摘要
目的探讨血清脂肪酸结合蛋白4(FABP4)在妊娠糖尿病(GDM)患者中的水平变化,并评估该变化与GDM患者发生妊娠高血压综合征和先兆子痫的关系。方法采用前瞻性研究方法,选取2019年1~6月南京医科大学附属无锡妇幼保健院收治的孕22~24周的产妇共1253例,将32例GDM合并妊娠高血压综合征及先兆子痫者纳入研究组,另外64例仅诊断为GDM的患者纳入对照组。收集相关病例资料及相关检测数据,稳态模型评估胰岛素抵抗指数(HOMA-IR)。采用酶联免疫吸附法检测血清孕24~28周和32~36周的FABP4水平,采用逐步Logistic回归分析影响GDM患者发生妊娠高血压综合征和先兆子痫的因素。结果研究组孕24~28周体重指数(25.83±3.38 kg/m^2)和HOMA-IR(3.18±0.46)显著高于对照组(24.52±3.12 kg/m^2,2.56±0.33),差异均具有统计学意义(P<0.05)。孕32~36周研究组血清FABP4水平(26.43±5.62 ng/ml)和对照组(17.53±4.09 ng/ml)均较孕24~28周(17.43±4.32 ng/ml,12.68±3.01 ng/ml)出现了显著提升,差异有统计学意义(P<0.05)。研究组孕24~28周(17.43±4.32ng/ml)和32~36周(26.43±5.62 ng/ml)的血清FABP4水平均显著高于对照组(12.68±3.01 ng/ml,17.53±4.09 ng/ml),差异有统计学意义(P<0.05)。逐步Logistic回归发现,孕24~28周血清FABP4水平(OR=2.542,95%CI:1.874~3.473)、HOMA-IR(OR=1.556,95%CI:1.244~1.785)和孕24~28周体重指数(OR=1.484,95%CI:1.152~1.843)是GDM患者发生妊娠高血压综合征与先兆子痫的影响因素,其中孕24~28周血清FABP4水平的归因危险度最高。结论血清FABP4水平变化是GDM患者发生妊娠高血压综合征和先兆子痫的重要影响因素。
Objective To investigate the changes of serum fatty acid binding protein 4(FABP4)levels in patients with gestational diabetes mellitus(GDM),and evaluate the relationship of the changes on the occurrence of pregnancy-induced hypertension syndrome and preeclampsia in patients with GDM.Methods A total of 1253 pregnant women with 22 to 24 weeks of pregnancy who were treated in Wuxi Maternal and Child Health Care Hospital Affiliated to Nanjing Medical University from January to June 2019 were selected for a prospective follow-up study.32 cases of GDM with pregnancy-induced hypertension syndrome and preeclampsia were included in the study group.An additional 64 patients with a diagnosis of GDM were included in the control group.Relevant case data and relevant test data were collected,and the insulin resistance index(HOMA-IR)was assessed using a steady state model.Enzyme-linked immunosorbent assay(ELISA)was used to detect serum FABP4 levels at 24~28 weeks and 32~36 weeks of gestation.Stepwise Logistic regression analysis was performed to analyze the factors that affected the occurrence of pregnancy-induced hypertension syndrome and preeclampsia in GDM patients.Results Body mass index(BMI)at 24~28 weeks of gestation and HOMA-IR in the study group were significantly higher than those in the control group(25.83±3.38 kg/m^2 vs.24.52±3.12 kg/m^2,3.18±0.46 vs.2.56±0.33,P<0.05).The serum FABP4 levels in the study group and the control group at 32 to 36 weeks of gestation were significantly higher than those at 24 to 28 weeks of gestation(26.43±5.62 ng/ml vs.17.43±4.32 ng/ml,17.53±4.09 ng/ml vs.12.68±3.01 ng/ml,P<0.05).The serum FABP4 levels in the study group at 24-28 weeks and 32-36 weeks of pregnancy were significantly higher than those in the control group(17.43±4.32 ng/ml vs.12.68±3.01 ng/ml,26.43±5.62 ng/ml vs.17.53±4.09 ng/ml,P<0.05).Stepwise Logistic regression results showed that serum FABP4 levels(OR=2.542,95%CI:1.874~3.473),HOMA-IR(OR=1.556,95%CI:1.244~1.785),and BMI at 24-28 weeks of gestation(OR=1.484,95%CI:1.152~1.843)were the influencing factors of pregnancy-induced hypertension syndrome and preeclampsia in patients with GDM,and the attributable risk of serum FABP4 level at 24 to 28 weeks of pregnancy was the highest.Conclusion Changes in serum FABP4 levels during the second trimester are important influencing factors for pregnancy-induced hypertension syndrome and preeclampsia in GDM patients.
作者
卞义华
沈涟
马凤英
吴晓丽
BIAN Yi-hua;SHEN Lian;MA Feng-ying(Department of Gynaecology and Obstetrics,Wuxi Maternal and Child Health Care Hospital Affiliated to Nanjing Medical University,Wuxi Jiangsu 214002,China)
出处
《临床和实验医学杂志》
2020年第13期1355-1358,共4页
Journal of Clinical and Experimental Medicine
基金
国家自然科学基金面上支持项目(编号:81801413)。
关键词
妊娠糖尿病
脂肪酸结合蛋白4
妊娠高血压综合征
先兆子痫
Gestational diabetes mellitus
Serum fatty acid binding protein 4
Pregnancy-induced hypertension syndrome
Preeclampsia
