目的 探讨甘油三酯葡萄糖-体质量指数（triglyceride-glucose body mass index,TyG-BMI）及血脂水平对高龄妊娠期糖尿病（gestational diabetes mellitus,GDM）孕妇妊娠结局的预测价值。方法 选取2023年9月—2024年7月到我院进行产检和分娩的300例高龄GDM患者进行回顾性研究,作为GDM组。选取同期在我院进行产检的健康高龄孕产妇350例作为对照组。根据妊娠结局将GDM组分为不良结局组（n=109）和结局良好组（n=191）。比较 GDM组与对照组基本资料、妊娠结局及TyG-BMI指数、血脂水平,对高龄GDM患者不良妊娠结局进行单因素和多因素分析,通过绘制受试者工作特征（receiver operating characteristic,ROC）曲线评价各指标的预测价值。结果 GDM组患者不良妊娠结局发生率显著高于对照组。相比于对照组,GDM组TyG-BMI指数、总胆固醇（total cholesterol,TC）、甘油三酯（triglyceride,TG）及低密度脂蛋白胆固醇（low-density lipoprotein cholesterol,LDL-C）水平更高,高密度脂蛋白胆固醇（high-density lipoprotein cholesterol,HDL-C）水平更低。高龄GDM患者不良结局组与结局良好组年龄、孕周、初产妇比较无统计学差异,不良结局组的糖化血红蛋白（hemoglobin A1c,HbA1c）、空腹血糖（fasting plasma glucose,FPG）、TyG-BMI指数、TG、TC、LDL-C均显著高于结局良好组,HDL-C显著低于结局良好组。Logistic多因素分析结果显示,HbA1c、FPG、TyG-BMI指数及TG是高龄GDM患者不良妊娠结局的独立危险因素,HDL-C是其保护因素。ROC结果显示,TyG-BMI指数联合TG、HDL-C的曲线下面积（area under the curve,AUC）为0.897,灵敏度90.0%,特异度83.8%,均显著高于各单独指标。结论 TyG-BMI指数联合血脂水平对高龄GDM孕妇妊娠结局具有较高的预测价值。

Objective To investigate the predictive value of the triglyceride glucose-body mass index (TyG-BMI) and blood lipid levels on pregnancy outcomes in advanced-age pregnant women with gestational diabetes mellitus (GDM). Methods A retrospective study was conducted on 300 advanced-age GDM patients who underwent prenatal examination and delivery at our hospital from September 2023 to July 2024, designated as the GDM group. Additionally, 350 healthy advanced-age pregnant women who attended our hospital during the same period were selected as the control group. Based on pregnancy outcomes, the GDM group was further divided into an adverse outcome group (n=109) and a good outcome group (n=191). Basic data, pregnancy outcomes, TyG-BMI index, and blood lipid levels were compared between the GDM group and the control group. Univariate and multivariate analyses were performed to identify factors associated with adverse pregnancy outcomes in advanced-age GDM patients. The predictive value of each indicator was evaluated by drawing receiver operating characteristic (ROC) curves. Results The incidence of adverse pregnancy outcomes was significantly higher in the GDM group than in the control group. Compared to the control group, the GDM group had higher TyG-BMI index, TC, TG, and LDL-C levels, and lower HDL-C levels. Among advanced-age GDM patients, there were no statistically significant differences in age, gestational weeks, or primiparity between the adverse outcome group and the good outcome group. The adverse outcome group had significantly higher HbA1c, FPG, TyG-BMI index, TG, TC, and LDL-C levels, and significantly lower HDL-C levels than the good outcome group. Multivariate logistic regression analysis showed that HbA1c, FPG, TyG-BMI index, and TG were independent risk factors for adverse pregnancy outcomes in advanced-age GDM patients, while HDL-C was a protective factor. The ROC results showed that the AUC of the TyG-BMI index combined with TG and HDL-C was 0.897, with a sensitivity of 90.0% and a specificity of 83.8%, which were all significantly higher than those of the individual indicators. Conclusion The TyG-BMI index combined with blood lipid levels has high predictive value for pregnancy outcomes in advanced-age pregnant women with GDM.