1提出的一种新的代谢指标，可反映个体肥胖情况，也可反映血脂水平。然而，目前关于CMI与GDM产后糖代谢转归关系的研究较少。因此，本研究通过分析102例GDM患者产后1年的随访资料，评估CMI与糖代谢异常的相关性，为GDM产后管理提供依据和新的思路。现