摘要
目的探讨妊娠期糖尿病(GDM)孕妇过氧化物酶体增殖物激活受体γ(PPARγ)、脂肪酸结合蛋白4(FABP4)及皮质抑素(CST)的表达与胰岛素抵抗的关系及对妊娠结局的影响,以期为GDM孕妇的临床干预提供参考。方法选取2021年9月—2023年9月陕西省人民医院收治的GDM孕妇83例作为观察组,另选取同期进行孕检且结果正常的健康孕妇67例作为对照组。统计GDM孕妇的妊娠结局,对比GDM孕妇和健康孕妇孕早期、孕中期及孕晚期血清PPARγ、FABP4、CST水平及胰岛素抵抗指数(HOMA-IR),采用Pearson相关分析PPARγ、FABP4、CST与HOMA-IR的关系,并分析影响GDM孕妇妊娠结局的相关因素。结果观察组孕妇孕早期、孕中期及孕晚期血清FABP4及HOMA-IR水平均高于对照组,血清PPARγ、CST水平均低于对照组,差异均有统计学意义(P<0.05)。Pearson相关分析结果显示,GDM孕妇血清FABP4水平与HOMA-IR呈正相关(r=0.754,P<0.001),血清PPARγ和CST水平与HOMA-IR呈负相关(r=-0.679、-0.836,P<0.001)。观察组孕妇正常妊娠69例,不良妊娠14例;对照组孕妇正常妊娠66例,不良妊娠1例;观察组孕妇不良妊娠结局发生率为16.87%(14/83),高于对照组的1.49%(1/67),差异有统计学意义(χ^(2)=9.737,P=0.002)。不同妊娠结局GDM孕妇的年龄、孕周及高血压病史比例比较,差异均无统计学意义(P>0.05);不良妊娠GDM孕妇身体质量指数(BMI)>25 kg/m^(2)、糖尿病家族史比例及血清FABP4、HOMA-IR水平均高于正常妊娠GDM孕妇,血清PPARγ及CST水平均低于正常妊娠GDM孕妇,差异均有统计学意义(P<0.05)。logistic回归分析结果显示,BMI、糖尿病家族史及血清PPARγ、CST、FABP4、HOMA-IR水平是GDM孕妇发生不良妊娠结局的影响因素(P<0.05)。结论GDM孕妇血清FABP4、PPARγ和CST表达异常,并与胰岛素抵抗、妊娠结局密切相关。临床应针对GDM孕妇给予饮食、药物等有效干预,以控制血糖变化,从而改善妊娠结局。
Objective To investigate the relationship between the expression of peroxisome proliferator-activated receptor gamma(PPARγ),fatty acid-binding protein 4(FABP4),and cortistatin(CST)in pregnant women with gestational diabetes mellitus(GDM)and insulin resistance,as well as their impact on pregnancy outcomes,aiming to provide a reference for the clinical intervention of GDM pregnant women.Methods A total of 83 GDM pregnant women treated at Shaanxi Provincial People's Hospital from September 2021 to September 2023 were selected as the observation group,and 67 healthy pregnant women with normal pregnancy check results during the same period were selected as the control group.The pregnancy outcomes of GDM pregnant women were statistically analyzed,and the serum levels of PPARγ,FABP4,CST,and insulin resistance index(HOMA-IR)in the early,middle,and late stages of pregnancy in GDM pregnant women and healthy pregnant women were compared.Pearson correlation analysis was used to analyze the relationship between PPARγ,FABP4,CST,and HOMA-IR,and to analyze the related factors affecting the pregnancy outcomes of GDM pregnant women.Results The serum levels of FABP4 and HOMA-IR in the observation group were higher than those in the control group during the early,middle,and late stages of pregnancy,while the serum levels of PPARγ and CST were lower than those in the control group,with all differences being statistically significant(P<0.05).Pearson correlation analysis showed that the serum level of FABP4 in GDM pregnant women was positively correlated with HOMA-IR(r=0.754,P<0.001),and the serum levels of PPARγand CST were negatively correlated with HOMA-IR(r=-0.679,-0.836,P<0.001).A total of 69 normal pregnancies and 14 adverse pregnancies were observed in the observation group;66 normal pregnancies and 1 adverse pregnancy were noted in the control group.The incidence of adverse pregnancy outcomes in the observation group was significantly higher than that in the control group[16.87%(14/83)vs.1.49%(1/67);χ^(2)=9.737,P=0.002].There were no statistically significant differences in age,gestational weeks,and the proportion of hypertension history between GDM pregnant women with different pregnancy outcomes(P>0.05).The proportion of GDM pregnant women with adverse pregnancies with a body mass index(BMI)>25 kg/m^(2),a family history of diabetes,serum FABP4,and HOMA-IR levels were higher than those with normal pregnancies,while the serum levels of PPARγ and CST were lower than those with normal pregnancies,with all differences being statistically significant(P<0.05).Logistic regression analysis showed that a BMI,a family history of diabetes,and serum levels of PPARγ,CST,FABP4,and HOMA-IR are influencing factors for adverse pregnancy outcomes in GDM pregnant women(P<0.05).Conclusion The abnormal expression of serum FABP4,PPARγ,and CST in GDM pregnant women is closely related to insulin resistance and pregnancy outcomes.Clinically,effective interventions such as diet and medication should be given to GDM pregnant women to control blood sugar changes,thereby strengthening pregnancy outcomes.
作者
李虹
沈鑫
菅莹莹
穆阁
王敏
孙港港
冯敏娟
Li Hong;Shen Xin;Jian Yingying;Mu Ge;Wang Min;Sun Ganggang;Feng Minjuan(Department of Obstetrics and Gynecology,Shaanxi Provincial People's Hospital,Xi'an 710068,China;Department of Medical Affairs,Shaanxi Provincial People's Hospital,Xi'an 710068,China;Graduate School,Xi'an Medical University,Xi'an 710068,China;Department of Obstetrics and Gynecology,The Second Affiliated Hospital of Xi'an Jiaotong University,Xi'an 710004,China)
出处
《保健医学研究与实践》
2024年第7期102-108,共7页
Health Medicine Research and Practice
基金
陕西省自然科学基础研究计划项目(2024JC-YBQN-0913)
陕西省人民医院2022年院内科技人才支持项目(2022JY-40)。
关键词
妊娠期糖尿病
氧化物酶体增殖物激活受体γ
脂肪酸结合蛋白4
皮质抑素
胰岛素抵抗
妊娠结局
Gestational diabetes mellitus
Peroxisome proliferator-activated receptor gamma
Fatty acid-binding protein 4
Cortistatin
Insulin resistance
Pregnancy outcomes
