天津医药

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糖耐量正常孕妇糖化血红蛋白、内脂素水平与围生结局的相关性研究

华绍芳,匡德凤,韩玉环   

  1. 天津医科大学第二医院产科
  • 收稿日期:2013-01-04 修回日期:2013-03-21 出版日期:2013-10-15 发布日期:2013-10-15
  • 通讯作者: 华绍芳

The Relationship between Glycosylated Hemoglobin, Serum Visfatin Level and Perinatal Outcome in Pregnant Women with Normal Glucose Tolerance

HUA Shao fang,KUANG De feng,HAN Yu huan   

  1. Department of Obstetrics, The Second Hospital of Tianjin Medical University
  • Received:2013-01-04 Revised:2013-03-21 Published:2013-10-15 Online:2013-10-15
  • Contact: HUA Shao fang

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摘要：

【摘要】  目的  探讨糖耐量正常（NGT）孕妇血清糖化血红蛋白（HbA1c）、内脂素水平与糖脂代谢、围生结局的相关性。  方法  135例研究对象均为经75g口服糖耐量试验（OGTT）诊断为NGT的孕足月妇女，根据HbA1c水平是否≥5.5%分为高HbA1c组（n=66）和正常HbA1c组（n=69）。收集临床资料，高效液相离子层析法测定HbA1c水平，双抗体夹心酶标免疫分析法检测血清内脂素水平。比较不同HbA1c组孕妇体质指数（BMI）、孕期体质量增加量、内脂素、血糖、血脂等水平的差异，分析HbA1c、内脂素水平与糖脂代谢、分娩方式、围生结局等的相关性。  结果  高HbA1c组NGT孕妇孕期体质量平均增长量、血清内脂素水平、总胆固醇（TC）、三酰甘油（TG）、低密度脂蛋白（LDL）、高密度脂蛋白（HDL）均高于正常HbA1c组；前组新生儿具有较高的平均出生体质量和较低的血糖水平以及较高的剖宫产率；羊水过多、羊水粪染、巨大儿、新生儿低血糖的发生率均高于正常HbA1c组。在135例NGT孕妇中HbA1c水平与孕期体质量增加量、内脂素和新生儿出生体质量水平呈正相关。  结论  孕期体质量增长过多、内脂素表达上调可引发孕妇血糖水平升高；应选择适宜分娩时机及方式预防不良妊娠结局的发生。

关键词: 妊娠, 血红蛋白A, 糖基化, 烟酰胺磷酸核糖基转移酶, 预后

Abstract:

[Abstract]   Objective   To investigatethe relationship between the levels of serum glycosylated hemoglobin (HbA1c),
serum visfatin, glucose and lipid metabolism and the perinatal outcome in pregnant women with normal glucose tolerance
(NGT).   Methods   A total of135NGT pregnant women diagnosed by oral glucose tolerance test (OGTT) entered this study. Patients were divided into two groups, high HbA1c group (HbA1c≥5.5%,n=66) and normal HbA1c group (HbA1c<5.5%,n=69). The clinical data were collected in two groups. HbA1c levels were measured by HPLC, and the serum visfatin levels were measured by ELISA method. The values of body mass index (BMI), pregnant weight gain, visfatin, glucose and lipid metabolic levels were analyzed between two groups. The relationship between levels of HbA1c, visfatin, glucose and lipid metabolism and perinatal outcome were compared between two groups.  Results  The values of mean pregnancy weight gain, visfatin, total cholesterol (TC), triacylglycerol (TG), low density lipoprotein (LDL) and high density lipoprotein (HDL) were higher in high HbA1c group than those of normal HbA1c group. In NGT women with high HbA1c level，there were higher average birth weight, lower blood glucose level in newborn babies and higher rates of cesarean section. The incidences of polyhydramnios, meconium- stained fluid, macrosomia and neonatal hypoglycemia were also higher in NGT women with high HbA1c than those of normal HbA1c group. There was a positive relationship between HbA1c level, pregnant weight gain and visfatin andbirth weight of newborn babies in135NGT pregnant women.  Conclusion   The excessive weight gain during pregnancy can induce the up- regulation of the visfatin level, resulting in the increased blood glucose level. The optimal timing and mode of delivery could prevent the occurrence of adverse pregnancy outcomes.

Key words: pregnancy, hemoglobin A, glycosylated, nicotinamide phosphoribosyltransferase, prognosis