协和医学杂志

2017, v.8(01) 20-24

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妊娠糖尿病孕妇孕中晚期维生素D营养状态及成因分析
Vitamin D Nutritional Status and Its Influencing Factors among Women with Gestational Diabetes Mellitus in Mid- to Late-gestation

刘燕萍;金洽尔;包媛媛;李珊珊;禹松林;邱玲;
LIU Yan-ping;JIN Qia-er;BAO Yuan-yuan;LI Shan-shan;YU Song-lin;QIU Ling;Department of Nutrition,Peking Union Medical College Hospital,Chinese Academy of Medical Sciences & Peking Union Medical College;Tufts University;Department of Clinical Laboratory,Peking Union Medical College Hospital,Chinese Academy of Medical Sciences & Peking Union Medical College;

摘要(Abstract):

目的观察妊娠糖尿病(gestational diabetes mellitus,GDM)孕妇孕中晚期维生素D的营养状态并分析其成因。方法以液相色谱串联质谱的方法检测2013年10月至2015年7月北京协和医院营养科门诊GDM孕妇血清中25羟维生素D(25-OH Vit D)浓度,根据是否服用含有维生素D制剂分为服用组和未服用组,服用组调查含维生素D的膳食补充剂应用情况,并根据患者膳食记录统计富含维生素D的食物消费频率。结果共纳入98例GDM孕妇,孕周(29.0±3.3)周,血清总25-OH Vit D浓度为(72.03±26.18)nmol/L,缺乏率(<50 nmol/L)为20.4%(20/98)。服用含维生素D制剂的孕妇血清25-OH Vit D高于未服用组[(74.35±26.13)nmol/L比(60.45±23.63)nmol/L,P=0.031],两组缺乏率分别为17.9%和35.7%。血清25-OH Vit D_2检出率为19.4%(19/98),检出者平均水平为(11.61±6.71)nmol/L(6.05~24.71 nmol/L),均服用维生素D制剂,未服用组均未检出。分季节比较发现,秋、冬季节孕妇维生素D水平显著低于春、夏两季,缺乏率显著高于春、夏季节。在四季中,仅在秋季服用组的血清25-OH Vit D浓度显著高于未服用组[(78.59±27.54)nmol/L比(46.18±18.77)nmol/L,P=0.045],其他3个季节两组无统计学差异;夏季两组缺乏率均为0。膳食记录显示,观察对象奶、蛋的消费频率分别为(7.5±3.8)次/周(不饮奶4例)和(5.6±2.2)次/周。结论本研究纳入的GDM孕妇孕中晚期维生素D秋冬季节缺乏较为严重,血清维生素D_2检出率高,对维持该群体血清维生素D水平有贡献。膳食中较高的奶、蛋制品消费频率或许有助于维持维生素D水平。
Objective To observe the vitamin D nutritional status and its influencing factors among women with gestational diabetes mellitus( GDM) in the last two trimesters of pregnancy. Methods The high-performance liquid chromatography-tandem mass spectrometry method was adopted for the 25-OH vitamin D( 25-OH Vit D) detection in pregnant women with GDM visiting the outpatient nutrition clinic in Peking Union Medical College Hospital between October 2013 and July 2015. The women were divided into two groups based on whether they were taking vitamin D supplements. We surveyed vitamin D containing dietary supplements use in the vitamin D intake group,and the frequency of consumption of food high in vitamin D based on the patients' diet records. Results Atotal of 98 pregnant women with GDM were included,with the gestational age of( 29. 0 ± 3. 3) weeks. The total serum25-OH Vit D was( 72. 03 ± 26. 18) nmol/L. The incidence of vitamin D deficiency( < 50 nmol/L) was 20. 4%( 20/98). The serum 25-OH Vit D level in the pregnant women was higher in the vitamin D intake group than in the non-intake group [( 74. 35 ± 26. 13) nmol/L vs( 60. 45 ± 23. 63) nmol/L,P = 0. 031]. The vitamin D deficiency rate was 17. 9% and 35. 7% in the vitamin D intake group and the non-intake group,respectively. The level of serum 25-OH Vit D_2was( 11. 61 ± 6. 71)( 6. 05- 24. 71) nmol/L,with the detection rate of 19. 4%( 19/98),all in the vitamin D intake group. Serum 25-OH Vit D_2 was not detected in the non-intake group. Analysis by season showed that the level of serum 25-OH Vit D in pregnant women in fall/winter was significantly lower than that in spring/summer; and the vitamin D deficiency rate was significantly higher in fall/winter. The serum 25-OH Vit D level in pregnant women in the vitamin D intake group was significantly higher than in the non-intake group in fall only [( 78. 59 ± 27. 54) nmol/L vs( 46. 18 ± 18. 77) nmol/L,P = 0. 045],while no significant difference was observed in the other seasons. The vitamin D deficiency rate was 0 in both groups in summer. The dietary diary showed that the frequencies of consumption of dairy and eggs in these women were 7. 5 ± 3. 8( 4 cases did not take dairy) and 5. 6 ± 2. 2 per week,respectively. Conclusions The vitamin D deficiency rate among the pregnant women with GDM in the last two trimesters in this study is higher in fall/winte. The high detection of serum 25-OH Vit D_2 may contribute to maintaining serum 25-OH Vit D level among this population. The high frequency of dietary consumption of dairy products and eggs maybe help to maintain the nutritional status of vitamin D.

关键词(KeyWords): 妊娠糖尿病;25羟维生素D;25羟维生素D_2
gestational diabetes mellitus;25-OH vitamin D;25-OH vitamin D_2

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基金项目(Foundation): 国家高技术研究发展计划(863计划)(2014AA022304)

作者(Author): 刘燕萍;金洽尔;包媛媛;李珊珊;禹松林;邱玲;
LIU Yan-ping;JIN Qia-er;BAO Yuan-yuan;LI Shan-shan;YU Song-lin;QIU Ling;Department of Nutrition,Peking Union Medical College Hospital,Chinese Academy of Medical Sciences & Peking Union Medical College;Tufts University;Department of Clinical Laboratory,Peking Union Medical College Hospital,Chinese Academy of Medical Sciences & Peking Union Medical College;

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