摘要
目的观察正常妊娠孕妇外周血血清视黄醇结合蛋白4（retinol binding protein 4，RBP4）浓度在不同孕期的变化，并探讨其在胎儿生长受限（fetal growth restriction，FGR）孕妇孕中期的表达。方法选择2014年1月至2015年1月在首都医科大学附属北京潞河医院进行常规产前检查并住院分娩的80例孕妇。40例胎儿出生体重低于同孕龄、同性别胎儿平均体重的2个标准差或第10百分位数，或孕37周后出生体重小于2 500 g者为FGR组；40例正常出生体重（〉2 500~〈4 000 g）胎儿的孕妇为对照组。孕妇分别在孕前、孕12~16周、孕20~24周、孕28~32周及孕36~40周检测血清RBP4、血浆白蛋白、空腹血糖、甘油三酯、总胆固醇、低密度脂蛋白-胆固醇（low density lipoprotein-cholesterol，LDL-C）、血红蛋白、空腹胰岛素、维生素A水平，并计算稳态模型胰岛素抵抗指数（homeostasis model assessment-insulin resistance，HOMA-IR）。采用独立样本t检验或单因素方差分析，以及χ2检验或Fisher精确概率法进行统计学分析。采用Pearson相关分析孕20~24周外周血RBP4水平与新生儿出生体重的关系。结果（1）正常妇女孕前、孕12~16周、孕20~24周、孕28~32周和孕36~40周血清RBP4浓度分别为（24.65±10.02）、（29.86±23.40）、（56.10±12.28）、（65.80±20.56）及（53.71±24.17） μg/ml。随孕周增加逐渐升高，孕28~32周时达高峰后下降（F=14.173，P〈0.001）。（2）与对照组比较，FGR组孕妇的体重指数、胎盘重量较低[分别为22.9±2.1与20.7±3.3，（501.3±64.7）与（401.3±56.2） g，t值分别为22.590和2.487，P值均〈0.05]。（3）与对照组比较，FGR组孕妇的孕中期空腹血糖、空腹胰岛素、HOMA-IR、RBP4及血浆白蛋白均较低[分别为（4.38±0.4）与（4.06±0.4） mmol/L，（31.76±1.5）与（21.84±15.2） μU/ml，0.7±0.2与0.5±0.2，（65.80±20.5）与（41.78±12.8） μg/ml，（36.5±2.3）与（35.1±2.7） g/L，t值分别为3.419、2.355、3.419、6.263及2.462，P值均〈0.05]。孕20~24周正常及FGR孕妇外周血血清RBP4水平分别与新生儿出生体重呈正相关（r值分别为0.717和0.748，P值均〈0.05）。结论孕妇血清RBP4可能与FGR发生具有相关性。
ObjectiveTo investigate the changes of serum retinol binding protein 4 （RBP4） concentration in peripheral blood of normal gravidas at different stages during pregancy and the differential expression of serum RBP4 in gravidas with fetal growth restriction （FGR） in second trimester.MethodsThis study enrolled 80 gravidas who received routine prenatal examination and delivered in the Beijing Luhe Hospital Affiliated to Capital Medical University from January 2014 to January 2015. Forty gravidas were classified to FGR group as the birth weight of their fetuses was below two standard deviations or below the 10th percentile for the corresponding gestationas and same sex, or less than 2 500 g after 37 weeks. The other 40 gravidas who delivered newborns with normal birth weight （2 500 g 〈 birth weight 〈 4 000 g） were used as control group. Levels of serum RBP4, plasma albumin, fasting blood glucose, triglyceride, total cholesterol, low density lipoprotein-cholesterol （LDL-C）, hemoglobin, fasting insulin and vitamin A were determined before pregnancy and at 12-16, 20-24, 28-32 and 36-40 weeks of gestation. Homeostasis model assessment-insulin resistance （HOMA-IR） was calculated. Independent sample t test or analysis of variance, Chi-square test or Fisher exact test was used for statistical analysis. Pearson correlation was used to analyze the relationship between peripheral blood RBP4 level and neonatal birth weight at 20-24 weeks.Results（1） Serum RBP4 levels in normal gravidas were （24.65±10.02）, （29.86±23.40）, （56.10±12.28）, （65.80±20.56） and （53.71±24.17） μg/ml before pregnancy and at 12-16, 20-24, 28-32 and 36-40 weeks of gestation, respectively, showing a gradually increasing trend with gestational week until a peak at 28-32 weeks and then followed by a decrease （F=14.173, P〈0.001）. （2） The body mass index and placental weight of gravidas in FGR group were lower than those in control group [20.7±3.3 vs 22.9±2.1, （401.3±56.2） vs （501.3±64.7） g; t=22.590 and 2.487, both P〈0.05]. （3） The fasting blood glucose, fasting insulin, HOMA-IR, RBP4 and plasma albumin in FGR group were lower than those in control group [（4.06±0.4） vs （4.38±0.4） mmol/L, （21.84±15.2） vs （31.76±1.5） μU/ml, 0.5±0.2 vs 0.7±0.2, （41.78±12.8） vs （65.80±20.5） μg/ml, （35.1±2.7） vs （36.5±2.3） g/L; t=3.419, 2.355, 3.419, 6.263 and 2.462, all P〈0.05]. Maternal serum RBP-4 at 20-24 weeks of normal gravidas and FGR gravidas were positively correlated with the birth weight of newborns （r=0.717 and 0.748, both P〈0.05）.ConclusionsSerum RBP4 of gravidas may be associated with the occurrence of FGR.
作者
金艳荣
刘崇东
张震宇
Jin Yanrong;Liu Chongdong;Zhang Zhenyu(Department of Obstetrics and Gynecology,Beijing Luhe Hospital,Capital Medical University,Beijing 101100,China)
出处
《中华围产医学杂志》
CAS
CSCD
北大核心
2018年第10期668-672,共5页
Chinese Journal of Perinatal Medicine
关键词
胎儿生长迟缓
视黄醇结合蛋白质类
血浆
妊娠中期
出生体重
Fetal growth retardation
Retinol-binding proteins, plasma
Pregnancy trimester, second
birth weight
