|
|
|
| Analysis of metabolism factors related to gestational diabetes mellitus and/or non-alcoholic fatty liver diease and diagnostic value of TyG index in pregnancy |
| NIU Tong WANG Wan LI Tiantian ZHU Yihan XIN Yaping |
| Department of Endocrinology, the Second Affiliated Hospital of Zhengzhou University, He′nan Province, Zhengzhou 450000, China |
|
|
|
Abstract Objective To investigate the metabolism factors related to gestational diabetes mellitus (GDM) and/or non-alcoholic fatty liver diease (NAFLD) and diagnostic value of Triglyceride-glucose (TyG) index in pregnancy. Methods From June 2018 to September 2019, Pregnant women who labor examination and delivery in the Second Affiliated Hospital of Zhengzhou University (“our hospital” for short) were selected. Pregnant women with GDM were divided into GDM group (137 cases), NAFLD group of pregnant women with NAFLD (70 cases), pregnant women with GDM combined with NAFLD were in complex group (73 cases), the healthy pregnant women who came to our hospital for labor examination at the same time were selected as normal group (73 cases). Fasting blood glucose (FBG), fasting insulin (FINS), glycosylated hemoglobin (HbA1c), total cholesterol (TC), triglyceride (TG), high-density lipoprotein cholesterol (HDL-C), low density lipoprotein cholesterol (LDL-C), aspartate aminotransferase (AST) and alanine aminotransferase (ALT), serum uric acid (SUA) in 24-28 weeks pregnancy were compared, the homeostasis model of insulin resistance index (HOMA-IR) and TyG index were calculated. Results FBG, HbA1c, HOMA-IR and TyG index in GDM group were higher than those in normal group. ATL, SUA, TG, HOMA-IR and TyG index of NAFLD group were higher than those of normal group. ATL, SUA, TG, FBG, HbA1c, HOMA-IR and TyG index in complex group were higher than those in normal group and GDM group and FBG, HbA1c, HOMA-IR and TyG index were higher than those in NAFLD group, with statistically significant differences (all P < 0.05). FINS and the incidence of macrosomia in GDM group, NAFLD group and complex group were higher than those in normal group, and the differences were statistically significant (P < 0.05). Pearson correlation analysis showed that TyG index was positively correlated with HOMA-IR and HbA1c (r = 0.473, 0.472, P < 0.001). Logistic regression analysis showed that FBG (OR = 1.707, 95%CI:1.202-2.424, P = 0.003) and TG (OR = 1.386, 95%CI:1.031-1.862, P = 0.031) were risk factors for NAFLD in pregnant women with GDM. ROC curve showed that HOMA-IR and TyG index had diagnostic value for the occurrence of GDM and/or NAFLD. Conclusion Pregnant women with GDM combined with NAFLD have severe IR and metabolic disorders, FBG and TG are involved in occurrence of NAFLD in pregnant women with GDM. Therefore, effective measures should be taken to control clinically. TyG index can initially identify IR and assess blood glucose level.
|
|
|
|
|
|
[1] Gilmartin AB，Ural SH，Repke JT，et al. Gestational diabetes mellitus [J]. Rev Obstet Gynecol，2008，1：129-134.
[2] Lonardo A，Byrne CD，Caldwell SH，et al. Global epidemiology of nonalcoholic fatty liver disease meta-analytic assessment of prevalence，incidence，and outcomes [J]. Hepatology，2016，64（1）：1388-1389.
[3] Hershman M，Mei R，Kushner T，et al. Implications of Nonalcoholic Fatty Liver Disease on Pregnancy and Maternal and Child Outcomes [J]. Gastroenterol Hepatol（NY），2019， 15（4）：221-228.
[4] Chalasani N，Younossi Z，Lavine JE，et al. The diagnosis and management of nonalcoholic fatty liver disease：practice guidance from the American Association for the Study of Liver Diseases [J]. Hepatology，2018，67（1）：328-357.
[5] Ajmera VH，Gunderson EP，Van Wagner LB，et al. Gestational Diabetes Mellitus is Strongly Associated with Non-Alcoholic Fatty Liver Disease [J]. Am J Gastroenterol，2016， 111（5）：658-664.
[6] Mazidi M，Kengne AP，Katsiki N，et al. Lipid accumulation product and triglycerides/glucose index are useful predictors of insulin resistance [J]. J Diabetes Complications，2018，32（3）：266-270.
[7] 魏小辉，王育璠.2015年国际妇产科联盟（FIGO）妊娠期糖尿病诊疗指南解读[J].中华内分泌代谢杂志，2016，32（11）：895-899.
[8] 中华医学会肝病学分会脂肪肝和酒精性肝病学组.非酒精性脂肪性肝病诊疗指南（2010年修订版）[J].中华肝脏病杂志，2010，18（3）：163-166.
[9] Brunt EM，Wong VM，Nobili V，et al. Nonalcoholic fatty liver disease [J]. Nature Reviews Primers，2015，1：15080.
[10] Firneisz G. Non-alcoholic fatty liver disease and type 2 diabetes mellitus：The liver disease of our age? [J]. World J Gastroenterol，2014，20（27）：9072-9089.
[11] Lin X，Zhang Z，Chen JM，et al. Role of APN and TNF-α in type 2 diabetes mellitus complicated by nonalcoholic fatty liver disease [J]. Genet Mol Res，2015，14（2）：2940-2946.
[12] 郭敏，郗光霞，杨娜，姚红.2型糖尿病合并非酒精性脂肪性肝病的代谢相关危险因素分析[J].中华肝脏病杂志，2014，22（8）：631-635.
[13] Brumbaugh DE，Tearse P，Cree-Green M，et al. Intrahepatic fat is increased in the neonatal offspring of obese women with gestational diabetes [J]. Pediatr，2013，162（5）：930.e1-936.e1.
[14] Szabo AJ. Transferred maternal fatty acids stimulate fetal adipogenesis and lead to neonatal and adult obesity [J]. Med Hypotheses，2019，122：82-88.
[15] Guerrero-Romero F，Simental-Mendía LE，González-Ortiz M，et al. The product of triglycerides and glucose，a simple measure of insulin sensitivity. Comparison with the euglycemic-hyperinsulinemic clamp [J]. Clin Endocrinol Metab，2010，95（7）：3347-3351.
[16] Lee SH，Kwon HS，Park YM，et al. Predicting the development of diabetes using the product of triglycerides and glucose：the Chungju Metabolic Disease Cohort（CMC）study [J]. PLoS One，2014，9（2）：e90430.
[17] Du T，Yuan G，Zhang M，et al. Clinical usefulness of lipid ratios，visceral adiposity indicators，and the triglycerides and glucose index as risk markers of insulin resistance [J]. Cardiovasc Diabetol，2014，13：146.
[18] Guerrero-Romero F，Villalobos-Molina R，Jiménez-Flores JR，et al. Fasting Triglycerides and Glucose Index as a Diagnostic Test for Insulin Resistance in Young Adults [J]. Arch Med Res，2016，47（5）：382-387.
[19] Hameed EK. TyG index a promising biomarker for glycemic control in type 2 Diabetes Mellitus [J]. Diabetes Metab Syndr，2019，13（1）：560-563.
[20] Parhofer KG. Interaction between glucose and lipid metabolism：more than diabetic dyslipidemia [J]. Diabetes Metab J，2015，39（5）：353-362. |
|
|
|
