中国医学科学院学报

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中国医学科学院学报

中国医学科学院学报 ›› 2016, Vol. 38 ›› Issue (3): 283-287.doi: 10.3881/j.issn.1000-503X.2016.03.007

• 论著 • 上一篇    下一篇

孕早期白细胞计数、丙氨酸氨基转移酶和天门冬氨酸氨基转移酶水平与妊娠期糖尿病的相关性

赵丽丽1, 李伟1, 平凡1, 马良坤2, 聂敏1   

  1. 中国医学科学院 北京协和医学院 北京协和医院
    1内分泌科国家卫生和计划生育委员会重点实验室
    2妇产科,北京 100730
  • 收稿日期:2015-06-08 出版日期:2016-03-15 发布日期:2016-06-10
  • 作者简介:

    通信作者:聂 敏 电话:010-69155357,电子邮件:nmlspumch@sina.com

  • 基金资助:
    国家自然科学基金(81270879)

Associations of White Blood Cell Count,Alanine Aminotransferase,and Aspartate Aminotransferase in the First Trimester with Gestational Diabetes Mellitus

Li-li ZHAO1, Wei LI1, Fan PING1, Liang-kun MA2, Min NIE1()   

  1. 1State Key Laboratory of Endocrinology,Ministry of Health,
    2Department of Obstetrics and Gynecology,PUMC Hospital,CAMS and PUMC,Beijing 100730,China
  • Received:2015-06-08 Online:2016-03-15 Published:2016-06-10
  • Supported by:
    Supported by the National Natural Sciences Foundation of China (81270879)

摘要:

目的 探讨孕早期白细胞(WBC)计数、丙氨酸氨基转移酶(ALT)和天门冬氨酸氨基转移酶(AST)水平与妊娠期糖尿病(GDM)发生的相关性。方法 纳入GDM孕妇725人,糖耐量正常(NGT)孕妇935人,详细记录受试者孕前体重、身高,于孕8~12周检测WBC、ALT和AST水平,孕24~28周检测血糖、胰岛素水平。比较两组孕妇孕早期WBC计数、ALT和AST水平,回顾性分析孕早期WBC、ALT和AST水平与孕中期血糖和胰岛素水平及GDM发生的相关性。结果 GDM组受试者的WBC计数[9.41(8.15,10.84)×109/L比9.04(7.64,10.37)×109/L,P=1.0×10-5]和ALT水平[18.00(12.00,30.00)U/L比16.00(11.00,26.00)U/L,P=0.004]明显高于NGT组,两组受试者的AST水平差异无统计学意义[41.00(26.00,43.00)U/L比41.00(23.00,43.00)U/L,P=0.588]。Logistic回归分析结果显示,校正年龄、孕前BMI、血压和糖尿病家族史后,WBC计数升高能明显增加GDM的发病风险(OR=1.119,P=0.001),根据ROC曲线得出患GDM的WBC计数最佳临界值为7.965×109/L(AUC 0.566,P=1×10-5),敏感性为79.4%,特异性为31.3%。多元线性回归分析结果显示,稳态胰岛素评估模型胰岛素抵抗指数与WBC计数成正相关(B=0.051,P=0.022,R2=0.083);口服50 g糖后1 h血糖(B=0.044,P=0.001,R2=0.044)和空腹真胰岛素(B=0.214,P=0.032,R2=0.066)与孕早期WBC计数成正相关;100 g 口服葡萄糖耐量试验(OGTT)后1 h真胰岛素与孕早期AST成正相关(B=0.616,P=1.85×10-5,R2=0.052);100 g OGTT后2 h真胰岛素与ALT(B=0.148,P=0.027)和AST(B=0.936,P=3.71×10-8)成正相关(R2=0.077);100 g OGTT后3 h真胰岛素与孕早期ALT(B=0.189,P=0.002)和AST(B=0.688,P=7.25×10-6)成正相关(R2=0.067)。结论 孕早期WBC计数升高能明显增加GDM的发病风险,有望成为GDM发病的预测指标之一。

关键词: 妊娠期糖尿病, 白细胞计数, 丙氨酸氨基转移酶, 天门冬氨酸氨基转移酶

Abstract:

Objective To explore the associations of white blood cell (WBC) count,alanine aminotransferase (ALT),and aspartate aminotransferase(AST) in the first trimester of pregnancy with gestational diabetes mellitus (GDM). Methods Totally 725 GDM women and 935 women who remained euglycemic throughout pregnancy were enrolled in this study. Pre-pregnancy weight/height were recorded. WBC,ALT,and AST levels were detected between 8 and 12 weeks of pregnancy.At 24 to 28 weeks of pregnancy,the glucose and insulin levels were measured. The WBC,ALT,and AST levels were compared between two groups,and the associations of WBC,ALT,and AST levels with the blood glucose and insulin levels were retrospectively analyzed. Meanwhile,the potential associations of those factors with the occurrence of GDM were analzyed. Results WBC count [9.41(8.15,10.84)×109/L vs. 9.04 (7.64,10.37)×109/L,P=1.0×10-5] and ALT levels [18.00(12.00,30.00)U/L vs. 16.00 (11.00,26.00)U/L,P=0.004] in the first trimester of pregnancy were significantly increased in GDM subjects than in normal glucose tolerance(NGT)subjects;however,the AST level showed no significant difference between these two groups [41.00 (26.00,43.00)U/L vs. 41.00 (23.00,43.00)U/L,P=0.588]. Logistic regression analysis illustrated that elevated WBC count was an independent risk factor for GDM after adjustment for age,pre-pregnancy body mass index,blood pressure,and family history of diabetes(OR=1.119,P=0.001). The ROC curve revealed that threshold of WBC count was 7.965×109/L(AUC=0.566,P=1×10-5),which had a sensitivity of 79.4% and a specificity of 31.3%. Multivariate linear regression analysis showed that homeostasis model assessment of insulin resistance was positively correlated with WBC count(B=0.051,P=0.022,R2=0.083);1-hour blood glucose after oral 50 grams of sugar (B=0.044,P=0.001,R2=0.044) and fasting plasma true insulin(B=0.214,P=0.032,R2=0.066) were positively correlated with WBC count;1-hour true insulin after 100 grams oral glucose to lerance test(OGTT) was positively correlated with AST (B=0.616,P=1.85×10-5,R2=0.052);2-hour true insulin after 100 grams OGTT was positively correlated with ALT (B=0.148,P=0.027)and AST(B=0.936,P=3.71×10-8,R2=0.077);and 3-hour true insulin after 100 grams oral glucose tolerance test(OGTT) was positively correlated with ALT (B=0.189,P=0.002) and AST (B=0.688,P=7.25×10-6,R2=0.067). Conclusions The WBC count in the first trimester of pregnancy can increase the risk of GDM. Thus,WBC count may be a useful predictors of GDM.

Key words: gestational diabetes mellitus, white blood cell count, alanine aminotransferase, aspartate aminotransferase

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