摘要
目的研究铁代谢、氧化应激水平对妊娠期糖尿病(GDM)患者孕期血糖控制的影响。方法选取温州市中心医院2020年1月至2021年6月产前检查的孕妇139例,依据孕24~28周葡萄糖耐量试验结果分为GDM组(68例)和对照组(71例),收集两组临床资料并检测铁代谢、氧化应激及血糖水平,分析铁代谢、氧化应激水平与GDM血糖控制的关系。结果两组年龄差异无统计学意义(P>0.05)。GDM组体质量指数、空腹血糖(FBG)、空腹胰岛素(FINS)、糖化血红蛋白(HbA1c)、核转录因子-κB(NF-κB)、丙二醛(MDA)、铁蛋白(SF)、血清铁(Fe)、转铁蛋白(TRF)和胰岛素抵抗指数(IRI)分别为(24.11±3.05)kg/m^(2)、(4.92±0.67)mmol/L、(10.56±2.21)pmol/mL、(6.15±0.62)%、(20.50±1.72)μg/L、(20.34±2.92)μmol/L、(70.77±7.01)μg/L、(30.18±4.25)μmol/L、(3.93±0.69)g/L、(2.50±1.03),均显著高于对照组的(21.41±2.86)kg/m^(2)、(4.69±0.62)mmol/L、(5.76±2.09)pmol/mL、(5.37±0.58)%、(15.43±1.55)μg/L、(12.93±2.17)μmol/L、(42.53±8.86)μg/L、(18.81±3.85)μmol/L、(2.89±0.53)g/L、(1.74±0.89)(t=5.39、2.10、13.16、7.66、18.27、17.03、20.78、16.54、9.99、4.66,均P<0.05);GDM组超氧化物歧化酶(SOD)、总抗氧化能力(TAOC)、胰岛素敏感性指数(ISI)分别为(21.49±3.52)U/L、(10.87±1.34)kU/L、(3.28±0.46),均显著低于对照组的(26.28±3.95)U/L、(13.28±1.52)kU/L、(3.86±0.53)(t=7.54、9.90、6.88,均P<0.001)。logistic多元回归分析结果显示SOD、TAOC、NF-κB、MDA、SF、TRF均为影响GDM发生的独立影响因素[OR(95%CI)=1.57(1.09~2.26)、3.15(1.71~5.80)、2.18(1.32~3.61)、3.27(1.58~6.76)、2.12(1.29~3.50)、1.23(0.99~1.53)、3.65(1.89~7.04),均P<0.05]。SOD、TAOC水平与IRI呈负相关(r=-0.75、-0.84,均P<0.05),NF-κB、MDA、SF、Fe、TRF均与IRI呈正相关(r=0.93、0.96、0.98、0.07、0.92,均P<0.05)。结论铁代谢、氧化应激水平增高是GDM发生的危险因素,且与胰岛素抵抗程度密切相关,对存在铁代谢、氧化应激指标增高的孕妇提前进行GDM筛查,对于临床诊治GDM有积极作用。
Objective To investigate the effects of iron metabolism and oxidative stress level on blood glucose control during pregnancy in patients with gestational diabetes mellitus(GDM).Methods A total of 139 pregnant women who received prenatal examination between January 2020 and June 2021 in Wenzhou Central Hospital were included in this study.They were divided into GDM group(n=68)and control group(n=71)according to oral glucose tolerance test results at 24-48 weeks of gestation.Clinical data were collected.Iron metabolism,oxidative stress and blood glucose levels were measured.The relationships between iron metabolism and oxidative stress levels and blood glucose control in GDM were analyzed.Results There was no significant difference in age between the GDM and control groups(P>0.05).Body mass index,fasting blood glucose,fasting insulin,glycosylated hemoglobin,nuclear factor-κB(NF-κB),malondialdehyde(MDA),ferritin(SF),serum iron,transferrin(TRF)and insulin resistance index(IRI)in the GDM group were(24.11±3.05)kg/m^(2),(4.92±0.67)mmol/L,(10.56±2.21)pmol/mL,(6.15±0.62)%,(20.50±1.72)μg/L,(20.34±2.92)μmol/L,(70.77±7.01)μg/L,(30.18±4.25)μmol/L,(3.93±0.69)g/L and(2.50±1.03),respectively,which were significantly higher than those in the control group[(21.41±2.86)kg/m^(2),(4.69±0.62)mmol/L,(5.76±2.09)pmol/mL,(5.37±0.58)%,(15.43±1.55)μg/L,(12.93±2.17)μmol/L,(42.53±8.86)μg/L,(18.81±3.85)μmol/L,(2.89±0.53)g/L and(1.74±0.89)](t=5.39,2.10,13.16,7.66,18.27,17.03,20.78,16.54,9.99,4.66,all P<0.05).Superoxide dismutase(SOD),total antioxidant capacity(TAOC)and insulin sensitivity index in the GDM group were(21.49±3.52)U/L,(10.87±1.34)kU/L and(3.28±0.46),respectively,which were significantly lower than those in the control group[(26.28±3.95)U/L,(13.28±1.52)kU/L,(3.86±0.53),t=7.54,9.90,6.88,all P<0.05].Multivariate logistic regression analysis revealed that SOD,TAOC,NF-κB,MDA,SF and TRF were independent influential factors of GDM occurrence[OR(95%CI)=1.57(1.09-2.26),3.15(1.71-5.80),2.18(1.32-3.61),3.27(1.58-6.76),2.12(1.29-3.50),1.23(0.99-1.53),3.65(1.89-7.04),all P<0.05].SOD and TAOC levels were negatively correlated with IRI(r=-0.75,-0.84,both P<0.05),while NF-κB,MDA,SF,serum iron and TRF were positively correlated with IRI(r=0.93,0.96,0.98,0.07,0.92,all P<0.05).Conclusion Increased levels of iron metabolism and oxidative stress are risk factors for the occurrence of GDM,and they are closely related to the degree of insulin resistance.GDM screening should be carried out in advance in pregnant women with increased levels of iron metabolism and oxidative stress indicators,which plays a positive role in clinical diagnosis and treatment of GDM.
作者
李苑艳
孙素玉
冯泽蛟
Yuanyan Li;Suyu Sun;Zejiao Feng(Department of Obstetrics and Gynecology,Wenzhou Central Hospital,Wenzhou 325000,Zhejiang Province,China)
出处
《中国基层医药》
CAS
2022年第6期811-815,共5页
Chinese Journal of Primary Medicine and Pharmacy
基金
浙江省温州市科研项目(Y2020484)。
关键词
糖尿病
妊娠
铁代谢障碍
转铁蛋白
氧化性应激
孕妇
血糖
胰岛素
NF-κB
丙二醛
胰岛素抗体
Diabetes,gestational
Iron metabolism disorders
Transferrin
Oxidative stress
Pregnant women
Blood glucose
Insulin
NF-kappa B
Malondialdehyde
Insulin antibodies
