【摘要】 目的 采用单一金属与混合暴露分析方法，评估孕早期全血中铅（Pb）、铜（Cu）、锌（Zn）、钙（Ca）、镁（Mg）与铁（Fe）六种金属与妊娠期糖尿病（GDM）风险的关联。方法 于2023年6月至10月在深圳市龙华区妇幼保健院纳入191例妊娠10～12⁺⁶周的孕妇。妊娠10～12⁺⁶周天采集全血样本，采用原子吸收光谱仪测定金属水平。24～28周进行75 g口服葡萄糖耐量试验（OGTT）诊断GDM。采用多变量逻辑回归评估单一金属与GDM的关联，运用贝叶斯核机器回归（BKMR）分析金属混合暴露效应。结果 191例孕妇中79例（41.4%）确诊GDM,且GDM组全血Zn水平显著高于非GDM组（Z=-2.086,P=0.038）。多变量调整后，Zn水平升高与GDM发生风险呈正相关（OR=1.975,95%CI:1.036～3.766）。BKMR分析提示金属混合暴露与GDM风险呈正向关联，Zn与GDM呈稳健正相关，而Cu表现为负相关。结论 孕早期全血金属混合暴露增加GDM发生风险，其中Zn在多模型分析中表现出稳定的正相关，而Cu可能具有一定的保护作用。更多还原

【Abstract】 Objective To evaluate the associations between early-pregnancy whole blood concentrations of lead（Pb）,copper（Cu）,zinc（Zn）,calcium（Ca）,magnesium（Mg）,and iron（Fe） and the risk of gestational diabetes mellitus（GDM） using both single-metal and mixture-based analytical approaches. Methods A total of 191 pregnant women at 10-12⁺⁶ weeks of gestation were recruited from the Longhua District Maternal and Child Health Hospital in Shenzhen between June and October 2023.Blood samples were collected at 10-12⁺⁶ weeks of gestation, and metal concentrations were measured using atomic absorption spectrometry.GDM was diagnosed by a 75 g oral glucose tolerance test（OGTT） at 24-28 weeks of gestation.Multivariable logistic regression was applied to assess associations between individual metals and GDM risk, and Bayesian kernel machine regression（BKMR） was used to evaluate the effects of metal mixture exposure. Results Among the 191 participants, 79（41.4%） were diagnosed with GDM.Blood Zn concentrations were significantly higher in the GDM group than in the non-GDM group（Z=-2.086,P=0.038）.After multivariable adjustment, higher Zn levels were positively associated with GDM risk（OR=1.975,95%CI:1.036-3.766）.BKMR analysis suggested an overall positive association between metal mixture exposure and GDM risk, with Zn showing a robust positive association and Cu exhibiting an inverse association. Conclusion Early pregnancy exposure to whole-blood metal mixture exposure was associated with GDM risk.Zn demonstrated a consistent positive association across multiple models, whereas Cu may have a protective effect.更多还原