MIP-1α诊断妊娠期糖尿病新生儿脑损伤的价值研究
|
摘要
目的 分析母亲为妊娠期糖尿病(GDM)新生儿脐血巨噬细胞炎性蛋白-1α(MIP-1α)的表达水平及其与新生儿行为神经测定(NBNA)评分的关系,并探讨MIP-1α含量变化对GDM母亲分娩新生儿脑损伤的诊断价值。方法 选取2017年1月至2018年1月在丽水市人民医院产科分娩的GDM母亲的足月新生儿69例,根据新生儿是否存在脑损伤(NBNA≤35分),分为GDM合并脑损伤A组(n=26)和GDM未合并脑损伤B组(n=43);并选取同期娩出的健康足月新生儿20名为对照C组。采用酶联免疫吸附试验(ELISA)法测定三组新生儿脐血血清MIP-1α水平,并于生后第三天对新生儿进行NBNA评分。结果 ①A组新生儿脐血MIP-1α蛋白含量显著高于B组和C组(F=54.37,P<0.05);且A组新生儿NBNA各项评分及总分均显著低于B组和C组(F=3.02～13.56,均P<0.05)。②A组新生儿脐血MIP-1α蛋白水平与NBNA评分呈负相关(r=-0.595,P<0.05)。③脐血MIP-1α蛋白ROC曲线下面积(AUC)为0.925,当以105.47pg/L作为MIP-1α的最佳截取值时,灵敏度为88.5%,特异度为86.0%。结论 GDM母亲分娩的新生儿脐血血清MIP-1α含量变化有助于新生儿脑损伤的早期诊断。
Objective To analyze the expression level of macrophage inflammatory protein-1 alpha(MIP-1α) in umbilical cord blood of neonates with gestational diabetes mellitus(GDM) and its relationship with neonatal behavioral neurological assessment(NBNA) score, and to explore the diagnostic value of changes in MIP-1α content in neonatal brain injury of GDM mothers. Methods A total of 69 cases of full-term neonates of GDM mothers who delivered in department of obstetrics and gynecology of Lishui People's Hospital during January 2017 to January 2018 were selected. According to whether the neonates had brain injury(NBNA ≤35), they were divided into neonates with GDM combined with brain injury as group A(n=26) and neonates with GDM without brain injury as group B(n=43), and 20 healthy full-term neonates delivered during the same time were selected as control group( group C). The levels of MIP-1α in cord blood serum of three groups of newborns were determined by enzyme-linked immunosorbent assay(ELISA), and the newborns were scored NBNA on the third day after birth. Results The content of MIP-1α protein in cord blood of group A was significantly higher than that of group B and C(F=54.37,P<0.05). And the each scores of NBNA and total scores in group A were significantly lower than those in group B and group C.(F value ranged 3.02-13.56, both P<0.05). The level of MIP-1α protein in cord blood of neonates in group A was negatively correlated with NBNA score(r=-0.595,P<0.05). The area under the ROC curve(AUC) of the cord blood MIP-1α protein was 0.925. When 105.47 pg/L was used as the optimal cutoff value of MIP-1α, the sensitivity was 88.5% and the specificity was 86.0%. Conclusion Changes in serum levels in neonates of GDM mothers contribute to the early diagnosis of neonatal brain injury.
Objective To analyze the expression level of macrophage inflammatory protein-1 alpha(MIP-1α) in umbilical cord blood of neonates with gestational diabetes mellitus(GDM) and its relationship with neonatal behavioral neurological assessment(NBNA) score, and to explore the diagnostic value of changes in MIP-1α content in neonatal brain injury of GDM mothers. Methods A total of 69 cases of full-term neonates of GDM mothers who delivered in department of obstetrics and gynecology of Lishui People's Hospital during January 2017 to January 2018 were selected. According to whether the neonates had brain injury(NBNA ≤35), they were divided into neonates with GDM combined with brain injury as group A(n=26) and neonates with GDM without brain injury as group B(n=43), and 20 healthy full-term neonates delivered during the same time were selected as control group( group C). The levels of MIP-1α in cord blood serum of three groups of newborns were determined by enzyme-linked immunosorbent assay(ELISA), and the newborns were scored NBNA on the third day after birth. Results The content of MIP-1α protein in cord blood of group A was significantly higher than that of group B and C(F=54.37,P<0.05). And the each scores of NBNA and total scores in group A were significantly lower than those in group B and group C.(F value ranged 3.02-13.56, both P<0.05). The level of MIP-1α protein in cord blood of neonates in group A was negatively correlated with NBNA score(r=-0.595,P<0.05). The area under the ROC curve(AUC) of the cord blood MIP-1α protein was 0.925. When 105.47 pg/L was used as the optimal cutoff value of MIP-1α, the sensitivity was 88.5% and the specificity was 86.0%. Conclusion Changes in serum levels in neonates of GDM mothers contribute to the early diagnosis of neonatal brain injury.
引文
[1]Koivusalo S B,R?n? K,Klemetti M M,et al.Gestational diabetes mellitus can be prevented by lifestyle intervention:the Finnish Gestational Diabetes Prevention Study(RADIEL):a randomized controlled trial[J].Diabetes Care,2016,39(1):24-30.
[2]郭琅.血脂检查在预测孕妇发生妊娠期高血压病、妊娠期糖尿病及生产巨大儿中的应用价值[J].当代医药论丛,2018,16(7):218-219.
[3]Ren X,Hong M,Zuo Z.Dexmedetomidine postconditioning reduces brain injury after brain hypoxia-ischemia in neonatal rats[J].J Neuroimmune Pharmacol,2016,11(2):238-247.
[4]邵乐,蔡光先,王宇红.趋化因子MCP-1、MIP-1α的表达与脑缺血关系的研究概况[J].湖南中医杂志,2014,30(2):136-138.
[5]吉艳梅,文彩铃.胰岛素干预对妊娠期糖尿病患者新生儿脐血中脑损伤相关蛋白及行为评分的影响[J].今日药学,2018,28(4):262-265.
[6]Guillén-Sacoto M A,Barquiel B,Hillman N,et al.Gestational diabetes mellitus:glycemic control during pregnancy and neonatal outcomes of twin and singleton pregnancies[J].Endocrinol Diabetes Nutr,2018,65(6):319-327.
[7]Pironkova R P,Giamelli J,Seiden H.Brain injury with systemic inflammation in newborns with congenital heart disease undergoing heart surgery[J].Exp Ther Med,2017,14(1):228-238.
[8]谭燕萍,谭健坤,李色薇.妊娠后盆底功能障碍性疾病和盆底肌收缩力的相关性研究[J].中国妇幼健康研究,2015,26(6):1254-1256.
[9]Baba T,Tanabe Y,Yoshikawa S,et al.MIP-1α/CCL3-expressing basophil-lineage cells drive the leukemic hematopoiesis of chronic myeloid leukemia in mice[J].Blood,2016,127(21):2607-2617.
[10]李海英,吴尤佳,孙宝兰,等.脐血S100B、巨噬细胞炎性蛋白-1α对母亲妊娠高血压病所生新生儿脑损伤的早期诊断价值[J].中华实用儿科临床杂志,2012,27(12):925-927.
[11]Singh N,Madhu M,Vanamail P,et al.Efficacy of metformin in improving glycaemic control & perinatal outcome in gestational diabetes mellitus:a non-randomized study[J].Indian J Med Res,2017,145(5):623-628.
[12]Timur B B,Timur H,Tokmak A,et al.The influence of maternal obesity on pregnancy complications and neonatal outcomes in diabetic and nondiabetic women[J].Geburtshilfe Frauenheilkd,2018,78(4):400-406.
[2]郭琅.血脂检查在预测孕妇发生妊娠期高血压病、妊娠期糖尿病及生产巨大儿中的应用价值[J].当代医药论丛,2018,16(7):218-219.
[3]Ren X,Hong M,Zuo Z.Dexmedetomidine postconditioning reduces brain injury after brain hypoxia-ischemia in neonatal rats[J].J Neuroimmune Pharmacol,2016,11(2):238-247.
[4]邵乐,蔡光先,王宇红.趋化因子MCP-1、MIP-1α的表达与脑缺血关系的研究概况[J].湖南中医杂志,2014,30(2):136-138.
[5]吉艳梅,文彩铃.胰岛素干预对妊娠期糖尿病患者新生儿脐血中脑损伤相关蛋白及行为评分的影响[J].今日药学,2018,28(4):262-265.
[6]Guillén-Sacoto M A,Barquiel B,Hillman N,et al.Gestational diabetes mellitus:glycemic control during pregnancy and neonatal outcomes of twin and singleton pregnancies[J].Endocrinol Diabetes Nutr,2018,65(6):319-327.
[7]Pironkova R P,Giamelli J,Seiden H.Brain injury with systemic inflammation in newborns with congenital heart disease undergoing heart surgery[J].Exp Ther Med,2017,14(1):228-238.
[8]谭燕萍,谭健坤,李色薇.妊娠后盆底功能障碍性疾病和盆底肌收缩力的相关性研究[J].中国妇幼健康研究,2015,26(6):1254-1256.
[9]Baba T,Tanabe Y,Yoshikawa S,et al.MIP-1α/CCL3-expressing basophil-lineage cells drive the leukemic hematopoiesis of chronic myeloid leukemia in mice[J].Blood,2016,127(21):2607-2617.
[10]李海英,吴尤佳,孙宝兰,等.脐血S100B、巨噬细胞炎性蛋白-1α对母亲妊娠高血压病所生新生儿脑损伤的早期诊断价值[J].中华实用儿科临床杂志,2012,27(12):925-927.
[11]Singh N,Madhu M,Vanamail P,et al.Efficacy of metformin in improving glycaemic control & perinatal outcome in gestational diabetes mellitus:a non-randomized study[J].Indian J Med Res,2017,145(5):623-628.
[12]Timur B B,Timur H,Tokmak A,et al.The influence of maternal obesity on pregnancy complications and neonatal outcomes in diabetic and nondiabetic women[J].Geburtshilfe Frauenheilkd,2018,78(4):400-406.