关键词: 糖尿病, 妊娠, 梭菌属, 球形梭菌, 多形拟杆菌, 病例对照研究

Abstract: Background　Gestational diabetes mellitus（GDM） accounts for an increasing proportion of gestational diseases in recent years，and its high incidence has brought great harm to maternal and infant health and public health in China．At present，studies suggest that the structural changes of human intestinal flora are closely related to related metabolic diseases．And more and more evidence suggests that changes in the structure and relative proportions of the constituents of intestinal flora may be high risk factors for diseases such as diabetes and obesity．Objective　To explore the relationship between the changes of intestinal Clostridium coccoides and Bacteroides thetaiotaomicron and the occurrence of GDM．Methods　In this study，a nested case-control design was used．A total of 1 034 pregnant women from the First Affiliated Hospital of Xinjiang Medical University were enrolled during March 1，2018 to March 30，2019 ．They were included as an observational cohort at the time of confirming the pregnancy in the first visit，receiving follow-up services once every 4 weeks as well as other antenatal care services from the hospital，till GDM was identified．And those with a definite diagnosis of GDM were included in the case group，who were compared with number-，age-，gestational week- and admission time-matched controls．Comparisons were made between two groups in terms of general data，Clostridium coccoides and Bacteroides thetaiotaomicron levels at admission，20 weeks of gestation，and time of identifying of GDM in the case group．The correlations of fasting blood glucose with Clostridium coccoides and Bacteroides thetaiotaomicron at different times in the case group were analyzed．Results　All the cases in the observational cohort completed the follow-up except for 28 dropouts and 5 missing cases，and the prevalence of GDM in them was 8.99％（90/1 001）.The case and control groups had no significant differences in mean age，education distribution，mean abdominal circumference，prevalence of family history of diabetes，polycystic ovary syndrome and hypertension（P>0.05 ）．There was no significant difference between the two groups in the level of Clostridium coccoides and Bacteroides thetaiotaomicron when they were enrolled in the group（P>0.05）；the level of Clostridium coccoides and Bacteroides thetaiotaomicron in the case group were higher than that in the control group at 20 weeks of gestation and time of identifying of GMD（P<0.05）.At 20 weeks of gestation and time of identifying of GMD，the levels of Clostridium coccoides and Bacteroides thetaiotaomicron in the case group were higher than admission（P<0.05）；Time corresponding to the diagnosis of GDM in case group，the levels of Clostridium coccoides and Bacteroides thetaiotaomicron in the control group were higher than admission and 20 weeks of gestation（P<0.05）．In case group，both Clostridium coccoides and Bacteroides thetaiotaomicron were positively correlated with fasting blood glucose at the time of identifying GDM（r=0.435， P<0.001； r=0.342，P=0.001）．Conclusion　The structural changes of Clostridium coccoides and Bacteroides thetaiotaomicron be one of the causes of GDM.

Key words: Diabetes, gestational；Clostridium；Clostridium coccoides；Bacteroides thetaiotaomicron；Case-control studies