妊娠期糖尿病孕产妇所生新生儿血糖与糖化血清白蛋白、胰岛素及C肽的关系
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摘要
目的探讨妊娠期糖尿病(GDM)孕产妇所生新生儿血糖与糖化血清白蛋白、胰岛素及C肽的关系。方法选择2017年2月～2018年4月保定市第一中心医院出生的新生儿293例,根据新生儿血糖值及新生儿母亲有无GDM分为GDM母亲新生儿低血糖组(74例)、GDM母亲新生儿正常血糖组(68例)、非GDM母亲新生儿低血糖组(16例)、非GDM母亲新生儿正常血糖组(135例)。检测并比较各组间糖化血清白蛋白、C肽、空腹胰岛素水平(FINS)、胰岛素敏感指数(ISI)及胰岛素抵抗指数(HOMA-IR),并进一步分析上述指标与新生儿血糖的相关性。结果 GDM母亲所生新生儿低血糖的发生率高于非GDM母亲(P <0.05);GDM母亲新生儿低血糖组的FINS、ISI、HOMA-IR及C肽均高于GDM母亲新生儿正常血糖组,差异有统计学意义(P <0.05),非GDM母亲新生儿低血糖组与非GDM母亲的新生儿正常血糖组血清白蛋白、FINS、ISI、HOMA-IR及C肽比较,差异无统计学意义(P> 0.05);进一步分析发现上述指标与GDM母亲所生新生儿血糖与FINS、ISI、HOMA-IR及C肽与血糖呈负相关(r=-0.581、-0.712、-0.642、-0.621,P <0.05),糖化血清白蛋白与血糖值变化无明显相关性(P> 0.05)。结论 GDM母亲所生新生儿易发生低血糖,且新生儿血糖值与胰岛素及C肽水平呈显著负相关,单独使用新生儿糖化血清白蛋白不能估测生后新生儿是否发生低血糖。
Objective To investigate the relationship among blood glucose and glycated albumin, insulin and C-peptide in neonates born by gestational diabetes(GMD) women. Methods From February 2017 to April 2018, in Baoding First Central Hospital, 293 neonates born were selected, according to the neonatal blood glucose and whether the neonatal mother had GDM or not, the neonates were divided into GDM mothers′ neonates hypoglycemia group(74 cases), GDM mothers' normal blood glucose group(68 cases), non-GDM mothers′ neonatal hypoglycemia group(16 cases), non-GDM mothers' normal blood glucose group(135 cases). Glycated albumin, C-peptide, fasting insulin level(FINS), insulin sensitivity index(ISI) and insulin resistance index(HOMA-IR) in groups were detected and compared, and the correlation between the above indicators and neonatal blood glucose was analyzed. Results The incidence of neonatal hypoglycemia in neonates born by GDM mothers was higher than that in neonates born by non-GDM mothers(P < 0.05).The levels of FINS, ISI, HOMA-IR and C-peptide in GDM mothers′ neonates hypoglycemia group were higher than those in GDM mothers' normal blood glucose group, the differences were statistically significant(P < 0.05). There was no significant difference in glycated albumin, FINS, ISI, HOMA-IR and C-peptide in non-GDM mothers′ neonatal hypoglycemia group and non-GDM mothers′ normal blood glucose group(P > 0.05). Further analysis showed that the above indicator were negatively correlated with FINS, ISI, HOMA-IR and C-peptide in neonates born by GDM mothers(r =-0.581,-0.712,-0.642,-0.621, P < 0.05). There was no significant correlation between glycosylated serum albumin and blood glucose(P > 0.05). Conclusion Neonates born by GDM mothers are prone to hypoglycemia, and the cor-relation between neonatal blood glucose and insulin and C-peptide level is significantly negative, with neonatal glycated albumin alone can not estimate whether hypoglycemia occurs in neonates after birth.
Objective To investigate the relationship among blood glucose and glycated albumin, insulin and C-peptide in neonates born by gestational diabetes(GMD) women. Methods From February 2017 to April 2018, in Baoding First Central Hospital, 293 neonates born were selected, according to the neonatal blood glucose and whether the neonatal mother had GDM or not, the neonates were divided into GDM mothers′ neonates hypoglycemia group(74 cases), GDM mothers' normal blood glucose group(68 cases), non-GDM mothers′ neonatal hypoglycemia group(16 cases), non-GDM mothers' normal blood glucose group(135 cases). Glycated albumin, C-peptide, fasting insulin level(FINS), insulin sensitivity index(ISI) and insulin resistance index(HOMA-IR) in groups were detected and compared, and the correlation between the above indicators and neonatal blood glucose was analyzed. Results The incidence of neonatal hypoglycemia in neonates born by GDM mothers was higher than that in neonates born by non-GDM mothers(P < 0.05).The levels of FINS, ISI, HOMA-IR and C-peptide in GDM mothers′ neonates hypoglycemia group were higher than those in GDM mothers' normal blood glucose group, the differences were statistically significant(P < 0.05). There was no significant difference in glycated albumin, FINS, ISI, HOMA-IR and C-peptide in non-GDM mothers′ neonatal hypoglycemia group and non-GDM mothers′ normal blood glucose group(P > 0.05). Further analysis showed that the above indicator were negatively correlated with FINS, ISI, HOMA-IR and C-peptide in neonates born by GDM mothers(r =-0.581,-0.712,-0.642,-0.621, P < 0.05). There was no significant correlation between glycosylated serum albumin and blood glucose(P > 0.05). Conclusion Neonates born by GDM mothers are prone to hypoglycemia, and the cor-relation between neonatal blood glucose and insulin and C-peptide level is significantly negative, with neonatal glycated albumin alone can not estimate whether hypoglycemia occurs in neonates after birth.
引文
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[16]符琳鑫,陈秀芹.孕妇糖耐量状态与胰岛素抵抗、胰岛β细胞功能情况及妊娠结局分析[J].中国计划生育学杂志,2017,25(8):533-535.
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[18]黄欣欣,江秀敏,林艳,等.妊娠期糖尿病母亲的新生儿出生48小时内血糖的动态变化及低血糖的影响因素[J].中国循证儿科杂志,2017,12(5):342-346.
[19] Wu WC,Ma WY,Wei JN,et al. Serum glycated albumin to guide the diagnosis of diabetes mellitus[J]. PLoS One,2016,11(1):e0146780.
[20]孙建斌.糖化血清白蛋白检验诊断糖尿病的临床价值研究[J].临床检验杂志:电子版,2017,6(4):728-729.
[21] Xu M,Liu B,Wu MF,et al. Relationships among acylationstimulating protein,insulin resistance,lipometabolism,and fetal growth in gestational diabetes mellitus women[J].J Obstet Gynaecol,2015,35(4):341-345.
[2] Chiefari E,Arcidiacono B,Foti D,et al. Gestational diabetes mellitus:an updated overview[J]. J Endocrinol Invest,2017,40(9):899-909.
[3]王蓬春,王琨,王斌,等.妊娠期糖尿病母亲新生儿常见检测异常指标[J].现代中西医结合杂志,2018,27(5):566-570.
[4] Damm P,Houshmand-Oeregaard A,Kelstrup L,et al. Gestational diabetes mellitus and long-term consequences for mother and offspring:a view from Denmark[J]. Diabetologia,2016,59(7):1396-1399.
[5]中华医学会妇产科学分会产科学组.妊娠合并糖尿病诊治指南(2014)[J].中华妇产科杂志,2014,8(8):489-98.
[6] Tang Q,Li X,Song P,et al. Optimal cut-off values for the homeostasis model assessment of insulin resistance(HOMAIR)and pre-diabetes screening:Developments in research and prospects for the future[J]. Drug Discov Ther,2015,9(6):380-385.
[7] Charles MA,Delpierre C,Bréant B. Developmental origin of health and adult diseases(DOHaD):evolution of a concept over three decades[J]. Med Sci(Paris),2016,32(1):15-20.
[8]邓冉冉,李洁,李增彦.发育源性成人疾病[J].国际生殖健康/计划生育杂志,2016,35(6):483-485.
[9]刘亚,黄韵,胡吉.妊娠期糖尿病早期预测因素的研究进展[J].医学综述,2018,24(4):776-780,786.
[10] Ma RC,Tutino GE,Lillycrop KA,et al. Maternal diabetes,gestational diabetes and the role of epigenetics in their long term effects on offspring[J]. Prog Biophys Mol Biol,2015,118(1-2):55-68.
[11] Wang Q,Huang R,Yu B,et al. Higher fetal insulin resistance in Chinese pregnant women with gestational diabetes mellitus and correlation with maternal insulin resistance[J]. PLoS One,2013,8(4):e59845.
[12]黄瑞萍,曹芳,虞斌,等.妊娠期糖尿病母亲胰岛素水平与胎儿胰岛素抵抗的相关性研究[J].中华全科医师杂志,2013,12(3):199-201.
[13] Wang L,Fan H,Zhou L,et al. Altered expression of PGC-1αand PDX1 and their methylation status are associated with fetal glucose metabolism in gestational diabetes mellitus[J]. Biochem Biophys Res Commun,2018,501(1):300-306.
[14]陈旭霞.新生儿脐带血胰岛素样生长因子-Ⅰ水平与妊娠期糖代谢异常母体糖化血红蛋白的关系[D].石家庄:河北医科大学,2010.
[15]沈文霞.妊娠期糖尿病与新生儿胰岛素抵抗的相关性研究[J].中国现代医生,2018,56(3):12-14.
[16]符琳鑫,陈秀芹.孕妇糖耐量状态与胰岛素抵抗、胰岛β细胞功能情况及妊娠结局分析[J].中国计划生育学杂志,2017,25(8):533-535.
[17]王智.孕妇血清妊娠相关蛋白、胰岛素抵抗指数与妊娠期糖尿病的关系[J].实用临床医药杂志,2018,22(11):69-71.
[18]黄欣欣,江秀敏,林艳,等.妊娠期糖尿病母亲的新生儿出生48小时内血糖的动态变化及低血糖的影响因素[J].中国循证儿科杂志,2017,12(5):342-346.
[19] Wu WC,Ma WY,Wei JN,et al. Serum glycated albumin to guide the diagnosis of diabetes mellitus[J]. PLoS One,2016,11(1):e0146780.
[20]孙建斌.糖化血清白蛋白检验诊断糖尿病的临床价值研究[J].临床检验杂志:电子版,2017,6(4):728-729.
[21] Xu M,Liu B,Wu MF,et al. Relationships among acylationstimulating protein,insulin resistance,lipometabolism,and fetal growth in gestational diabetes mellitus women[J].J Obstet Gynaecol,2015,35(4):341-345.
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