残留在孕妇体内的胆固醇，而不是其他胆固醇参数，与妊娠糖尿病有关：一项前瞻性队列研究。
Remnant cholesterol, but not other cholesterol parameters, is associated with gestational diabetes mellitus in pregnant women: a prospective cohort study.
机构信息
Department of Anesthesiology, Affiliated Shenzhen Maternity and Child Healthcare Hospital, Southern Medical University, Shenzhen, 518028, China.
College of Information Science and Engineering, Liuzhou Institute of Technology, No. 99, Xinliu Avenue, Yufeng District, Liuzhou, 545616, Guangxi Zhuang Autonomous Region, China.
出版信息
J Transl Med. 2023 Aug 7;21(1):531. doi: 10.1186/s12967-023-04322-0.
OBJECTIVE
No evidence has been found of a relationship between remnant cholesterol (RC) and the likelihood of gestational diabetes mellitus (GDM) in pregnant women. The aim of our study was to investigate the link between serum RC at 12-14 weeks of gestation and the risk of GDM.
METHODS
This was a secondary analysis with data from a prospective cohort study in Korea. A total of 590 single pregnant women attending two hospitals in Korea, up to 14 weeks gestation, from November 2014 to July 2016 were included in the study. The formula used to calculate RC in detail was RC (mg/dL) = TC (mg/dL)-HDL-c (mg/dL)-LDL-c (mg/dL). Logistic regression models were employed to examine the relationship between RC and GDM and explore the association between other lipoprotein cholesterol parameters and the risk of GDM. Furthermore, receiver operating characteristic (ROC) analysis was performed to assess the ability of RC to identify GDM. Additionally, sensitivity and subgroup analyses were conducted.
RESULTS
The mean age of participants was 32.06 ± 3.80 years. The median of RC was 34.66 mg/dL. 37 pregnant women (6.27%) were eventually diagnosed with GDM. Multivariate adjusted logistic regression analysis showed that RC was positively associated with the risk of GDM (OR = 1.458, 95% CI 1.221, 1.741). There was no significant association between other lipoprotein cholesterols (including TC, LDL-c, HDL-c) and the risk of GDM. The area under the ROC curve for RC as a predictor of GDM was 0.8038 (95% CI 0.7338-0.8738), and the optimal RC cut-off was 24.30 mg/dL. Our findings were demonstrated to be robust by performing a series of sensitivity analyses.
CONCLUSION
Serum RC levels at 12-14 weeks of gestation are positively associated with GDM risk in pregnant women. RC in early pregnancy is an early warning indicator of GDM in pregnant women, especially those with normal HDL-c, LDL-c, and TC that are easily overlooked. There is a high risk of developing GDM in pregnant women whose RC is more than 24.30 mg/dL. This study may help optimize GDM prevention in pregnant women and facilitate communication between physicians, pregnant patients, and their families.
目的
目前尚未发现孕妇残余胆固醇（RC）与妊娠糖尿病（GDM）之间存在关联。本研究旨在探讨 12-14 孕周时血清 RC 与 GDM 风险之间的关系。
方法
这是一项来自韩国前瞻性队列研究的二次分析。共纳入 2014 年 11 月至 2016 年 7 月在韩国两家医院就诊的 590 名单胎孕妇，孕周不超过 14 周。详细计算 RC 的公式为 RC（mg/dL）=TC（mg/dL）-HDL-c（mg/dL）-LDL-c（mg/dL）。采用 logistic 回归模型探讨 RC 与 GDM 的关系，并探讨其他脂蛋白胆固醇参数与 GDM 风险的关系。此外，还进行了受试者工作特征（ROC）分析，以评估 RC 识别 GDM 的能力。另外还进行了敏感性和亚组分析。
结果
参与者的平均年龄为 32.06±3.80 岁。RC 的中位数为 34.66mg/dL。最终有 37 名孕妇（6.27%）被诊断为 GDM。多变量调整的 logistic 回归分析显示，RC 与 GDM 风险呈正相关（OR=1.458，95%CI 1.221，1.741）。其他脂蛋白胆固醇（包括 TC、LDL-c、HDL-c）与 GDM 风险无显著关联。RC 作为 GDM 预测指标的 ROC 曲线下面积为 0.8038（95%CI 0.7338-0.8738），最佳 RC 截断值为 24.30mg/dL。通过一系列敏感性分析，证实了我们的发现是稳健的。
结论
妊娠 12-14 周时血清 RC 水平与孕妇 GDM 风险呈正相关。早孕期 RC 是孕妇 GDM 的早期预警指标，特别是对于那些容易被忽视的 HDL-c、LDL-c 和 TC 正常的孕妇。RC 超过 24.30mg/dL 的孕妇发生 GDM 的风险较高。本研究可能有助于优化孕妇 GDM 的预防，并促进医生、孕妇及其家属之间的沟通。
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