摘要
目的探究妊娠糖尿病(GDM)病人胎盘组织中胰岛素受体底物2(IRS2)和胰岛素样生长因子结合蛋白3(IGFBP3)表达对胰岛素抵抗及妊娠结局的影响。方法选取达州市中西医结合医院2021年2月至2022年8月收治的105例GDM病人为GDM组,并根据妊娠结局将105例孕妇分为妊娠结局良好组(n=84)和妊娠结局不良组(n=21)。另选取同期于该院产检的105例健康孕妇为对照组。实时荧光定量PCR(RT-PCR)检测胎盘组织中IRS2和IGFBP3表达水平;全自动生化分析仪检测空腹血糖(FBG)、空腹胰岛素(FINS)。Pearson法分析胎盘组织中IRS2和IGFBP3表达与FBG、FINS、稳态模型胰岛素抵抗指数(HOMA-IR)的相关性;多因素logistic回归分析法分析影响妊娠结局的因素。结果GDM组孕妇胎盘组织中IRS20.52±0.11和IGFBP3表达水平0.65±0.13低于对照组(1.06±0.20、0.94±0.18)(均P<0.001),GDM组孕妇FBG(5.93±1.24)mmol/L、FINS(12.59±2.57)μU/L、HOMA-IR 3.32±0.64均明显高于对照组[(4.26±0.81)mmol/L、(9.35±1.82)μU/L、1.77±0.43](均P<0.001),GDM组孕妇早产、流产、产后出血等不良妊娠结局总发生率(16.2%)高于对照组(5.7%)(P<0.001)。Pearson分析结果显示,GDM病人胎盘组织中IRS2和IGFBP3表达水平与FBG、FINS、HOMA-IR均呈显著负相关(P<0.001)。与妊娠结局不良组比较[0.36±0.08、0.53±0.12、(6.72±1.44)mmol/L、(13.97±3.11)μU/L、4.17±0.86],妊娠结局良好组孕妇胎盘组织中IRS20.56±0.14和IGFBP3表达水平0.68±0.17明显较高,FBG(5.68±1.19)mmol/L、FINS(12.25±2.44)μU/L和HOMA-IR 3.09±0.57明显较低(均P<0.05);多因素logistic回归分析结果显示,IRS2、IGFBP3和HOMA-IR均是妊娠结局的影响因素(OR=0.92、0.92、1.30,P<0.05)。结论IRS2和IGFBP3在GDM病人胎盘组织中低表达,且与胰岛素抵抗和妊娠结局密切相关。
Objective To investigate the effects of insulin receptor substrate 2(IRS2)and insulin-like growth factor binding protein 3(IGFBP3)expressions in placental tissue of gestational diabetes mellitus(GDM)patients on insulin resistance and pregnancy outcome.Methods A total of 105 GDM patients admitted to Dazhou Hospital of Integrated Traditional Chinese and Western Medicine from February 2021 to August 2022 were selected as GDM group and then assigned into good pregnancy outcome group(n=84)and bad pregnancy outcome group(n=21)according to pregnancy outcome.Meanwhile,105 healthy pregnant women who were examined in the same hospital during the same period were selected as the control group.Real-time fluorescence quantitative PCR(RT-PCR)was applied to detect the expressions of IRS2 and IGFBP3 in placenta;the fasting blood glucose(FBG)and fasting insulin(FINS)were measured by automatic biochemical analyzer.Pearson method was applied to analyze the correlation between the expressions of IRS2 and IGFBP3 in placenta and FBG,FINS,homeostatic model assessment of insulin resistance(HOMA-IR).The influencing factors of pregnancy outcome were analyzed by Logistic regression analysis.Results The expression levels of IRS2(0.52±0.11)and IGFBP3(0.65±0.13)in placental tissue of pregnant women in GDM group were lower than those in control group(1.06±0.20,0.94±0.18)(all P<0.001).FBG mmol/L,FINS and HOMA-IR in GDM group were significantly higher than those in control group[(5.93±1.24)mmol/L vs.(4.26±0.81)mmol/L,(12.59±2.57)μU/L vs.(9.35±1.82)μU/L,(3.32±0.64 vs.1.77±0.43),respectively](all P<0.001).The total incidence of preterm birth,abortion,postpartum hemorrhage and other adverse pregnancy outcomes in GDM group was higher than that in control group(16.2%vs.5.7%;P<0.001).Pearson analysis results showed that the expression levels of IRS2 and IGFBP3 in placenta tissue of GDM patients were obviously negatively correlated with FBG,FINS and HOMA-IR(all P<0.001).Compared with the poor pregnancy outcome group,the expression levels of IRS2 and IGFBP3 in placental tissue of pregnant women in good pregnancy outcome group were significantly higher[(0.56±0.14 vs.0.36±0.08),(0.68±0.17 vs.0.53±0.12),respectively],while FBG,FINS and HOMA-IR were significantly lower[(5.68±1.19)mmol/L vs.(6.72±1.44)mmol/L,(12.25±2.44)μU/L vs.(13.97±3.11)μU/L,(3.09±0.57 vs.4.17±0.86)](all P<0.05).Multivariate Logistic regression analysis results showed that IRS2,IGFBP3 and HOMA-IR were all influencing factors of pregnancy outcome(OR=0.92,0.92,1.30,all P<0.05).Conclusion The expressions of IRS2 and IGFBP3 are low in the placenta of GDM patients,which is closely related to insulin resistance and pregnancy outcome.
作者
陈鑫
肖琳
靳健美
CHEN Xin;XIAO Lin;JIN Jianmei(Department of Obstetrics and Gynecology,Dazhou Hospital of Integrated Traditional Chinese and Western Medicine,Dazhou,Sichuan 635000,China)
出处
《安徽医药》
2025年第3期575-579,共5页
Anhui Medical and Pharmaceutical Journal
关键词
糖尿病
妊娠
胰岛素受体底物2
胰岛素样生长因子结合蛋白3
胰岛素抵抗
妊娠结局
Diabetes,gestational
Insulin receptor substrate 2
Insulin-like growth factor binding protein 3
Insulin resistance
Pregnancy outcome
