妊娠合并甲状腺功能减退患者血清apelin、lipocalin-2表达及与血脂关系
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摘要
目的:探讨妊娠合并甲状腺功能减退患者血清apelin、中性粒细胞明胶酶相关脂质运载蛋白-2(lipocalin-2)的表达特点,分析其与血脂异常的关系及对妊娠结局影响。方法:应用酶联免疫吸附试验检测92例妊娠期合并亚临床甲状腺功能减退症孕妇(观察组)和60例非亚临床甲状腺功能减退症孕妇(对照组)血清apelin、lipocalin-2水平,全自动生化分析仪检测两组血清总胆固醇(TC)、甘油三酯(TG)、高密度脂蛋白(HDL)、低密度脂蛋白(LDL)、载脂蛋白A (ApoA)和载脂蛋白B (ApoB)水平,Pearson相关分析apelin、lipocalin-2与血脂异常的关系以及对妊娠结局的影响。结果:观察组血清TC、TG、HOMA-IR(6.51±0.62mmol/L、2.52±0.73mmol/L、2.05±0.71)高于对照组(5.62±0.51mmol/L、1.85±0.95mmol/L、0.85±0.26)(P<0.05),LDL低于对照组(4.26±0.69mmol/L、3.25±0.42mmol/L)(P<0.05),HDL、ApoA、ApoB两组无差异(P>0.05)。观察组血清apelin(483.51±32.62ng/L)、lipocalin-2(38.52±6.73μg/L)均高于对照组(333.62±20.51ng/L)(22.85±4.95μg/L)(P<0.05)。apelin、lipocalin-2与TC、TG、HOMA-IR呈正相关(r=0.419、0.435,0.437、0.357,0.521、0.603,P<0.05),与LDL呈负相关(r=-0.406、-0.395,P<0.05),与HDL、APoA、APoB无关(P>0.05);两组新生儿甲减、胎儿宫内生长受限、妊娠期糖尿病、妊娠期高血压疾病、胎盘早剥、胎死宫内及流产等的发生率均无差异(P>0.05),低体重新生儿出生率观察组高于对照组(P<0.05)。结论:妊娠合并甲状腺功能减退患者血脂与血清apelin、lipocalin-2相关, apelin、lipocalin-2的水平与低体重儿出生可能有关。
Objective: To investigate the expression characteristics of serum apelin and neutrophil gelatinase associated lipocalin-2(lipocalin-2) of pregnant women with hypothyroidism, to analyze the relationship between the expressions of serum apelin and lipocalin-2 and dyslipidemia, and to study their influence on the pregnancy outcomes. Methods: 92 pregnant women with subclinical hypothyroidism were selected in study group, and 60 normal pregnant women hypothyroidism women were selected in control group. Enzyme-linked immunosorbent assay(ELISA) was used to detect serum apelin and lipocalin-2 levels, and automated biochemical analyzers was used to test the levels of serum total cholesterol(TC), triglycerides(TG), high-density lipoprotein(HDL), low-density lipoprotein(LDL), apolipoprotein A(ApoA), and Apolipoprotein B(ApoB).The relationship between the serum apelin and lipocalin-2 and blood lipids levels, and the levels of apelin and lipocalin-2 influenced on the pregnancy outcomes were analyzed by Pearson correlation analysis. Results: The serum levels of TC, TG and HOMA-IR of women in the study group were significant higher than those of women in the control group(P<0.05), LDL level was significant lower than that of women the control group(P<0.05),but there were no significant different levels of HDL the ApoA and ApoB between the two groups(P>0.05).The levels of serum apelin and lipocalin-2 of women in study group were significant higher than those of women in control group(P<0.05).Correlation analysis showed that apelin and lipocalin-2 were positively correlated with levels of TC,TG and HOMA-IR(r=0.419,0.435,0.437,0.357,0.521,0.603,P<0.05),and negatively correlated with LDL level(r=-0.406,-0.395,P<0.05),but there were no correlated to the levels of HDL,APoA,ApoB(P>0.05).There were no significant different in the incidence of neonatal hypothyroidism,fetal growth restriction,gestational diabetes mellitus,gestational hypertension,placental abruption,fetal death,and abortion between the two groups(P>0.05).However,the rate of low birth weight infants in study group was significant higher than that in control group(P<0.05).Conclusion:As for pregnant women with hypothyroidism,the levels of Apelin and lipocalin-2 are correlated to dyslipidemia,and maybe related to the rate of low birth weight infants.
Objective: To investigate the expression characteristics of serum apelin and neutrophil gelatinase associated lipocalin-2(lipocalin-2) of pregnant women with hypothyroidism, to analyze the relationship between the expressions of serum apelin and lipocalin-2 and dyslipidemia, and to study their influence on the pregnancy outcomes. Methods: 92 pregnant women with subclinical hypothyroidism were selected in study group, and 60 normal pregnant women hypothyroidism women were selected in control group. Enzyme-linked immunosorbent assay(ELISA) was used to detect serum apelin and lipocalin-2 levels, and automated biochemical analyzers was used to test the levels of serum total cholesterol(TC), triglycerides(TG), high-density lipoprotein(HDL), low-density lipoprotein(LDL), apolipoprotein A(ApoA), and Apolipoprotein B(ApoB).The relationship between the serum apelin and lipocalin-2 and blood lipids levels, and the levels of apelin and lipocalin-2 influenced on the pregnancy outcomes were analyzed by Pearson correlation analysis. Results: The serum levels of TC, TG and HOMA-IR of women in the study group were significant higher than those of women in the control group(P<0.05), LDL level was significant lower than that of women the control group(P<0.05),but there were no significant different levels of HDL the ApoA and ApoB between the two groups(P>0.05).The levels of serum apelin and lipocalin-2 of women in study group were significant higher than those of women in control group(P<0.05).Correlation analysis showed that apelin and lipocalin-2 were positively correlated with levels of TC,TG and HOMA-IR(r=0.419,0.435,0.437,0.357,0.521,0.603,P<0.05),and negatively correlated with LDL level(r=-0.406,-0.395,P<0.05),but there were no correlated to the levels of HDL,APoA,ApoB(P>0.05).There were no significant different in the incidence of neonatal hypothyroidism,fetal growth restriction,gestational diabetes mellitus,gestational hypertension,placental abruption,fetal death,and abortion between the two groups(P>0.05).However,the rate of low birth weight infants in study group was significant higher than that in control group(P<0.05).Conclusion:As for pregnant women with hypothyroidism,the levels of Apelin and lipocalin-2 are correlated to dyslipidemia,and maybe related to the rate of low birth weight infants.
引文
[1] 张颖珍,赵明辉,潘学继 . Graves 病早期检测TSH受体抗体临床意义[J].标记免疫分析与临床,2004,11 (2): 123.
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[6] Korevaar T I. Evidence-Based Tightrope Walking: The 2017 Guidelines of the American Thyroid Association for the Diagnosis and Management of Thyroid Disease During Pregnancy and the Postpartum.[J].Thyroid Official Journal of the American Thyroid Association, 2017, 27 (3):315-389.
[7] Bojarska SA,Janicki K,Pietura R,et al.Changes in TSH receptor antibody levels (TRAb) as markers of effectiveness of various therapies in Graves-Basedow's diseaseAnn[J].Univ MariaeCurie Sklodowska Med,2003,58 (1): 248-253.
[8] 宋武战,池君,汪静.促甲状腺激素受体抗体 (TRb) 测定的临床价值[J].免疫学杂志,2007,20 (5): 399-401.
[9] 陈菁,宋杰,张洪文,等.妊娠合并亚临床甲状腺功能减退症的诊治[J].中国妇幼保健,2013,28 (36): 6073-6075.
[10] Lazarus J,Brown RS,Daumerie C,et al.2014 European thyroid association guidelines for the management of subclinical hypothyroidismin pregnancy and in children[J]. Eur Thyroid J,2014,3 (2):76-94.
[11] Bernardi LA,Cohen RN,Stephenson MD. Impact of subclinical hypothyroidism in women with recurrent early pregnancy loss[J]. Fertil Steril,2013,100 (5): 1326-1331.
[12] 齐艳平,吕永平,祁翠鲜.妊娠合并亚临床甲状腺功能减退症对妊娠结局的影响[J].中国药物与临床,2014,14 (11):1586-1588.
[13] 刘芳,陶芳标,苏普玉,等.孕 20 周前母体亚临床甲状腺功能减退对不良妊娠的影响[J].实用儿科临床杂志,2012,27(8): 574-576.
[14] 于晓会,王薇薇,滕卫平,等 . 左旋甲状腺素治疗妊娠期亚临床甲减妇女对后代神经智力发育影响的前瞻性研究[J].中华内分泌代谢杂志,2010,26 (11): 921-925.
[15] 孔丽丽,周金华,黄沁 . 妊娠合并亚临床甲状腺功能减退症的早期治疗对妊娠结局的影响[J].实用妇产科杂志,2014,30 (12): 937-939.
[16] Lee DK,George SR,ODowd BF.Unravelling the roles of the Apelin system:prospective therapeutic applications in heart failure and obesity[J]. Trends Pharmacol Sci,2006,27(4):190-194.
[17] 张爱鸣,李锐,厉钗微.2 型糖尿病患者血脂水平与血清 Apelin等细胞因子的关系研究[J].疾病监测,2009,24(12):961-963.
[18] Wang Y,Lam KS,Kraegen EW,et al. Lipocalin-2 is an inflammatory marker closely associated with obesity,insulin resistance,and hyperglycemia in humans[J].Clin Chem,2007( 1) : 34-41.
[2] 李建宁,赵迎春,何岚,等.妊娠期亚临床甲状腺功能减退症对其后代智力的影响及干预效果分析[J].中国医科大学学报,2015,44(1):64-67,71.
[3] 魏丽,侯兴华,贾伟平.胰岛素上调 3T3-L1细胞 Apelin 基因表达的初步观察[J].中华内分泌代谢杂志,2006,22 (4):384-385.
[4] Boucher J,Masri B,Daviand D,et al.Apelin,a newly identified adipokine up-regulated by insulin and obesity[J].Endocrinology,2005,146(4):1764-1771.
[5] 顾娟,王学东,潘兆麟,等. 肥胖与代谢综合征患者血清 lipocalin-2、hsCRP变化[J].贵阳医学院学报,2012,37(4):364-368.
[6] Korevaar T I. Evidence-Based Tightrope Walking: The 2017 Guidelines of the American Thyroid Association for the Diagnosis and Management of Thyroid Disease During Pregnancy and the Postpartum.[J].Thyroid Official Journal of the American Thyroid Association, 2017, 27 (3):315-389.
[7] Bojarska SA,Janicki K,Pietura R,et al.Changes in TSH receptor antibody levels (TRAb) as markers of effectiveness of various therapies in Graves-Basedow's diseaseAnn[J].Univ MariaeCurie Sklodowska Med,2003,58 (1): 248-253.
[8] 宋武战,池君,汪静.促甲状腺激素受体抗体 (TRb) 测定的临床价值[J].免疫学杂志,2007,20 (5): 399-401.
[9] 陈菁,宋杰,张洪文,等.妊娠合并亚临床甲状腺功能减退症的诊治[J].中国妇幼保健,2013,28 (36): 6073-6075.
[10] Lazarus J,Brown RS,Daumerie C,et al.2014 European thyroid association guidelines for the management of subclinical hypothyroidismin pregnancy and in children[J]. Eur Thyroid J,2014,3 (2):76-94.
[11] Bernardi LA,Cohen RN,Stephenson MD. Impact of subclinical hypothyroidism in women with recurrent early pregnancy loss[J]. Fertil Steril,2013,100 (5): 1326-1331.
[12] 齐艳平,吕永平,祁翠鲜.妊娠合并亚临床甲状腺功能减退症对妊娠结局的影响[J].中国药物与临床,2014,14 (11):1586-1588.
[13] 刘芳,陶芳标,苏普玉,等.孕 20 周前母体亚临床甲状腺功能减退对不良妊娠的影响[J].实用儿科临床杂志,2012,27(8): 574-576.
[14] 于晓会,王薇薇,滕卫平,等 . 左旋甲状腺素治疗妊娠期亚临床甲减妇女对后代神经智力发育影响的前瞻性研究[J].中华内分泌代谢杂志,2010,26 (11): 921-925.
[15] 孔丽丽,周金华,黄沁 . 妊娠合并亚临床甲状腺功能减退症的早期治疗对妊娠结局的影响[J].实用妇产科杂志,2014,30 (12): 937-939.
[16] Lee DK,George SR,ODowd BF.Unravelling the roles of the Apelin system:prospective therapeutic applications in heart failure and obesity[J]. Trends Pharmacol Sci,2006,27(4):190-194.
[17] 张爱鸣,李锐,厉钗微.2 型糖尿病患者血脂水平与血清 Apelin等细胞因子的关系研究[J].疾病监测,2009,24(12):961-963.
[18] Wang Y,Lam KS,Kraegen EW,et al. Lipocalin-2 is an inflammatory marker closely associated with obesity,insulin resistance,and hyperglycemia in humans[J].Clin Chem,2007( 1) : 34-41.