孕早期血管生成素样蛋白8表达与妊娠糖尿病及妊娠结局的关系
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摘要
目的探讨妊娠早期血管生成素样蛋白8(ANGPTL8)表达与妊娠糖尿病(GDM)及妊娠结局的关系。方法前瞻性收集2015年4月至2017年6月期间在青岛市妇女儿童医院建档及分娩的妊娠小于14周的GDM孕妇共78例作为研究组,选择同时期妊娠小于14周的健康孕妇89例为对照组。观察两组孕妇临床资料和相关生化指标,利用ROC曲线和Logistic回归分析ANGPTL8与GDM及妊娠结局的关系。结果研究组与对照组在孕次、产次、TG、HDL组间比较无显著差异(P> 0. 05),研究组在孕前BMI指数、糖尿病家族史、自然流产史、胆固醇(TC)、低密度脂蛋白(LDL)、超敏C反应蛋白(hs-CRP)、ANGPTL8、糖化血红蛋白(Hb A1c)血清水平明显高于对照组,差异均有显著性(P<0. 05)。研究组的不良妊娠结局:新生儿呼吸窘迫综合征、高胆红素血症、早产儿、巨大儿均明显多于对照组,不良妊娠总发生率明显高于对照组,差异均有显著性(P <0. 05)。多因素非条件Logistic回归分析结果显示ANGPTL8为GDM(P=0. 027,OR=1. 182,95%CI=1. 025~3. 107)和不良妊娠结局(P=0. 031,OR=1. 421,95%CI=1. 077~2. 503)的独立危险因素。结论孕早期ANGPTL8是GDM和不良妊娠结局的独立危险因素,值得在临床中进一步关注。
Objective To investigate the relationship between the expression of angiopoietin like protein 8 in early pregnancy and gestational diabetes mellitus and pregnancy outcome. Methods A total of 78 pregnant women who had been pregnant for less than 14 weeks in our hospital from April 2015 to June 2017 were enrolled as the research group. There were 78 cases in the study group. 89 healthy pregnant women with less than 14 weeks of pregnancy were selected into control group. The clinical data and related biochemical indicators of the two groups were observed. The relationship between angiopoietin like protein 8 and GDM and pregnancy outcome was analyzed by ROC curve and Logistic regression.Results There was no significant difference between the study group and the control group in the times of gestation,birth times,TG and HDL( P > 0. 05). The serum levels of BMI index,family history of diabetes,history of spontaneous abortion,TC,LDL,hs-CRP,ANGPTL8 and HbA1 c in the study group were significantly higher than those in the control group. The difference was statistically significant( P < 0. 05). The adverse pregnancy outcomes in the study group,including neonatal respiratory distress syndrome,hyperbilirubinemia,premature infants and macrosomia,were significantly more than those in the control group. The total incidence of undesirable pregnancy was significantly higher than that of the control group. The difference was significant( P < 0. 05). The results of multivariate non conditional Logistic regression analysis showed that angiopoietin like protein 8 was an independent risk factor for GDM( P = 0. 027,OR = 1. 182,95% CI = 1. 025 ~ 3. 107) and bad pregnancy outcome( P = 0. 031,OR = 1. 421,95% CI = 1. 077 ~ 2. 503). Conclusion ANGPTL8 is a common independent risk factor for gestational diabetes mellitus and adverse pregnancy outcomes. It is worth further attention in the clinic.
Objective To investigate the relationship between the expression of angiopoietin like protein 8 in early pregnancy and gestational diabetes mellitus and pregnancy outcome. Methods A total of 78 pregnant women who had been pregnant for less than 14 weeks in our hospital from April 2015 to June 2017 were enrolled as the research group. There were 78 cases in the study group. 89 healthy pregnant women with less than 14 weeks of pregnancy were selected into control group. The clinical data and related biochemical indicators of the two groups were observed. The relationship between angiopoietin like protein 8 and GDM and pregnancy outcome was analyzed by ROC curve and Logistic regression.Results There was no significant difference between the study group and the control group in the times of gestation,birth times,TG and HDL( P > 0. 05). The serum levels of BMI index,family history of diabetes,history of spontaneous abortion,TC,LDL,hs-CRP,ANGPTL8 and HbA1 c in the study group were significantly higher than those in the control group. The difference was statistically significant( P < 0. 05). The adverse pregnancy outcomes in the study group,including neonatal respiratory distress syndrome,hyperbilirubinemia,premature infants and macrosomia,were significantly more than those in the control group. The total incidence of undesirable pregnancy was significantly higher than that of the control group. The difference was significant( P < 0. 05). The results of multivariate non conditional Logistic regression analysis showed that angiopoietin like protein 8 was an independent risk factor for GDM( P = 0. 027,OR = 1. 182,95% CI = 1. 025 ~ 3. 107) and bad pregnancy outcome( P = 0. 031,OR = 1. 421,95% CI = 1. 077 ~ 2. 503). Conclusion ANGPTL8 is a common independent risk factor for gestational diabetes mellitus and adverse pregnancy outcomes. It is worth further attention in the clinic.
引文
[1]余凡,廖海明,殷文静,等.妊娠期糖尿病患者血糖波动与新生儿出生体重、母体及新生儿不良妊娠结局的相关性研究[J].中华妇幼临床医学杂志(电子版),2016,12(3):305-311.
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[6]张朝燕,田亚强,苏旭东.妊娠早期血清25-羟维生素D3水平与妊娠期糖尿病发病风险的研究[J].中华临床医师杂志(电子版),2013,7(16):7617-7619.
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[9]唐苏娅,汪云,伍理.亚临床甲状腺功能减退对妊娠期糖尿病发病及其妊娠结局的影响[J].国际妇产科学杂志,2014,41(4):419-422.
[10]许大帅,赵琼.妊娠期糖尿病患者糖化血红蛋白水平与母婴结局的关系研究[J].实用妇科内分泌杂志(电子版),2016,3(8):122-123.
[11]黄子开. HbA1c水平与妊娠期糖尿病孕妇妊娠结局相关性[J].中国当代医药,2018,25(3):145-147.
[12]武春艳,郭晔.胰岛素持续泵入与皮下注射胰岛素对高龄妊娠期糖尿病孕妇血清HbA1c、Hcy、Cys-C水平及母婴结局的影响[J].临床和实验医学杂志,2018,17(21):2304-2307.
[13] Syngelaki A,Visser GH,Krithinakis K,et al. First trimester screening for gestational diabetes mellitus by maternal factors and markers of inflammation[J]. Metabolism,2016,65(3):131-137.
[14] Wang Y,Quagliarini F,Gusarova V,et al. Mice lacking ANGPTL8(Betatrophin)manifest disrupted triglyceride metabolism without inpaired glucose homeostasis[J]. Pro Natl Acad Sci U S A,2013,110(40):16109-16114.
[15]朱苗苗,周洁,秦彦文.血管生成素样蛋白家族在脂代谢中的作用研究进展[J].心肺血管病杂志,2018,37(5):486-489.
[16] Huang Y,Chen X,Chen X,et al. Angiopoietin-like protein 8 in early pregnancy improves the prediction of gestational diabetes[J]. Diabetologia,2018,61(3):574-580.
[17] Ortega-Senovilla H,van Poppel MNM,Desoye G,et al. Angiopoietin-like protein 4(ANGPTL4)is related to gestational weight gain in pregnant women with obesity[J]. Sci Rep,2018,8(1):12428.
[2]周羡梅,尚琪.妊娠糖尿病高危因素研究进展[J].环境卫生学杂志,2013,3(2):160-166.
[3]李培培,王建华,张宝珣,等.血管生成素样蛋白8基因研究进展[J].中国畜牧兽医,2014,41(7):26-29.
[4] Yi P,Park J S,Melton D A. Betatrophin:A hormone that controls pancreaticcell proliferation[J]. Cell,2013,153(4):747-758.
[5]中华医学会妇产科学分会产科学组,中华医学会围产医学分会妊娠合并糖尿病协作组.妊娠合并糖尿病诊治指南(2014)[J].中华妇产科杂志,2014,49(8):561-569.
[6]张朝燕,田亚强,苏旭东.妊娠早期血清25-羟维生素D3水平与妊娠期糖尿病发病风险的研究[J].中华临床医师杂志(电子版),2013,7(16):7617-7619.
[7]徐霞,尤子善.妊娠期糖尿病高危孕妇血清中T3、T4、FT3、FT4、TSH、TPOAb及TGAb含量变化分析[J].临床和实验医学杂志,2017,16(24):2463-2466..
[8]罗明娟,胡园园,吴雪琴,等.妊娠期糖尿病的危险因素分析[J].上海交通大学学报(医学版),2016,36(8):1171-1174.
[9]唐苏娅,汪云,伍理.亚临床甲状腺功能减退对妊娠期糖尿病发病及其妊娠结局的影响[J].国际妇产科学杂志,2014,41(4):419-422.
[10]许大帅,赵琼.妊娠期糖尿病患者糖化血红蛋白水平与母婴结局的关系研究[J].实用妇科内分泌杂志(电子版),2016,3(8):122-123.
[11]黄子开. HbA1c水平与妊娠期糖尿病孕妇妊娠结局相关性[J].中国当代医药,2018,25(3):145-147.
[12]武春艳,郭晔.胰岛素持续泵入与皮下注射胰岛素对高龄妊娠期糖尿病孕妇血清HbA1c、Hcy、Cys-C水平及母婴结局的影响[J].临床和实验医学杂志,2018,17(21):2304-2307.
[13] Syngelaki A,Visser GH,Krithinakis K,et al. First trimester screening for gestational diabetes mellitus by maternal factors and markers of inflammation[J]. Metabolism,2016,65(3):131-137.
[14] Wang Y,Quagliarini F,Gusarova V,et al. Mice lacking ANGPTL8(Betatrophin)manifest disrupted triglyceride metabolism without inpaired glucose homeostasis[J]. Pro Natl Acad Sci U S A,2013,110(40):16109-16114.
[15]朱苗苗,周洁,秦彦文.血管生成素样蛋白家族在脂代谢中的作用研究进展[J].心肺血管病杂志,2018,37(5):486-489.
[16] Huang Y,Chen X,Chen X,et al. Angiopoietin-like protein 8 in early pregnancy improves the prediction of gestational diabetes[J]. Diabetologia,2018,61(3):574-580.
[17] Ortega-Senovilla H,van Poppel MNM,Desoye G,et al. Angiopoietin-like protein 4(ANGPTL4)is related to gestational weight gain in pregnant women with obesity[J]. Sci Rep,2018,8(1):12428.