【摘要】 目的 探讨孕早期全身免疫炎症指数(systemic immune-inflammation index, SII)和全身炎症反应指数(systemic inflammation response index, SIRI)对妊娠期糖尿病(gestational diabetes mellitus, GDM)、GDM亚型及血糖水平的影响。方法 采用回顾性队列研究，从广东省妇幼保健院2015～2024年电子病历系统中抽取34171名孕妇作为研究对象。GDM及其亚型采用75 g口服葡萄糖耐量试验(oral glucose tolerance test, OGTT)诊断。利用修正泊松回归模型、多分类Logistic回归模型及线性回归模型分析SII、SIRI与GDM、GDM亚型及血糖水平的关联，运用限制性立方样条模型探讨SII、SIRI与GDM及血糖水平可能的非线性关系。结果 调整协变量后，修正泊松回归模型结果显示自然对数转换的SII(RR=1.30,95%CI:1.23～1.37)和SIRI(RR=1.21,95%CI:1.16～1.27)升高与GDM发病风险增加相关。多分类Logistic回归模型结果显示自然对数转换的SII、SIRI升高与GDM中单纯负荷后高血糖亚型(SII:OR=1.36,95%CI:1.26～1.47;SIRI:OR=1.27,95%CI:1.19～1.36)及混合高血糖亚型(SII:OR=1.82,95%CI:1.49～2.21;SIRI:OR=1.47,95%CI:1.25～1.73)发病风险增加相关，对单纯空腹高血糖亚型(SII:OR=1.22,95%CI:0.99～1.51;SIRI:OR=1.09,95%CI:0.92～1.30)发病风险的影响无统计学意义。限制性立方样条结果显示自然对数转换的SII与空腹血糖、负荷后1 h血糖水平呈J型剂量反应关系，与负荷后2 h血糖水平呈线性剂量反应关系；自然对数转换的SIRI与负荷后1、2 h血糖水平呈线性剂量反应关系。结论 孕早期SII、SIRI升高与GDM以及其单纯负荷后高血糖亚型和混合高血糖亚型发病风险增加显著相关，研究结果可为GDM的早期风险识别与亚型针对性管理提供新的炎症标志物。更多还原

【Abstract】 Objective To evaluate the impact of the first-trimester systemic immune-inflammation index(SII)and systemic inflammation response index(SIRI)on gestational diabetes mellitus(GDM),subtypes of GDM,and blood glucose levels.MethodsA retrospective cohort study was conducted, involving 34,171 pregnant women from the electronic medical record system of Guangdong Women and Children Hospital from 2015 to 2024.GDM patients and their subtypes were diagnosed via the 75 g oral glucose tolerance test.A modified Poisson regression model, multinomial Logistic regression model and linear regression model were used to explore the associations of the SII and SIRI with GDM,subtypes of GDM and blood glucose levels, respectively.A restricted cubic spline(RCS)model was applied to explore the possible nonlinear relationships between SII,SIRI and GDM as well as blood glucose levels.Results After adjusting for covariates, a modified Poisson regression model revealed that an elevated ln-transformed SII(RR=1.30,95%CI:1.23-1.37)and SIRI(RR=1.21,95%CI:1.16-1.27)were associated with an increased risk of developing GDM.The multinomial logistic regression model revealed that elevated ln-transformed SII and SIRI were associated with an increased risk of developing GDM-isolated post-load hyperglycemia(GDM-IPH)(SII:OR=1.36,95%CI:1.26-1.47;SIRI:OR=1.27,95%CI:1.19-1.36)and GDM-combined hyperglycemia(GDM-CH)(SII:OR = 1.82,95%CI:1.49-2.21;SIRI:OR = 1.47,95%CI:1.25-1.73),but elevated SII and SIRI did not have statistically significant effect on the risk of developing GDM-isolated fasting hyperglycemia(GDM-IFH)(SII:OR=1.22,95%CI:0.99-1.51;SIRI:OR=1.09,95%CI:0.92-1.30).The RCS results revealed that the ln-transformed SII exhibited a J-shaped dose-response relationship with fasting and 1-hour blood glucose levels and a linear dose-response relationship with 2-hour blood glucose levels, whereas the ln-transformed SIRI exhibited a linear dose-response relationship with 1-and 2-hour blood glucose levels.Conclusion Elevated SII and SIRI in the first trimester are significantly associated with an increased risk of GDM and its GDM-IPH and GDM-CH subtypes.The results provide new inflammatory markers for early risk identification and subtype-specific management of GDM.更多还原