生殖医学杂志

目的 探讨孕早期残余胆固醇(RC)水平与妊娠期糖尿病(GDM)孕妇新生儿出生体重的关系。方法 选取2021年1月至2023年12月于西安交通大学第二附属医院收治的420例GDM孕妇(GDM组)和同期来院孕检的210例健康孕妇(对照组)作为研究对象，采集空腹静脉血检测血脂水平，计算RC值。根据血清RC水平的三分位数将GDM孕妇分为T1组(RC<0.37 mmol/L,143例)、T2组(0.37≤RC≤0.75 mmol/L,140例)和T3组(RC>0.75 mmol/L,137例),通过多因素Logistic回归和限制性立方样条分析孕早期RC水平与GDM孕妇大于胎龄儿和巨大儿的关系；采用受试者工作特征(ROC)曲线分析孕早期RC水平对GDM孕妇大于胎龄儿和巨大儿的预测价值。结果 GDM组总胆固醇(TC)、甘油三酯(TG)、低密度脂蛋白胆固醇(LDL-C)、RC水平和大于胎龄儿、巨大儿比例均显著高于对照组(P<0.05),高密度脂蛋白胆固醇(HDL-C)水平显著低于对照组(P<0.05)。根据血清RC水平三分位数分组后，T1、T2、T3三组间的孕前体质量指数(BMI)、空腹血糖(FPG)、胰岛素抵抗指数(HOMA-IR)、TC、TG、LDL-C、RC、HDL-C水平及大于胎龄儿比例、巨大儿比例两两比较均有显著性差异(P<0.05)。多因素Logistic回归分析显示，RC水平升高为GDM孕妇大于胎龄儿、巨大儿发生的独立危险因素，且与T1相比，T2、T3的大于胎龄儿、巨大儿发生风险更高(P<0.05)。限制性立方样条图显示，调整年龄、孕前BMI、受教育程度、家庭月收入、产次、FPG、空腹胰岛素(FINS)、HOMA-IR、TC、TG、HDL-C、LDL-C后，孕早期RC水平与GDM孕妇大于胎龄儿和巨大儿发生比例存在正性剂量-反应关系(非线性P<0.05)。ROC曲线显示，孕早期RC水平为0.53 mmol/L时，预测GDM孕妇大于胎龄儿和巨大儿的曲线下面积分别为0.779、0.783。结论 孕早期RC水平升高与GDM孕妇大于胎龄儿和巨大儿风险增加呈正相关，并对GDM孕妇大于胎龄儿和巨大儿具有一定预测价值。

Objectives:To explore the relationship between remnant cholesterol(RC) level in early pregnancy and birth weight of newborns in pregnant women with gestational diabetes mellitus(GDM).Methods:A total of 420 pregnant women with GDM(GDM group) and 210 healthy pregnant women undergoing prenatal examinations(the control group) at The Second Affiliated Hospital of Xi'an Jiaotong University from January 2021 to December 2023 were selected as the research subjects. Blood lipid level of fasting venous blood was measured and RC level was calculated. The GDM pregnant women were divided into T1 group(RC<0.37 mmol/L,143 cases),T2 group(0.37≤RC≤0.75 mmol/L,140 cases) and T3 group(RC>0.75 mmol/L,137 cases) according to the third quartile of serum RC levels. Multivariate logistic regression and restricted cubic spline analyses were used to examine the association of early pregnancy RC levels with both large-for-gestational-age infant and macrosomia in GDM pregnant women. Receiver operating characteristic(ROC) curve was used to assess the predictive value of early pregnancy RC level for large-for-gestational-age infant and macrosomia in GDM pregnant women.Results:The levels of total cholesterol(TC),triglycerides(TG),low-density lipoprotein cholesterol(LDL-C),RC,and the proportion of large-for-gestational-age infants and macrosomia in the GDM group were significantly higher than those in the control group(P<0.05),while the high-density lipoprotein cholesterol(HDL-C) level was significantly lower than that in the control group(P<0.05). After the GDM pregnant women were divided into T1 group, T2 group and T3 group according to the third quartile of serum RC levels, there were significant differences in preconception body mass index(BMI),the levels of fasting blood glucose(FPG),the Homeostasis Model Assessment of Insulin Resistance(HOMA-IR),TC,TG,LDL-C,RC,HDL-C as well as the proportion of large-for-gestational-age infants and macrosomia among the three groups when compared pairwise(P<0.05). Multivariate logistic regression analysis showed that the elevated RC level was an independent risk factor for the occurrence of large-for-gestational-age infant and macrosomia in GDM pregnant women, and T2 and T3 had a higher risk for the occurrence of large-for-gestational-age infant and macrosomia when compared with T1(P<0.05). Restricted cubic spline plot display, after adjusting for age, preconception BMI,educational level, monthly family income, parity and the levels of FPG,fasting insulin(FINS),HOMA-IR,TC,TG,HDL-C,LDL-C,there were positive dose-response relationships of early pregnancy RC level with the proportion of both large-for-gestational-age infants and macrosomia in GDM pregnant women(nonlinear P<0.05). The ROC curve showed that when the RC level in early pregnancy was 0.53 mmol/L,the predicted area under the curve for large-for-gestational-age infant and macrosomia in GDM pregnant women was 0.779 and 0.783 respectively.Conclusions:Elevated early pregnancy RC level is positively correlated with an increased risk of large-for-gestational-age infant and macrosomia in GDM pregnant women, and it has certain predictive value for the occurrence of large-for-gestational-age infant and macrosomia in GDM pregnant women.