Influence of Glycemic Control on Coagulation and Lipid Metabolism in Pregnancies Complicated by Pregestational and Gestational Diabetes Mellitus
Influence of Glycemic Control on Coagulation and Lipid Metabolism in Pregnancies Complicated by Pregestational and Gestational Diabetes Mellitus
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DOI：
10.1007/5584_2019_382
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发表时间：
2019-01-01
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影响因子：
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通讯作者：
Czajkowski, Krzysztof
中科院分区：
文献类型：
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作者：
Teliga-Czajkowska, Justyna;Sienko, Jacek;Czajkowski, Krzysztof
在正常妊娠中观察到的高凝状态和脂质代谢改变在糖尿病中可能会增强。该研究的目的是评估血糖控制对接受胰岛素治疗的孕前 (PGDM) 和妊娠 (GDM) 糖尿病女性的凝血和脂质代谢的影响。共有 50 名 PGDM 患者和 101 名 GDM 患者参加了该研究。在妊娠18-22周、25-28周和31-34周时评估血脂和凝血参数，并在糖尿病组内进行比较，参考血糖控制的有效性。我们发现，糖尿病组中血糖控制不佳与活化部分凝血活酶时间（APTT）缩短和抗凝血酶 III（ATIII）活性增加有关，并且 GDM 组中纤溶酶原激活剂抑制剂（PAI-1）含量水平较高。 PGDM 控制不佳与妊娠中期的总胆固醇和高密度胆固醇 (HDL) 水平较高以及妊娠晚期的甘油三酯水平较高有关。在 GDM 控制不佳的患者中，妊娠晚期的 HDL 浓度较高，而妊娠中期和晚期的甘油三酯水平较高。在控制不佳的PGDM组中发现总胆固醇与APTT之间以及甘油三酯与APTT和ATIII之间呈正相关。我们的结论是，糖尿病妊娠的血糖控制不良会影响脂质代谢和凝血系统。
Hypercoagulability and altered lipid metabolism, which are observed in normal pregnancy, can be enhanced in diabetes mellitus. The aim of the study was to evaluate the influence of glycemic control on coagulation and lipid metabolism in women with pregestational (PGDM) and gestational (GDM) diabetes treated with insulin. There were 50 patients with PGDM and 101 patients with GDM enrolled into the study. Serum lipid and coagulation parameters were assessed at 18-22, 25-28, and 31-34 weeks of pregnancy and were compared within the diabetic groups with reference to the effectiveness of glycemia control. We found that poor glycemic control was associated with shortened activated partial thromboplastin time (APTT) and increased activity of antithrombin III (ATIII) in both diabetic groups and with a higher plasminogen activator inhibitor (PAI-1) content level in the GDM group. Poorly controlled PGDM was associated with higher levels of total cholesterol and high-density cholesterol (HDL) in the second trimester and triglycerides in the third trimester. In patients with poorly controlled GDM, a higher concentration of HDL was observed in third trimester, whereas a higher triglyceride level was found in both second and third trimesters. Positive correlations between total cholesterol and APTT and between triglyceride and APTT and ATIII were found in the poorly controlled PGDM group. We conclude that poor glycemic control of diabetic pregnancy impacts both lipid metabolism and the blood coagulation system.