CAJ | 학술논문

目的：探讨孕中期血糖水平与不良妊娠结局的关系。方法回顾性分析2010年8月至2011年1月孕24周起于湖北省妇幼保健院产科行50 g葡萄糖负荷试验（glucose challenge test，GCT）的693例单胎自然受孕孕妇的临床资料，检测孕晚期孕妇空腹血糖（FBG）、空腹血清胰岛素、分娩后即刻脐血血糖及脐血胰岛素水平。分析孕中期50 g GCT血糖水平与不良妊娠结局的关系。结果50 g GCT血糖水平分组：剖宫产的发生率随孕妇血糖水平升高而逐渐下降（P＝0.000）。随孕妇血糖水平升高，妊娠高血压、剖宫产、早产及大于胎龄儿（LGA）的发生无固定优势趋势。但从第3组开始，患妊娠高血压的可能性递增，早产发生的可能性也呈递增趋势，剖宫产发生的可能性呈递减趋势，而第4组LGA发生率最高。FBG水平分组：剖宫产和早产的发生率在不同血糖水平中差异具有显著性。剖宫产发生的可能性随FBG的升高而递减，从第3组开始，患妊娠高血压的可能性递增，早产发生的可能性亦递增，而第5组LGA发生率最高。孕中期50 g GCT血糖水平与母亲胰岛素、脐血胰岛素、脐血血糖均无明显相关性（P＞0.05），孕晚期FBG水平与母亲胰岛素、脐血胰岛素、脐血血糖的偏相关系数分别为0.402、0.080、0.159。按孕晚期FBG分组，母亲胰岛素及脐血胰岛素水平呈明显上升趋势（P＜0.05）。结论在一定血糖范围内，LGA发生的可能性随孕中期50 g GCT血糖升高而升高。而随着孕期血糖升高，妊娠高血压及早产发生的可能性呈相似变化，剖宫产发生的可能性降低。
목적：탐토잉중기혈당수평여불량임신결국적관계。방법회고성분석2010년8월지2011년1월잉24주기우호북성부유보건원산과행50 g포도당부하시험（glucose challenge test，GCT）적693례단태자연수잉잉부적림상자료，검측잉만기잉부공복혈당（FBG）、공복혈청이도소、분면후즉각제혈혈당급제혈이도소수평。분석잉중기50 g GCT혈당수평여불량임신결국적관계。결과50 g GCT혈당수평분조：부궁산적발생솔수잉부혈당수평승고이축점하강（P＝0.000）。수잉부혈당수평승고，임신고혈압、부궁산、조산급대우태령인（LGA）적발생무고정우세추세。단종제3조개시，환임신고혈압적가능성체증，조산발생적가능성야정체증추세，부궁산발생적가능성정체감추세，이제4조LGA발생솔최고。FBG수평분조：부궁산화조산적발생솔재불동혈당수평중차이구유현저성。부궁산발생적가능성수FBG적승고이체감，종제3조개시，환임신고혈압적가능성체증，조산발생적가능성역체증，이제5조LGA발생솔최고。잉중기50 g GCT혈당수평여모친이도소、제혈이도소、제혈혈당균무명현상관성（P＞0.05），잉만기FBG수평여모친이도소、제혈이도소、제혈혈당적편상관계수분별위0.402、0.080、0.159。안잉만기FBG분조，모친이도소급제혈이도소수평정명현상승추세（P＜0.05）。결론재일정혈당범위내，LGA발생적가능성수잉중기50 g GCT혈당승고이승고。이수착잉기혈당승고，임신고혈압급조산발생적가능성정상사변화，부궁산발생적가능성강저。
ObjectiveTo investigate the relationship between second trimester blood glucose levels and adverse pregnancy outcomes.MethodThe clinical data of 693 pregnant women who underwent the 50 g glucose challenge test (GCT) from August 2010 to January 2011 in Maternal and Child Health Hospital of Hubei Province were collected. Detected the third trimester pregnant women with fasting blood glucose (FBG), fasting serum insulin, the blood glucose and insulin of umbilical cord blood. The relationship between adverse pregnancy outcomes and the blood glucose levels of 50 g GCT was analyzed.Result50 g GCT blood glucose levels: The incidence of cesarean section was gradually decreased with the increase of blood glucose level of pregnant women (P=0.000). With the increase of blood glucose level, there was no ifxed advantage for the occurrence of gestational hypertension, cesarean section, premature delivery and LGA. But from the third group, the possibility of the gestational hypertension of pregnant was gradually decreased, as well as the possibility of premature delivery, while the occurrence of cesarean delivery was decreased. The incidence of LGA was highest in the fourth group. There was the signiifcant difference in the incidence of cesarean section and premature delivery at different blood glucose levels. The possibility of cesarean section was decreased with the increase of FBG. From the third group, the possibility of gestational hypertension was gradually increased;the possibility of premature delivery was also increased, with the highest incidence of LGA in the iffth group. FBG level group: There was signiifcant difference in the incidence of cesarean section and premature delivery in different blood glucose levels. The probability of occurrence of cesarean section decreased with the increased of FBG. From the third group, the possibility of the gestational hypertension was gradually decreased, as well as the possibility of premature delivery. The incidence of LGA was highest in the iffth group. There was no signiifcant correlation between the levels of blood glucose of 50 g GCT in the second trimester with maternal insulin, umbilical cord blood insulin and blood glucose (P>0.05). The partial correlation coefifcients of FBG in late pregnancy with maternal insulin, umbilical cord blood insulin and blood glucose were 0.402, 0.080 and 0.159 respectively. Grouped by FBG in late pregnancy, the levels of maternal insulin and umbilical cord blood insulin showed clear rising trend (P<0.05).ConclusionWithin the certain range of blood glucose, the possibility for the occurrence of LGA is increased with the increase of 50 g GCT blood glucose level in the second trimester. With the increase of gestational blood glucose, the possibility of gestational hypertension and premature labor also has the similar change, while the possibility of cesarean section is decreased.