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中华产科急救电子杂志

中华产科急救电子杂志 ›› 2026, Vol. 15 ›› Issue (03) : 158 -166. doi: 10.3877/cma.j.issn.2095-3259.2026.03.006

论著

高海拔地区孕妇妊娠晚期非空腹甘油三酯-葡萄糖指数与巨大儿之间的关系
王青青1,2, 王秋凤3, 尼玛2, 梁亚婷2, 陈晓宇2, 刘强2, 侯红瑛1, 韩振艳1,†()   
  1. 1中山大学附属第三医院产科　中山大学附属第三医院高危围产医学中心，广州　510630
    2察雅县人民医院妇产科，西藏自治区昌都　854300
    3深圳市龙岗中心医院产科，深圳　518116
  • 收稿日期:2025-09-08 出版日期:2026-08-18
  • 通信作者: 韩振艳
  • 基金资助:
    广东省基础与应用基础研究基金项目(2024A1515012206)

Association between non-fasting triglyceride-glucose index in the third trimester and macrosomia in pregnant women at high altitude

Qingqing Wang1,2, Qiufeng Wang3, Ma Ni2, Yating Liang2, Xiaoyu Chen2, Qiang Liu2, Hongying Hou1, Zhenyan Han1,†()   

  1. 1Department of Obstetrics, High-Risk Perinatal Medicine Center, The Third Affiliated Hospital, Sun Yat-sen University, Guangzhou 510630, China
    2Department of Obstetrics and Gynecology, Chaya People′s Hospital, Changdu 854300, China
    3Department of Obstetrics, Shenzhen Longgang Central Hospital, Shenzhen 518116, China
  • Received:2025-09-08 Published:2026-08-18
  • Corresponding author: Zhenyan Han
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引用本文：

王青青, 王秋凤, 尼玛, 梁亚婷, 陈晓宇, 刘强, 侯红瑛, 韩振艳. 高海拔地区孕妇妊娠晚期非空腹甘油三酯-葡萄糖指数与巨大儿之间的关系[J/OL]. 中华产科急救电子杂志, 2026, 15(03): 158-166.

Qingqing Wang, Qiufeng Wang, Ma Ni, Yating Liang, Xiaoyu Chen, Qiang Liu, Hongying Hou, Zhenyan Han. Association between non-fasting triglyceride-glucose index in the third trimester and macrosomia in pregnant women at high altitude[J/OL]. Chinese Journal of Obstetric Emergency(Electronic Edition), 2026, 15(03): 158-166.

目的

分析高原地区孕妇妊娠晚期非空腹甘油三酯-葡萄糖(triglyceride-glucose, TyG)指数与巨大儿之间的关系。

方法

采用回顾性研究方法对2023年1月至2025年4月在西藏自治区昌都市察雅县人民医院住院分娩的单胎妊娠孕妇的临床资料进行分析。根据胎儿出生体重将研究对象分为巨大儿组及对照组；通过非空腹甘油三酯(triglyceride, TG)及随机血浆葡萄糖(plasma glucose，PG)计算非空腹TyG指数，并根据非空腹TyG指数的三分位数数值将研究对象平均分成3组，比较3组孕妇的一般临床特征、血脂水平及发生巨大儿的风险。采用单因素方差分析、非参数检验、χ2检验或Fisher精确概率法进行多组间比较，以及多因素Logistic回归分析和限制性立方样条(restricted cubic spline，RCS)分析非空腹TyG指数与巨大儿之间的相关性，并进行分层分析。

结果

(1)研究共纳入771例单胎妊娠孕妇，孕妇年龄为(27.3±6.1)岁，初产妇所占比例为26.72%(206/771)，分娩前体重指数为(25.1±2.3)kg/m2，非空腹TyG指数为9.1±0.4。诊断分娩巨大儿的产妇有21例，检出率为2.72%(21/771)。(2)分娩前体重指数、长期居住地海拔高度、血清总胆固醇(total cholesterol, TC)、TG、高密度脂蛋白胆固醇(high-density lipoprotein cholesterol, HDL-C)、低密度脂蛋白胆固醇(low-density lipoprotein cholesterol, LDL-C)、PG、新生儿出生体重、巨大儿发生率在不同非空腹TyG组间比较差异均有统计学意义(P值均<0.05)；进一步趋势性检验发现，随非空腹TyG指数的增加，TC、TG、LDL-C、PG、新生儿出生体重、巨大儿发生率均呈上升趋势(P值均<0.001)。(3)对非空腹TyG指数与巨大儿发生风险进行多因素Logistic回归分析发现，非空腹TyG指数与巨大儿发生风险存在独立正相关(OR＝6.64，95%CI：2.00~22.01，P<0.05)；且随非空腹TyG指数的增加发生巨大儿的风险随之增加，差异均有统计学意义(P趋势<0.05)。(4)对非空腹TyG指数与巨大儿进行RCS曲线拟合，结果显示两者之间存在线性剂量-反应关系(P非线性检验＝0.355)。(5)分层分析结果显示，在巨大儿中非空腹TyG指数与妊娠期高血糖之间未发现存在交互作用(P交互作用>0.05)。

结论

高原地区单胎妊娠孕妇妊娠晚期非空腹TyG指数是巨大儿发生的独立危险因素，且随非空腹TyG指数的增加，巨大儿的发生风险也随之增加。

关键词: 高海拔, 妊娠晚期, 非空腹甘油三酯-葡萄糖指数, 巨大儿
Objective

To investigate the relationship between the non-fasting triglyceride-glucose (TyG) index and macrosomia during the third trimester in pregnant women at high altitudes.

Methods

A retrospective study was conducted on singleton pregnant women who delivered at Chaya People's Hospital of Qamdo City, Xizang Autonomous Region, from January 2023 to April 2025. Participants were divided into a macrosomia group and a control group based on newborn birth weight. The non-fasting TyG index was calculated from non-fasting triglyceride (TG) and random plasma glucose (PG). Based on the tertiles of the non-fasting TyG index, participants were divided into three groups. The baseline clinical characteristics, lipid profiles, and the risk of macrosomia were compared among the three groups. Statistical analyses were performed using one-way ANOVA, Kruskal-Wallis H test, Chi-square test, or Fisher's exact test for multi-group comparisons. Multivariate logistic regression and restricted cubic spline (RCS) analyses were used to evaluate the correlation between the non-fasting TyG index and macrosomia. Subgroup analyses were also conducted.

Results

(1) A total of 771 singleton pregnant women were included, with a mean age of 27.3±6.1 years, a proportion of 26.72% (206/771) primiparous women, a pre-pregnancy BMI of (25.1±2.3) kg/m2, and a mean non-fasting TyG index of 9.1±0.4. Twenty-one pregnant women were diagnosed with macrosomia, with a detection rate of 2.72% (21/771). (2) Statistically significant differences in pre-pregnancy BMI, altitude, serum total cholesterol (TC), TG, high-density lipoprotein cholesterol (HDL-C), low-density lipoprotein cholesterol (LDL-C), PG, newborn birth weight, and the incidence of macrosomia were observed among the three non-fasting TyG groups (all P<0.05). Trend tests further revealed that TC, TG, LDL-C, PG, newborn birth weight, and macrosomia incidence all showed increasing trends with the elevation of the non-fasting TyG index (all P<0.001). (3) Multivariate logistic regression analysis demonstrated an independent positive association between the non-fasting TyG index and macrosomia (OR=6.64, 95%CI: 2.00-22.01, P=0.002), and the risk of macrosomia increased progressively with the non-fasting TyG index (P for trend <0.05). (4) Restricted cubic spline analysis showed a linear dose-response relationship between the non-fasting TyG index and macrosomia (P for non-linearity =0.355). (5) Subgroup analysis revealed no interaction between the non-fasting TyG index and hyperglycemia in pregnancy (HIP) in relation to macrosomia (P for interaction >0.05).

Conclusions

The non-fasting TyG index in the third trimester is an independent risk factor for macrosomia in singleton pregnant women at high altitudes, and the risk of macrosomia increases progressively with the elevation of the non-fasting TyG index.

Key words: High altitude, Pregnancy trimester, third, Non-fasting triglyceride-glucose index, Fetal macrosomia
表1 3组研究对象的一般临床特征、实验室检查及妊娠结局比较
分组 例数 年龄(岁，±s) 孕次[次，M(P25，P75)] 产次[次，M(P25，P75)] 分娩前体重指数(kg/m2，±s) 收缩压(mmHg，±s) 舒张压(mmHg，±s) 海拔高度(m，±s)
Q1组 257 26.9±6.1 2.0(2.0, 4.0) 1.0(1.0, 3.0) 25.0±2.2 121.5±13.1 78.3±9.9 3931.7±311.8
Q2组 257 27.0±6.2 2.0(1.0, 3.0) 1.0(0.0, 2.0) 24.9±2.2 122.9±14.1 80.0±10.3 3939.0±336.7
Q3组 257 27.8±6.1 2.0(1.0, 3.0) 1.0(0.0, 2.0) 25.4±2.5 123.4±14.7 81.3±10.7 3851.3±384.5
统计值   t＝1.682 Z＝3.71 Z＝4.532 t＝3.267 t＝1.212 t＝5.399 t＝5.088
P值   0.187 0.156 0.104 0.039 0.298 0.005 0.006
分组 例数 总胆固醇(mmol/L，±s) 甘油三酯(mmol/L，±s) 高密度脂蛋白胆固醇(mmol/L，±s) 低密度脂蛋白胆固醇(mmol/L，±s) 血糖(mmol/L，±s) 非空腹TyG(±s) 糖化血红蛋白(%，±s)
Q1组 257 5.5±0.9 1.7±0.4 2.1±0.4 3.2±0.8 4.2±0.7 8.6±0.2 4.6±0.4
Q2组 257 6.0±1.0 2.4±0.4 2.0±0.5 3.6±0.9 4.6±0.7 9.0±0.1 4.6±0.4
Q3组 257 6.4±1.2 3.4±0.9 2.0±0.5 4.1±1.1 5.2±1.0 9.5±0.2 4.7±0.5
统计值   t＝47.337 t＝534.071 t＝3.762 t＝48.115 t＝99.556 t＝1267.053 t＝1.861
P值   <0.001 <0.001 0.024 <0.001 <0.001 <0.001 0.156
分组 例数 ALT[U/L，M(P25，P75)] AST[U/L，M(P25，P75)] γ-GT[U/L，M(P25，P75)] 尿酸(μmmol/L，±s) 肌酐(μmmol/L，±s) C反应蛋白(mg/L，±s)
Q1组 257 12.9(10.2, 18.3) 17.9(15.2, 22.5) 14.6(10.8, 20.5) 289.4±59.7 53.3±9.3 12.0±17.3
Q2组 257 12.3(9.4, 16.1) 17.2(14.6, 20.5) 14.0(10.2, 21.0) 288.3±62.0 52.4±10.8 11.5±16.5
Q3组 257 11.8(9.1, 15.5) 16.8(13.7, 20.5) 14.5(10.9, 21.2) 310.3±67.5 53.9±10.9 9.6±13.9
统计值   Z＝9.046 Z＝9.463 Z＝1.863 t＝9.852 t＝1.312 t＝1.663
P值   0.011 0.009 0.394 < 0.001 0.27 0.19
分组 例数 TSH[μIU/ml，M(P25，P75)] FT3[pg/ml，M(P25，P75)] FT4[ng/dL，M(P25，P75)] 新生儿出生体重(g，±s) 妊娠期高血糖[例(%)] 巨大儿[例(%)]
Q1组 257 3.3(1.9, 5.1) 2.0(1.8, 2.1) 1.0(0.9, 1.1) 3 042.5±432.8 7(2.7) 2(0.8)
Q2组 257 3.6(2.4, 5.7) 2.0(1.8, 2.1) 1.0(0.9, 1.1) 3 165.6±408.1 9(3.5) 3(1.2)
Q3组 257 3.7(2.2, 5.9) 1.9(1.8, 2.1) 1.0(0.9, 1.1) 3 261.8±514.7 14(5.4) 16(6.2)
统计值   Z＝5.428 Z＝1.772 Z＝9.536 t＝15.047 χ2＝2.705 χ2＝17.917
P值   0.066 0.412 0.008 <0.001 0.259 <0.001
表2 对照组与巨大儿组孕妇一般临床特征、实验室检查及妊娠结局比较
分组 例数 年龄(岁，±s) 孕次[次，M(P25~P75)] 产次[次，M(P25~P75)] 海拔高度(km，±s) 分娩前体重指数(kg/m2，±s) 收缩压(mmHg，±s) 舒张压(mmHg，±s)
对照组 750 27.2±6.0 2.0(1.0，3.0) 1.0(0.0，2.0) 3.911 1±0.344 9 25.1±2.2 122.6±14.1 79.9±10.4
巨大儿组 21 29.1±8.4 3.0(2.0，3.0) 2.0(1.0，2.0) 3.772 4±0.416 7 26.2±4.3 120.7±9.4 78.8±8.0
OR值(95%CI)   1.05(0.98~1.12) 1.08(0.83~1.4) 1.07(0.82~1.39) 0.34(0.11~1.11) 1.18(1.02~1.37) 0.99(0.96~1.02) 0.99(0.95~1.03)
P值   0.156 0.579 0.626 0.073 0.023 0.521 0.638
分组 例数 总胆固醇(mmol/L，±s) 甘油三酯(mmol/L，±s) 高密度脂蛋白胆固醇(mmol/L，±s) 低密度脂蛋白胆固醇(mmol/L，±s) 血糖(mmol/L，±s) 非空腹TyG(±s) 糖化血红蛋白(%，±s)
对照组 750 6.0±1.1 2.5±0.9 2.0±0.4 3.6±1.0 4.7±0.9 9.1±0.4 4.6±0.4
巨大儿组 21 6.5±0.8 3.1±0.8 2.1±0.4 4.0±0.8 5.4±1.5 9.4±0.4 4.7±0.6
OR值(95%CI)   1.45(1.03~2.04) 1.76(1.22~2.55) 1.18(0.45~3.05) 1.34(0.9~1.99) 1.98(1.36~2.88) 8.42(3.04~23.36) 1.66(0.59~4.65)
P值   0.033 0.003 0.74 0.145 <0.001 <0.001 0.334
分组 例数 ALT[U/L，M(P25，P75)] AST[U/L，M(P25，P75)] γ－GT[U/L，M(P25，P75)] 尿酸(μmmol/L，±s) 肌酐(μmmol/L，±s) C反应蛋白(mg/L，±s)
对照组 750 12.3(9.5，16.7) 17.3(14.5，21.6) 14.4(10.7，21.0) 296.4±64.0 53.3±10.4 11.1±16.0
巨大儿组 21 12.1(8.3，14.9) 17.6(14.1，21.6) 13.9(11.3，19.4) 280.3±57.2 50.8±9.6 8.1±14.3
OR值(95%CI)   0.97(0.91~1.04) 0.99(0.95~1.03) 1.00(0.96~1.03) 1.00(0.99~1.00) 0.97(0.93~1.02) 0.98(0.94~1.02)
P值   0.394 0.682 0.845 0.253 0.271 0.401
分组 例数 TSH[μIU/ml，M(P25，P75)] FT3[pg/ml，M(P25，P75)] FT4[ng/dL，M(P25，P75)] 新生儿出生体重(kg，±s) 妊娠期高血糖[例(%)]
对照组 750 3.5(2.2，5.5) 2.0(1.8，2.1) 1.0(0.9，1.1) 3.13±0.43 28(3.7)
巨大儿组 21 3.5(1.6，5.8) 2.0(1.8，2.2) 1.0(0.9，1.1) 4.19±0.22 2(9.5)
OR值(95%CI)   1.03(0.92~1.16) 1.08(0.26~4.39) 1.77(0.16~19.4) 1.00(0.92~1.09) 2.71(0.6~12.23)
P值   0.585 0.916 0.641 0.972 0.194
表3 3组非空腹TyG指数与巨大儿在不同校正模型之间的关系
分组 模型1 模型2 模型3 模型4
原始OR(95%CI) P值 调整后OR(95%CI) P值 调整后OR(95%CI) P值 调整后OR(95%CI) P值
Q1组 1(Ref)   1(Ref)   1(Ref)   1(Ref)  
Q2组 1.51(0.25~9.09) 0.655 1.49(0.25~9.02) 0.664 1.32(0.21~8.12) 0.766 1.24(0.20~7.82) 0.817
Q3组 8.46(1.93~37.2) 0.005 7.77(1.75~34.58) 0.007 6.23(1.31~29.66) 0.022 6.22(1.31~29.58) 0.022
趋势P值 3.57(1.71~7.47) 0.001 3.37(1.60~7.08) 0.001 3.01(1.38~6.59) 0.006 3.07(1.40~6.75) 0.005
图1 高海拔地区孕妇非空腹TyG指数与巨大儿之间的剂量-反应关系
表4 非空腹TyG指数与巨大儿关系的分层分析
变量 调整后的比值比(95%置信区间) 调整后的P值 P交互作用
年龄(岁)      
<35 1.02(1.01~1.03) 0.005 0.623
≥35 1.04(0.98~1.11) 0.212  
分娩前体重指数      
<24.0 kg/m2 1.05(1.02~1.08) 0.002 0.076
≥24.0 kg/m2 1.01(1.00~1.03) 0.067  
产次(次)      
≤1 1.01(0.98~1.05) 0.516 0.978
>1 1.02(1.01~1.03) 0.002  
妊娠期高血糖      
否 1.02(1.01~1.03) 0.003 0.458
是 2.3(0~Inf) 1.000  
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