摘要
目的分析妊娠期糖尿病(gestational diabetes mellitus,GDM)并发子痫前期(preeclampsia,PE)孕妇胎盘组织抵抗素、人脂质运载蛋白(lipid carrier protein,LCN)及血糖脂代谢检测价值,为GDM并发子痫前期诊疗提供指导。方法收集2017年1月至2020年1月烟台市烟台山医院收治的GDM并发PE孕妇96例(GDM-PE组),按2∶1比例选取单纯GDM孕妇(GDM组)与正常孕妇各48例(对照组),免疫组化法测定胎盘组织抵抗素、LCN水平,采血测定糖脂代谢水平,比较各组妊娠结局,分析抵抗素、LCN、糖脂代谢与GDM并发PE的关系。结果GDM组、GMD-PE组空腹血糖(fasting blood-glucose,FBG)[(4.57±0.66)、(5.23±0.61)mmol/L]、空腹胰岛素(fasting insulin,FINS)[(11.97±1.5)、(15.12±3.52)mIU/L]高于对照组[(4.11±0.23)、(6.75±1.34)mIU/L(P<0.05)],GDM-PE组FBG、FINS、糖化血红蛋白(glycosylated hemoglobin,HbA1c)高于GDM组,总胆固醇(total cholesterol,TC)(6.71±1.63)mmol/L、甘油三酯(triglyceride,TG)(6.59±0.87)mmol/L高于对照组(5.87±0.73)、(4.57±0.59)mmol/L与GDM组(6.02±1.55)、(4.71±0.63)mmol/L(P<0.05),高密度脂蛋白胆固醇(high-density lipoprotein cholesterol,HDL-C)(1.21±0.34)mmol/L低于对照组(1.54±0.39)mmol/L与GDM组(1.55±0.43)mmol/L(P<0.05)。GDM-PE组、GDM组抵抗素85.42%、60.42%、LCN阳性率81.25%、56.25%高于对照组39.58%、31.25%(χ^(2)=32.096、4.167;34.975、6.095,P均<0.05),GDM-PE组抵抗素、LCN阳性率又高于GDM组(χ^(2)=11.322、11.257,P均<0.01)。GDM-PE组分娩孕周(37.11±2.06)周早于GDM组(38.21±1.75)周、对照组(38.36±1.42)周(F=9.836,P<0.05);新生儿出生体重(2905.45±356.79)g低于对照组(3321.52±366.46)g、GDM组(3425.14±269.87)g(F=46.606,P<0.05);产后出血量(415.34±126.75)ml多于GDM组(338.65±105.63)ml与对照组(298.42±75.26)ml(F=19.932,P<0.05);早产率20.83%高于GDM组8.33%与对照组4.17%(χ^(2)=9.075,P<0.05);GDM组产后出血量高于对照组(t=-2.148,P<0.05)。GDM-PE组胎儿窘迫、胎膜早破、胎儿生长受限、产后出血发生率均高于对照组(χ^(2)=4.571、6.867、5.941、5.123,P<0.05)。GDM-PE孕妇胎盘组织抵抗素、LCN蛋白表达与FBG、FINS、TC、TG呈正相关(r=0.517、0.463、0.559、0.521,0.485、0.497,0.557、0.571,P<0.05),与HDL-C呈负相关(r=-0.317、-0.357,P<0.05)。结论GDM并发PE孕妇胎盘组织抵抗素、LCN阳性率较GDM与正常孕妇高,糖脂代谢紊乱更明显,母婴不良结局发生率更高;推测抵抗素、LCN可协同影响糖脂代谢造成GDM并发PE不良妊娠结局。
Objective To analyze the detective value of placental tissue resistin,human lipid carrier protein(LCN)and blood glucose and lipid metabolism in pregnant women with gestational diabetes mellitus(GDM)complicated with preeclampsia(PE),providing guidance for the early treatment of GDM complicated with preeclampsia.Methods96 pregnant women with GDM complicated with PE(GDM-PE group)admitted to Yantai Yantaishan Hospital from Jan.2017 to Jan.2020 were selected and retrospectively studied.According to the ratio of 2:1,the pure GDM pregnant women(GDM group)and 48 normal pregnant women(the control group)were selected.The placenta tissue resistin and LCN levels were determined by immunohistochemistry.Blood samples were collected to determine the glucose and lipid metabolism.The pregnancy outcomes of each group were compared and the relationship between resistin,LCN,glucose and lipid metabolism and GDM complicated with PE was analyzed.ResultsFasting blood-glucose(FBG)was(4.57±0.66)mmol/L in GDM group and(5.23±0.61)mmol/L in GMD-PE group.FINS(11.97±1.5)mIU/L,(15.12±3.52)mIU/L were higher than those of control group(4.11±0.23)mmol/L,(6.75±1.34)mIU/L(P<0.05).FBG,FINS,glycosylated hemoglobin(HbA1c)in GDM-PE group were higher than those in GDM group.TC)(6.71±1.63)mmol/L,triglyceride,TG(6.59+0.87)mmol/L was higher than that of control group(5.87±0.73)mmol/L,((4.57±0.59)mmol/L and GDM group(6.02±1.55)mmol/L,(4.71±0.63)mmol/L(P<0.05).high density lipoprotein cholesterol(HDL-C)(1.21±0.34)was lower than that of control group(1.54±0.39)and GDM group(1.55±0.43)(P<0.05).The positive rates of resistin 85.42%,60.42%,LCN 81.25%,56.25%in GDM-PE group and GDM group were higher than those in control group 39.58%,31.25%(X=32.096,4.167;34.975,6.095,both P<0.05).The positive rates of resistin and LCN in GDM-PE group were higher than those in GDM group(X=11.322,11.257,both P<0.01).The gestational age of delivery in GDM-PE group was(37.11±2.06)weeks earlier than that in GDM group(38.21±1.75)weeks and control group(38.36±1.42)weeks(F=9.836,P<0.05).The birth weight of neonates(2905.45±356.79)g was lower than that of control group(3321.52±366.46)g and GDM group(3425.14±269.87)g(F=46.606,P<0.05).Postpartum blood loss(415.34±126.75)ml was significantly higher than that of GDM group(338.65±105.63)ml and control group(298.42±75.26)ml(F=19.932,P<0.05).The preterm birth rate of 20.83%was higher than that of the GDM group(8.33%)and the control group(4.17%)(×=9.075,P<0.05).The postpartum blood loss of the GDM group was higher than that of the control group(t=-2.148,P<0.05).The incidences of fetal distress,premature rupture of membranes,fetal growth restriction and postpartum hemorrhage in GDM-PE group were higher than those in control group(X=4.571,6.867,5.941,5.123,P<0.05).The protein expressions of resistin and LCN in placenta of pregnant women with GDM-PE were positively correlated with FBG,FINS,TC and TG(r=0.517,0.463,0.559,0.521,0.485,0.497,0.557,0.571,P<0.05).Was negatively correlated with HDL-C(r=-0.317,-0.357,P<0.05).ConclusionsThe positive rate of resistin and LCN in the placenta tissue of pregnant women with GDM complicated with PE is higher than that of GDM and normal pregnant women,their disorder of glucose and lipid metabolism is more obvious,and the incidence of adverse maternal and infant outcomes is higher.It is speculated that resistin and LCN may synergistically affect the metabolism of glucose and lipids causing adverse pregnancy outcomes in GDM complicated with PE.
作者
张素芹
姜萍
赵明瑜
时艳梅
Zhang Suqin;Jiang Ping;Zhao Mingyu;Shi Yanmei(Department of Obstetrics,Yantai Yantaishan Hospital,Yantai 264001,China)
出处
《中华内分泌外科杂志》
CAS
2022年第5期627-632,共6页
Chinese Journal of Endocrine Surgery
基金
烟台市科技创新发展计划(2020MSGY088)。
关键词
妊娠期糖尿病
子痫前期
抵抗素
人脂质运载蛋白
糖脂代谢
Gestational diabetes mellitus
Preeclampsia
Resistin
Human lipocalin
Glucose and lipid metabolism
