探讨妊娠期糖尿病(GDM)孕妇晚孕期血脂浓度检测的临床价值。

选择2017年1月至12月，于首都医科大学附属北京友谊医院产科门诊接受产前检查的108例晚孕期GDM孕妇为研究对象，纳入观察组。采用随机数字表法，选择同期在同一家医院接受产前检查的晚孕期健康孕妇108例，纳入对照组。采用成组t检验，对2组晚孕期孕妇血脂指标，如血清总胆固醇(TC)、三酰甘油(TG)、低密度脂蛋白胆固醇(LDL-C)及高密度脂蛋白胆固醇(HDL-C)浓度进行比较。根据观察组GDM孕妇孕期的体重增加值，将其进一步分为体重增加过多亚组、体重增加合适亚组、体重增加不足亚组。采用单因素方差分析，对观察组3个亚组GDM孕妇晚孕期血脂浓度进行比较。本研究遵循的程序符合首都医科大学附属北京友谊医院人体试验委员会所制定的伦理学标准，得到该委员会批准(审批文号：2017-9-1)，分组征得受试者本人的知情同意，并与之签署临床研究知情同意书。

①观察组与对照组孕妇年龄、孕龄及孕期体重增加值比较，差异均无统计学意义(P>0.05)。②观察组GDM孕妇晚孕期血清TC、TG、LDL-C浓度，分别为(7.49±0.69)、(3.64±0.56)、(3.93±0.49) mmol/L，均分别显著高于对照组的(5.52±0.41)、(2.13±0.39)、(2.81±0.17) mmol/L，而血清HDL-C浓度为(1.62±0.22) mmol/L，显著低于对照组的(1.96±0.16) mmol/L，2组分别比较，差异均有统计学意义(t＝5.463，P<0.001；t＝4.981，P<0.001；t＝4.795，P<0.001；t＝－2.736，P＝0.007)。③根据观察组108例GDM孕妇孕期的体重增加值，将其分为体重增加过多亚组、体重增加合适亚组、体重增加不足亚组，分别为38、42及28例。观察组3个亚组GDM孕妇晚孕期血清TC、TG及LDL-C浓度分别比较，差异均有统计学意义(F＝8.587，P＝0.020；F＝6.164，P＝0.030；F＝14.266，P＝0.001)，并且体重增加过多亚组孕妇上述3个指标均为最高。但是，3个亚组GDM孕妇晚孕期血清HDL-C浓度比较，差异无统计学意义(P>0.05)。

GDM孕妇更容易发生脂代谢异常，尤其是孕期体重增加过多的GDM孕妇，其晚孕期血脂浓度更高。产科医师应加强对GDM孕妇进行合理营养饮食的宣传教育及孕期体重管理，这不仅有利于降低GDM孕妇晚孕期血脂浓度，还有利于减少其围生期并发症及不良妊娠结局的发生。

To study the clinical values of blood lipids concentrations detection in the third trimester pregnant women with gestational diabetes mellitus (GDM).

From January to December 2017, a total of 108 pregnant women in the third trimester who were diagnosed as GDM during routine prenatal care in Beijing Friendship Hospital, Capital Medical University were selected as research subjects and enrolled into observation group. Meanwhile, another 108 healthy pregnant women in the third trimester who received routine prenatal care in the same hospital during the same period were included into control group by random number table method. Concentrations of blood lipid indexes, such as serum total cholesterol (TC), triglyceride (TG), low density lipoprotein cholesterol (LDL-C), and high density lipoprotein cholesterol (HDL-C) were compared by independent-samples t test between two groups. According to gestational weight gain of GDM pregnant women in observation group, they were further divided into excessive weight gain subgroup, appropriate weight gain subgroup and underweight gain subgroup, and concentrations of blood lipid indexes among these three subgroups were compared by one-ANOVA method. This study protocol was in line with the Institutional Review Board of Beijing Friendship Hospital, Capital Medical University (Approval No. 2017-9-1), and clinical research consents were obtained from all participants.

①There were no significant differences in age, gestational age and gestational weight gain between observation group and control group (P>0.05). ②Serum concentrations of TC, TG and LDL-C in observation group were (7.49±0.69) mmol/L, (3.64±0.56) mmol/L and (3.93±0.49) mmol/L, respectively, which were significantly higher than those (5.52±0.41) mmol/L, (2.13±0.39) mmol/L and (2.81±0.17) mmol/L, respectively in control group; but serum concentration of HDL-C in observation group was (1.62±0.22) mmol/L, which was significantly lower than that (1.96±0.16) mmol/L in control group, and all differences of serum concentrations of blood lipid indexes between observation group and control group were statistically significant (t=5.463, P<0.001; t=4.981, P<0.001; t=4.795, P<0.001; t=-2.736, P=0.007). ③Among the 108 pregnant women in the third trimester with GDM of observation group, 38, 42, and 28 cases were divided into excessive weight gain subgroup, appropriate weight gain subgroup and underweight gain subgroup, respectively. There were statistically significant differences among three subgroups in serum concentrations of TC, TG and LDL-C (F=8.587, P=0.020; F=6.164, P=0.030; F=14.266, P=0.001), and these three blood lipid indexes in excessive weight gain subgroup all were higher than those in appropriate weight gain subgroup and underweight gain subgroup. But there was no significant difference in serum concentration of HDL-C among three subgroups (P>0.05).

GDM women are more likely to have abnormal blood lipid metabolism, especially in those who have excessive gestational weight gain, and their serum concentrations of blood lipid indexes, such as serum concentrations of TC, TG and LDL-C are much higher in the third trimester pregnancy compared with healthy pregnant women. Obstetricians should strengthen the education of rational nutrition diet and weight management in GDM women, which not only helps to reduce serum concentrations of blood lipid indexes, such as serum concentrations of TC, TG and LDL-C of pregnant women with GDM in the third trimester, but also helps to reduce the incidences of perinatal complications and adverse pregnancy outcomes.