妊娠糖尿病与2型糖尿病风险：西班牙裔拉丁裔人群中肠道微生物组的作用
在HCHS/SOL研究的西班牙裔拉丁裔经产女性中，有GDM史者肠道菌群与血清代谢物存在差异，部分代谢物与血糖性状及2型糖尿病发病相关；由9种微生物相关代谢物构建的评分可介导GDM史与2型糖尿病关联的约20%（95%CI 9%，42%）。
要点
- 有GDM史的女性肠道中促炎菌Parabacteroides merdae CAG:48丰度较高，产短链脂肪酸的Dialister sp. CAG:588丰度较低。
- 15种代谢物与GDM史及GDM相关微生物组一致相关，其中9种与血糖性状和2型糖尿病发病相关。
- 微生物相关代谢物评分介导了GDM史与2型糖尿病关联的约20%。
核心结论
- 有GDM史的美国西班牙裔/拉丁裔女性存在不利的肠道菌群及相关代谢物改变，提示肠道菌群可能在GDM相关2型糖尿病中发挥作用。
研究设计与样本
- 基于HCHS/SOL队列的经产女性，分析GDM史与微生物种（访视2，n=1525）、血清代谢物（访视1，n=2968）的关联，并前瞻性分析GDM相关微生物组（访视2，n=925）6年内及微生物相关代谢物（访视1，n=2341）12年内与新发2型糖尿病的关联。
主要发现
- 1525名美国西班牙裔/拉丁裔经产女性（中位年龄58岁）中，有与无GDM史者间有7种微生物种存在差异，包括4种丰度较高（如促炎分类群Parabacteroides merdae CAG:48）和3种丰度较低（如产短链脂肪酸的Dialister sp. CAG:588）。
- 15种代谢物与GDM史及GDM相关微生物组呈一致方向关联，其中9种（如饱和鞘磷脂和不饱和脂肪酸）与血糖性状及新发2型糖尿病相关。
- 以微生物相关代谢物为代理指标的代理分析提示GDM相关微生物组与2型糖尿病呈正相关（r=0.55，p=0.036）。
- 由9种微生物相关代谢物构建的代谢物评分介导了GDM史与2型糖尿病关联的估计20%（95% CI 9%，42%）。
临床怎么用
- 对有GDM史的女性，可关注肠道菌群及代谢物谱作为2型糖尿病风险分层的潜在辅助信息。
- 微生物相关代谢物评分可能有助于识别GDM后2型糖尿病高风险个体，但尚需进一步验证。
以上解读依据论文摘要（全文未开放获取或许可不允许翻译转载）。
原文
AIMS/HYPOTHESIS: Women with a history of gestational diabetes mellitus (GDM) have an elevated risk of type 2 diabetes in their later life, yet the underlying mechanisms of this remain unclear. We aimed to investigate the long-term impact of GDM on gut microbiota and related metabolites and to explore whether such alterations may contribute to type 2 diabetes risk. METHODS: Among parous women from the Hispanic Community Health Study/Study of Latinos (HCHS/SOL), we identified microbial species associated with a history of GDM (visit 2, 2014-2017, n=1525), and serum metabolites associated with both a history of GDM (visit 1, 2008-2011, n=2968) and GDM-related microbiota (visit 2, n=391). We further examined prospective associations of the GDM-related microbiome (visit 2, n=925) with incident type 2 diabetes over 6 years of follow-up, and of microbial-related metabolites (visit 1, n=2341) with incident type 2 diabetes over 12 years. RESULTS: Among 1525 US Hispanic/Latino parous women (median age: 58 years), seven species differed between women with and without a history of GDM, including higher abundances of four species (e.g. Parabacteroides merdae CAG:48, a proinflammatory taxon) and lower abundances of three species (e.g. Dialister sp. CAG:588, a short-chain fatty acid producer). Fifteen metabolites were associated with both a history of GDM and the GDM-related microbiome in a consistent direction, nine of which (e.g. saturated sphingomyelins and unsaturated fatty acids) were associated with glycaemic traits and incident type 2 diabetes. Using these microbial-related metabolites as proxy measures, proxy analysis suggested a positive relationship between the GDM-related microbiome and type 2 diabetes (r=0.55, p=0.036). A metabolite score derived from the nine microbial-related metabolites mediated an estimated 20% (95% CI 9%, 42%) of the association between a history of GDM and type 2 diabetes. CONCLUSIONS/INTERPRETATION: A history of GDM is associated with an unfavourable gut microbiota and related metabolites in US Hispanic/Latino women, suggesting a potential role of the gut microbiota in GDM-related type 2 diabetes.
引用
- Wang Y, Isasi CR, Stuebe AM, et al. Gestational diabetes and risk of type 2 diabetes: exploring the role of the gut microbiome in the Hispanic Community Health Study/Study of Latinos (HCHS/SOL). Diabetologia. 2026. PMID: 42062589. doi:10.1007/s00125-026-06727-0
供执业医师工作参考，不替代临床判断；数值与分级以指南原文为准。