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孕中期血浆n-6多不饱和脂肪酸水平与妊娠期糖尿病的关联

王凡,  刘艳,  王意,  叶怡翔,  黄以超,  陈达,  潘雄飞,  潘安

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文章导航 > 中华疾病控制杂志  > 2022 >  26(4): 417-422
王凡, 刘艳, 王意, 叶怡翔, 黄以超, 陈达, 潘雄飞, 潘安. 孕中期血浆n-6多不饱和脂肪酸水平与妊娠期糖尿病的关联[J]. 中华疾病控制杂志, 2022, 26(4): 417-422. doi: 10.16462/j.cnki.zhjbkz.2022.04.010
引用本文: 王凡, 刘艳, 王意, 叶怡翔, 黄以超, 陈达, 潘雄飞, 潘安. 孕中期血浆n-6多不饱和脂肪酸水平与妊娠期糖尿病的关联[J]. 中华疾病控制杂志, 2022, 26(4): 417-422. doi: 10.16462/j.cnki.zhjbkz.2022.04.010
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WANG Fan, LIU Yan, WANG Yi, YE Yi-xiang, HUANG Yi-chao, CHEN Da, PAN Xiong-fei, PAN An. Association of plasma n-6 polyunsaturated fatty acids with gestational diabetes mellitus in the second trimester[J]. CHINESE JOURNAL OF DISEASE CONTROL & PREVENTION, 2022, 26(4): 417-422. doi: 10.16462/j.cnki.zhjbkz.2022.04.010
Citation: WANG Fan, LIU Yan, WANG Yi, YE Yi-xiang, HUANG Yi-chao, CHEN Da, PAN Xiong-fei, PAN An. Association of plasma n-6 polyunsaturated fatty acids with gestational diabetes mellitus in the second trimester[J]. CHINESE JOURNAL OF DISEASE CONTROL & PREVENTION, 2022, 26(4): 417-422. doi: 10.16462/j.cnki.zhjbkz.2022.04.010
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孕中期血浆n-6多不饱和脂肪酸水平与妊娠期糖尿病的关联

doi: 10.16462/j.cnki.zhjbkz.2022.04.010
  • 1.

    430030 武汉，华中科技大学同济医学院公共卫生学院流行病与卫生统计学系

  • 2.

    610200 成都，成都市双流区妇幼保健院妇产科

  • 3.

    230032 合肥，安徽医科大学公共卫生学院卫生毒理学系

  • 4.

    510632 广州，暨南大学环境学院

王凡和刘艳为共同第一作者
基金项目: 

国家自然科学基金 81773517

四川省卫生健康委员会科研课题 19PJ182

中央高校基本科研业务费专项资金 2019kfyXKJC052

博士后科学基金 2017M622457

详细信息
    通讯作者:

    刘艳，E-mail: 965145847@qq.com

    潘雄飞，E-mail: pxiongfei@gmail.com

  • 中图分类号: R181;R714.25

Association of plasma n-6 polyunsaturated fatty acids with gestational diabetes mellitus in the second trimester

  • 1.

    Department of Epidemiology and Biostatistics, School of Public Health, Tongji Medical College, Huazhong University of Science and Technology, Wuhan 430030, China

  • 2.

    Department of Obstetrics and Gynecology, Shuangliu Maternal and Child Health Hospital of Chengdu, Chengdu 610200, China

  • 3.

    Department of Hygienic Toxicology, School of Public Health, Anhui Medical University, Hefei 230032, China

  • 4.

    College of Environmental Sciences, Jinan University, Guangzhou 510632, China

WANG Fan and LIU Yan contributed equally to this article
Funds: 

National Natural Science Foundation of China 81773517

Sichuan Health Research Grant from the Sichuan Health Commission 19PJ182

Fundamental Research Funds for the Central Universities 2019kfyXKJC052

China Postdoctoral Science Foundation 2017M622457

More Information

    摘要
  • 摘要:   目的  探讨中国西南地区孕妇孕中期血浆n-6多不饱和脂肪酸(polyunsaturated fatty acids, PUFAs)水平与妊娠期糖尿病(gestational diabetes mellitus, GDM)的关联。  方法  本研究基于同济-双流出生队列，于2017-2019年在成都市双流区妇幼保健院围产保健门诊纳入18~40岁的6 143名单胎妊娠孕妇。通过问卷调查收集孕妇基本信息和孕期健康状况，并对其进行体格测量和血液样本收集。根据孕24~28周孕妇75 g口服葡萄糖耐量试验(oral glucose tolerance test, OGTT)结果，选取269名符合GDM诊断标准的孕妇作为病例组。在非GDM的孕妇中按照孕妇年龄(±3岁)、基线孕周(±4周)进行1∶2匹配，选取538名非GDM孕妇作为对照组。采用气相色谱-质谱联用的方法检测孕妇孕中期血浆多种n-6 PUFAs水平。采用多变量校正的条件Logistic回归分析模型评估孕中期血浆各n-6 PUFAs类别和总n-6 PUFAs与GDM患病风险的关联，并利用错误发现率(false discovery rate, FDR)法校正多重检验。采用敏感性分析探讨其稳健性。  结果  807名研究对象的年龄为(27.8±3.9)岁，孕周为(24.8±1.1)周，孕前BMI为(21.5±3.1) kg/m2。孕中期血浆亚油酸(linoleic acid, LA)、γ-亚油酸(gamma-linolenic acid, GLA)、二十碳二烯酸(eicosadienoic acid, EDA)和花生四烯酸(arachidonic acid, AA)水平每增加一个标准差，GDM的患病风险的OR值分别为0.83(95% CI：0.69~0.99, P=0.039)、0.82(95% CI：0.69~0.99, P=0.037)、0.63(95% CI：0.50~0.79, P < 0.001)和1.20(95% CI：1.02~1.42, P=0.032)，而多重校正后LA、GLA和AA与GDM患病风险关联无统计学意义(均有P > 0.05)。敏感性分析结果显示EDA与GDM患病风险的关联稳定。  结论  孕中期血浆n-6 PUFAs中EDA与GDM患病风险有关，此结论需进一步在大样本人群中进行验证。
    Abstract:   Objective  The study aims to explore the association of plasma n-6 polyunsaturated fatty acids (PUFAs) with gestational diabetes mellitus (GDM) in the second trimester of pregnant women in southwest China.  Methods  In the Tongji-Shuangliu Birth Cohort, 6 143 women with a singleton pregnancy (aged 18-40 years) were enrolled at the clinics of perinatal care in the Shuangliu Maternal and Child Health Care Hospital in Chengdu from 2017 to 2019. Basic information of participants was collected by questionnaire and physical examinations were performed at enrollment, and blood samples were collected in the second trimester. A total of 269 pregnant women were diagnosed as having GDM based on the 75 g oral glucose tolerance test during 24-28 weeks. The GDM cases were matched individually to 538 non-GDM controls at a 1∶2 ratio on maternal age (±3 years) and baseline gestational week (±4 weeks). Plasma n-6 PUFAs were determined by gas chromatography-mass spectrometry in the second trimester. The associations of individual n-6 PUFAs and total n-6 PUFAs with GDM were evaluated using multivariable conditional Logistic regression models, and false discovery rate (FDR) was used for the correction of multiple comparison. Sensitivity analysis was used to test the robustness of the associations.  Results  Of the 807 participants, maternal age was (27.8±3.9) years, and gestational age was (24.8±1.1) weeks, and pre-pregnancy BMI was (21.5±3.1) kg/m2. Odds ratios (ORs) for GDM in relation to each 1-SD increase in plasma linoleic acid (LA), gamma-linolenic acid (GLA), eicosadienoic acid (EDA), and arachidonic acid (AA) were 0.83 (95% CI: 0.69-0.99, P=0.039), 0.82 (95% CI: 0.69-0.99, P=0.037), 0.63 (95% CI: 0.50-0.79, P < 0.001) and 1.20 (95% CI: 1.02-1.42, P=0.032), respectively; however, the associations of LA, GLA, and AA with GDM became not significant after FDR correction (all P > 0.05). The association of EDA with GDM were robust in sensitivity analyses.  Conclusion  Plasma EDA in the second trimester was associated with GDM, which needs to be further validated in other populations.
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  • 表  1  GDM组与非GDM组人群基本特征[n(%)]

    Table  1.   Basic characteristics of GDM group and non-GDM group [n(%)]

    基本特征 总计(N=807) GDM (n=269) 非GDM (n=538) P值 基本特征 总计(N=807) GDM (n=269) 非GDM (n=538) P值
    孕妇年龄(x±s, 岁) 27.8±3.9 27.9±4.0 27.7±3.8 - 孕中期蔬菜摄入(g/d) 0.112
    孕周(x±s, 周) 24.8±1.1 24.8±1.3 24.7±1.0 -   0~50 132(16.4) 42(15.7) 90(16.7)
    孕前BMI(x±s, kg/m2) 21.5±3.1 22.2±3.3 21.1±3.0 < 0.001    > 50~100 113(14.0) 32(11.9) 81(15.1)
    教育水平 0.763    > 100~150 95(11.8) 25(9.3) 70(13.0)
      初中或以下 171(21.2) 58(21.6) 113(21.00)    > 150 466(57.8) 169(63.1) 297(55.2)
      高中或高职学校 304(37.7) 105(39.0) 199(37.0) 孕中期水果摄入(g/d) 0.775
      大专或以上 332(41.1) 106(39.4) 226(42.0)   0~50 51(6.3) 14(5.2) 37(6.9)
    吸烟 0.322    > 50~100 95(11.8) 31(11.6) 64(11.9)
      过去或现在吸烟 42(5.2) 17(6.3) 25(4.7)    > 100~150 42(5.2) 13(4.8) 29(5.4)
      从不吸烟 765(94.8) 252(93.7) 513(95.3)    > 150 618(76.7) 210(78.4) 408(75.8)
    饮酒 0.448 孕中期鸡蛋摄入(个/d) 0.441
      过去或现在饮酒 147(18.2) 53(19.7) 94(17.5)   0 99(12.3) 32(11.9) 67(12.4)
      从不饮酒 660(81.8) 216(80.3) 444(82.5)   1 654(81.1) 214(79.9) 440(81.8)
    孕中期体力活动(x±s, MET-h/周) 125.0±76.1 120.8±79.0 127.1±74.6 0.240    > 1 53(6.6) 22(8.2) 31(5.8)
    产次(次) 0.339 FPG(x±s, mmol/L) 4.1±0.5 4.3±0.6 3.9±0.3 < 0.001
      ≥1 403(49.9) 140(52.0) 263(48.9) OGTT-1h(x±s, mmol/L) 7.9±2.0 10.0±1.5 6.8±1.4 < 0.001
      0 404(50.1) 129(48.0) 275(51.1) OGTT-2h(x±s, mmol/L) 6.9±1.8 8.6±1.6 6.0±1.1 < 0.001
    糖尿病家族史 0.013 LA(x±s, %) 21.12±2.78 20.82±2.64 21.28±2.84 0.018
      是 60(7.4) 29(10.8) 31(5.8) GLA(x±s, %) 0.09±0.05 0.09±0.04 0.09±0.05 0.034
      否 747(92.6) 240(89.2) 507(94.2) EDA(x±s, %) 0.36±0.08 0.34±0.08 0.37±0.08 < 0.001
    GDM史 0.001 DGLA(x±s, %) 1.77±0.47 1.74±0.45 1.78±0.48 0.246
      是 22(2.7) 15(5.6) 7(1.3) AA(x±s, %) 6.99±1.46 7.16±1.54 6.91±1.42 0.015
      否 785(97.3) 254(94.4) 531(98.7) DTA(x±s, %) 0.08±0.03 0.08±0.03 0.08±0.03 0.182
    孕中期HbA1c(x±s, %) 4.7±0.3 4.8±0.4 4.6±0.3 < 0.001 总n-6 PUFAs(%) 30.41±2.68 30.22±2.60 30.51±2.72 0.095
    孕中期肉类摄入(g/d) 0.819
      0~50 553(68.6) 186(69.4) 367(68.2)
       > 50~100 g/d 202(25.1) 67(25.0) 135(25.1)
      > 100 g/d 51(6.3) 15(5.6) 36(6.7)
    下载: 导出CSV

    表  2  孕中期血浆多种n-6 PUFAs与GDM关联性分析

    Table  2.   Correlation analysis between multiple n-6 PUFAs and GDM in second trimester plasma

    PUFAs PUFAs四分位组OR(95% CI)值 P趋势值 PFDR值 PUFAs 1-SD P值 PFDR值
    Q1 Q2 Q3 Q4 OR(95% CI)值
    LA
      GDM/非GDM 73/136 70/134 76/134 50/134 269/538
      模型1 1.00 0.97(0.64~1.47) 1.03(0.68~1.57) 0.67(0.43~1.06) 0.121 0.82(0.70~0.97) 0.018
      模型2 1.00 0.98(0.64~ 1.50) 1.10(0.71~1.71) 0.72(0.45~1.15) 0.226 0.84(0.71~1.00) 0.049
      模型3 1.00 0.95(0.61~ 1.47) 1.06(0.68~1.67) 0.68(0.41~1.11) 0.190 0.317 0.83(0.69~0.99) 0.039 0.098
    GLA
      GDM/非GDM 93/174 69/104 58/127 49/133 269/538
      模型1 1.00 1.26(0.84~1.90) 0.84(0.56~1.26) 0.66(0.43~1.02) 0.022 0.83(0.70~0.99) 0.034
      模型2 1.00 1.30(0.85~1.99) 0.83(0.55~1.26) 0.61(0.39~0.96) 0.010 0.82(0.69~0.98) 0.027
      模型3 1.00 1.23(0.79~1.90) 0.83(0.54~1.29) 0.61(0.38~0.97) 0.014 0.053 0.82(0.69~0.99) 0.037 0.111
    EDA
      GDM/非GDM 86/138 91/134 54/136 38/130 269/538
      模型1 1.00 0.85(0.56~1.29) 0.41(0.24~0.69) 0.27(0.15~0.48) < 0.001 0.56(0.45~0.70) < 0.001
      模型2 1.00 0.97(0.63~1.50) 0.46(0.27~0.78) 0.32~0.17~0.59) < 0.001 0.60(0.48~0.75) < 0.001
      模型3 1.00 1.01(0.65~1.57) 0.48(0.28~0.83) 0.35(0.19~0.65) < 0.001 0.015 0.63(0.50~0.79) < 0.001 0.015
    DGLA
      GDM/非GDM 64/135 86/139 69/133 50/131 269/538
      模型1 1.00 1.29(0.86~1.93) 1.06(0.70~1.61) 0.78(0.49~1.24) 0.196 0.91(0.78~1.07) 0.246
      模型2 1.00 1.24(0.82~1.88) 0.90(0.58~1.40) 0.64(0.40~1.05) 0.037 0.84(0.71~1.00) 0.045
      模型3 1.00 1.23(0.80~1.89) 0.87(0.56~1.37) 0.64(0.38~1.06) 0.041 0.103 0.84(0.71~1.01) 0.062 0.116
    AA
      GDM/非GDM 61/135 64/134 63/135 81/134 269/538
      模型1 1.00 1.06(0.69~1.63) 1.04(0.69~1.59) 1.39(0.90~2.14) 0.146 1.21(1.04~1.41) 0.015
      模型2 1.00 1.12(0.72~1.75) 1.06(0.68~1.63) 1.33(0.86~2.08) 0.245 1.21(1.03~1.41) 0.021
      模型3 1.00 1.20(0.76~1.89) 1.03(0.66~1.62) 1.34(0.84~2.14) 0.309 0.357 1.20(1.02~1.42) 0.032 0.120
    DTA
      GDM/非GDM 89/161 88/164 56/124 36/89 269/538
      模型1 1.00 0.98(0.67~1.42) 0.80(0.53~1.23) 0.71(0.44~1.14) 0.119 0.90(0.77~1.05) 0.182
      模型2 1.00 0.98(0.67~1.45) 0.85(0.55~1.32) 0.76(0.46~1.26) 0.243 0.93(0.79~1.09) 0.382
      模型3 1.00 0.95(0.64~1.42) 0.78(0.50~1.24) 0.76(0.45~1.27) 0.213 0.290 0.92(0.78~1.09) 0.344 0.469
    总n-6 PUFAs
      GDM/非GDM 74/136 70/133 70/135 55/134 269/538
      模型1 1.00 0.93(0.60~1.44) 0.88(0.56~1.39) 0.69(0.42~1.14) 0.142 0.86(0.72~1.03) 0.095
      模型2 1.00 0.92(0.59~1.44) 0.91(0.57~1.45) 0.70(0.42~1.17) 0.183 0.87(0.73~1.05) 0.155
      模型3 1.00 0.89(0.56~1.42) 0.90(0.55~1.47) 0.67(0.39~1.13) 0.148 0.278 0.85(0.70~1.04) 0.113 0.188
    注：模型1未校正; 模型2校正因素为孕妇年龄和孕前BMI; 模型3在模型2基础上增加教育水平、孕周、产次、吸烟、饮酒、体力活动水平、孕妇糖尿病家族史、GDM病史。
    下载: 导出CSV

    表  3  孕中期血浆PUFAs水平与GDM患病风险的敏感性分析

    Table  3.   Sensitivity analysis of plasma PUFAs level and risk of GDM in the second trimester of pregnancy

    PUFAs PUFAs四分位组OR(95% CI)值 P趋势值 PFDR值 PUFAs 1-SD P值 PFDR值
    Q1 Q2 Q3 Q4 OR(95% CI)值
    LA 1.00 0.87(0.54~1.40) 1.03(0.63~1.68) 0.69(0.40~1.19) 0.270 0.405 0.82(0.67~0.99) 0.041 0.088
    GLA 1.00 1.14(0.70~1.86) 0.70(0.43~1.13) 0.59(0.36~0.98) 0.013 0.039 0.79(0.65~0.97) 0.024 0.060
    EDA 1.00 1.04(0.64~1.69) 0.41(0.23~0.76) 0.29(0.15~0.58) < 0.001 0.015 0.59(0.46~0.76) < 0.001 0.015
    DGLA 1.00 0.86(0.53~1.39) 0.73(0.44~1.21) 0.42(0.24~0.75) 0.003 0.015 0.74(0.60~0.90) 0.003 0.030
    AA 1.00 1.19(0.72~1.97) 0.94(0.57~1.53) 1.33(0.79~2.26) 0.437 0.546 1.19(0.99~1.44) 0.063 0.105
    DTA 1.00 0.92(0.59~1.43) 0.80(0.48~1.33) 0.76(0.43~1.36) 0.292 0.398 0.92(0.76~1.11) 0.380 0.475
    总n-6 PUFAs 1.00 0.90(0.53~1.52) 0.91(0.53~1.57) 0.63(0.35~1.14) 0.144 0.240 0.80(0.64~0.99) 0.043 0.081
    注：校正因素为孕妇年龄、教育水平、孕前BMI、孕周、产次、孕期吸烟、孕期饮酒、孕中期体力活动水平、孕妇糖尿病家族史、GDM病史、孕中期血浆HbA1c、孕中期饮食(水果、蔬菜、肉类和鸡蛋摄入量)。
    下载: 导出CSV
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  • 收稿日期:  2021-06-24
  • 修回日期:  2021-10-06
  • 网络出版日期:  2022-04-14
  • 刊出日期:  2022-04-10

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