维生素及叶酸水平对妊娠期糖尿病并发子痫前期的预测价值

doi:10.11958/20240818

摘要/Abstract

摘要：

目的探究维生素A、E、D及叶酸水平与妊娠期糖尿病（GDM）患者并发子痫前期（PE）的相关性。方法纳入108例GDM并发PE患者作为PE组，另纳入同期诊治并完成随访的108例GDM未合并PE患者作为GDM组，108例孕检正常孕妇作为正常对照组。比较3组一般资料，维生素A、E、D及叶酸水平。依病情严重程度将PE组再分为轻中度PE组62例和重度PE组46例并比较这2组患者维生素A、E、D及叶酸水平。结果正常对照组、GDM组和PE组收缩压、舒张压、空腹血糖（FBG）、空腹胰岛素（FINS）依次升高（P<0.05），维生素A、E、D及叶酸水平依次降低（P<0.05）。PE组甘油三酯、总胆固醇、糖化血红蛋白高于GDM组和正常对照组，高密度脂蛋白胆固醇低于后2组（P<0.05）。重度PE组维生素A、E、D及叶酸水平低于轻中度PE组（P<0.05）。较高水平的维生素A、E、D及叶酸为影响GDM患者并发重度PE的保护因素。单指标分析时，叶酸预测效能较高，敏感度较高，维生素A预测特异度较高，四者联合预测GDM患者并发重度PE的效能优于各单独指标。结论维生素A、E、D及叶酸水平在GDM并发PE患者血清中显著降低，四者联合可提高对GDM患者并发重度PE的预测价值。

关键词: 维生素A, 维生素E, 维生素D, 叶酸, 糖尿病，妊娠, 高血压，妊娠性, 子痫前期

Abstract:

Objective To investigate the correlation between vitamin A, E, D and folic acid levels and concomitant preeclampsia (PE) in patients with gestational diabetes mellitus (GDM). Methods A total of 108 patients with GDM complicated with PE were used as the PE group, and another 108 GDM patients without PE were used as the GDM group. A total of 108 normal pregnant women with normal pregnancy test were used as the normal control group. The general information and vitamin A, E, D and folic acid levels were compared between the three groups. According to the severity of the disease, the PE group was subdivided into the mild-moderate PE group (62 cases) and the severe PE group (46 cases), and vitamin A, E, D and folic acid levels were compared between these two groups. Results Systolic blood pressure (SBP), diastolic blood pressure (DBP), fasting blood glucose (FBG), fasting insulin (FINS) were increased in turn in the normal control group, the GDM group and the PE groups (P< 0.05), and vitamins A, E, D and folic acid levels were decreased in turn (P< 0.05). Triglyceride, total cholesterol and glycated haemoglobin were higher in the PE group than those in the GDM group and the normal control, and high density lipoprotein (HDL) cholesterol was lower than that in the GDM group and the normal control group (P<0.05). Vitamin A, vitamin E, vitamin D and folic acid levels were lower in the severe PE group than those in the mild to moderate PE group (P<0.05). Higher levels of vitamin A, vitamin E, vitamin D and folate were protective factors for GDM patients with severe PE. Folic acid showed higher predictive efficacy and specificity in single indicator analysis. Vitamin A showed high predictive specificity. The combined prediction of four indicators for severe PE in GDM patients was more effective than each individual indicator. Conclusion Serum vitamin A, E, D and folate levels are significantly lower in patients with GDM complicated with PE, and the combination of all four may improve the predictive value of severe PE complicated with GDM.

Key words: vitamin A, vitamin E, vitamin D, folic acid, diabetes, gestational, hypertension, pregnancy-induced, preeclampsia

中图分类号:

R714.256，R714.245

图/表 6

参考文献 21

[1]	HILDÉN K, HANSON U, PERSSON M, et al. Gestational diabetes and adiposity are independent risk factors for perinatal outcomes:a population based cohort study in Sweden[J]. Diabet Med, 2019, 36(2):151-157. doi:10.1111/dme.13843.
[2]	杨冠兰, 郑丹, 杨冠佼, 等. 分泌型卷曲相关蛋白5与妊娠期糖尿病患者产后糖代谢异常的关系研究[J]. 天津医药, 2022, 50(11):1182-1186.
	YANG G L, ZHENG D, YANG G J, et al. The relationship between secreted frizzled-related protein 5 and abnormal postpartum glucose metabolism in patients with gestational diabetes mellitus[J]. Tianjin Med J, 2022, 50(11):1182-1186. doi:10.11958/20220140.
[3]	刘华, 王敏, 马园园. 孕早期血清afamin浓度与孕妇发生妊娠期高血压疾病和妊娠期糖尿病的关系[J]. 中国妇幼保健, 2019, 34(10):2217-2220.
	LIU H, WANG M, MA Y Y. Relationship between serum afamin concentration in early pregnancy and the occurrence of hypertensive disorders of pregnancy and gestational diabetes mellitus in pregnant women[J]. China Maternal and Child Health, 2019, 34(10):2217-2220. doi:10.7620/zgfybj.j.issn.1001-4411.2019.10.13.
[4]	王芳. 血清维生素水平、氧化应激损伤与孕妇子痫前期的相关性研究[J]. 实用临床医药杂志, 2020, 24(15):87-89.
	WANG F. Correlation between serum vitamin level,oxidative stress injury and preeclampsia in pregnant women[J]. J Practical Clinic Med, 2020, 24(15):87-89. doi:10.7619/jcmp.202015024.
[5]	杜梅, 余云志, 黄静, 等. 孕妇血清维生素A维生素E水平与子痫前期的相关性分析[J]. 中国妇幼保健, 2023, 38(2):195-198.
	DU M, YU Y Z, HUANG J, et al. Correlation analysis of serum vitamin A and vitamin E levels in pregnant women with preeclampsia[J]. Maternal & Child Health Care of China, 2023, 38(2):195-198. doi:10.19829/j.zgfybj.issn.1001-4411.2023.02.001.
[6]	李莉, 赵向阳. 妊娠期糖尿病孕妇25-羟维生素D、Hcy与胰岛素抵抗的相关性分析[J]. 贵州医药, 2023, 47(5):693-694.
	LI L, ZHAO X Y. Correlation analysis of 25-hydroxyvitamin D, Hcy and insulin resistance in pregnant women with gestational diabetes mellitus[J]. Guizhou Medicine, 2023, 47(5):693-694.doi:10.3969/j.issn.1000-744X.2023.05.008.
[7]	刘忠, 周晓明, 张永妍. 血清叶酸血脂及平滑肌22α与妊娠期高血压疾病发病机制的相关性[J]. 中国妇幼保健, 2021, 36(10):2199-2202.
	LIU Z, ZHOU X M, ZHANG Y Y. Correlation of serum folate lipids and smooth muscle 22α with the pathogenesis of hypertensive disorders in pregnancy[J]. China Maternal and Child Health, 2021, 36(10):2199-2202. doi:10.19829/j.zgfybj.issn.1001-4411.2021.10.002.
[8]	隽娟, 杨慧霞. 美国糖尿病学会2022年“妊娠合并糖尿病诊治指南”介绍[J]. 中华围产医学杂志, 2022, 25(4):313-315.
	JUN J, YANG H X. Introduction to the American Diabetes Association's 2022 "Guidelines for the diagnosis and management of gestational diabetes mellitus"[J]. Chinese Journal of Perinatal Medicine, 2022, 25(4):313-315. doi:10.3760/cma.j.cn113903-20220125-00079.
[9]	谢幸, 孔北华, 段涛. 妇产科学[M]. 9版. 北京: 人民卫生出版社, 2018:83-84.
	XIE X, KONG B H, DUAN T. Obstetrics and Gynaecology[M]. 9th ed. Beijing: People's Health Press, 2018:83-84.
[10]	HOMAYOUNI A, BAGHERI N, MOHAMMAD-ALIZADEH-CHARANDABI S, et al. Prevention of gestational diabetes mellitus(GDM) and probiotics:mechanism of action:a review[J]. Curr Diabetes Rev, 2020, 16(6):538-545. doi:10.2174/1573399815666190712193828.
[11]	COSSON E, VICAUT E, SANDRE-BANON D, et al. Early screening for gestational diabetes mellitus is not associated with improved pregnancy outcomes:an observational study including 9795 women[J]. Diabetes Metab, 2019, 45(5):465-472. doi:10.1016/j.diabet.2018.11.006.
[12]	阿依古丽·阿不都, 阿依吐拉·买明, 吴努尔. 妊娠期糖尿病患者血清脂联素和内脂素水平与并发子痫前期的相关性[J]. 中华实用诊断与治疗杂志, 2021, 35(2):139-142.
	AYIGULI A B D, AYITULA M M, WU N R. Correlations of serum adiponectin and visfatin levels with preeclampsia in patients with gestational diabetes[J]. Journal of Chinese Practical Diagnosis and Therapy, 2021, 35(2):139-142. doi:10.13507/j.issn.1674-3474.2021.02.008.
[13]	程娅, 谢吉蓉, 张玲. 妊娠期糖尿病患者孕期维生素A E水平与重度子痫前期的相关性[J]. 中国妇幼保健, 2023, 38(4):583-586.
	CHENG Y, XIE J R, ZHANG L. Correlation between vitamin A,vitamin E levels in pregnancy and severe preeclampsia in patients with gestational diabetes[J]. Maternal & Child Health Care of China, 2023, 38(4):583-586. doi:10.19829/j.zgfybj.issn.1001-4411.2023.04.001.
[14]	黄玲, 赵洁, 杜鹃, 等. 血清维生素A、D及胎盘组织中维生素D受体水平与子痫前期发病的相关性[J]. 临床和实验医学杂志, 2020, 19(11):1188-1191.
	HUANG L, ZHAO J, DU J, et al. Relationship between the levels of Vitamin A,Vitamin D in serum and Vitamin D receptor in placenta and the pathogenesis of preeclampsia[J]. J Clinic and Experimental Med, 2020, 19(11):1188-1191. doi:10.3969/j.issn.1671-4695.2020.11.020.
[15]	NEMA J, SUNDRANI D, JOSHI S. Role of vitamin D in influencing angiogenesis in preeclampsia[J]. Hypertens Pregnancy, 2019, 38(4):201-207. doi:10.1080/10641955.2019.1647231.
[16]	何淑莹, 周燕, 张嵘, 等. 孕期血清维生素A、E水平与子痫前期的相关性研究[J]. 中国妇幼保健, 2018, 33(24):5702-5704.
	HE S Y, ZHOU Y, ZHANG R, et al. Study on the correlations between serum vitamin A and vitamin E levels during pregnancy and preeclampsia[J]. Maternal & Child Health Care of China, 2018, 33(24):5702-5704. doi:10.7620/zgfybj.j.issn.1001-4411.2018.24.11.
[17]	李怡茹, 郭春悦, 陈晔, 等. AMH和INHB及25-(OH)D在PCOS不孕症患者血清中表达水平及与性激素水平的相关性[J]. 热带医学杂志, 2023, 23(6):838-841+888.
	LI Y R, GUO C Y, CHEN Y, et al. The expression levels of AMH,INHB and 25-(OH)D in the serum of PCOS infertility patients and their correlation with sex hormones[J]. Journal of Tropical Medicine, 2023, 23(6):838-841+888. doi:10.3969/j.issn.1672-3619.2023.06.022.
[18]	路红琴, 何玉洁. 血清及卵泡液中25-羟维生素D与体外受精-胚胎移植妊娠结局的相关性[J]. 中华临床医师杂志(电子版), 2020, 14(6):407-412.
	LU H Q, HE Y J. Correlation between 25 hydroxyvitamin D in serum and follicular fluid and pregnancy outcome of in vitro fertilization and embryo transfer[J]. Chin J Clinic Physicians(Electronic Edition), 2020, 14(6):407-412. doi:10.3877/cma.j.issn.1674-0785.2020.06.002.
[19]	FATIMA K, ASIF M, NIHAL K, et al. Association between vitamin D levels in early pregnancy and gestational diabetes mellitus:a systematic review and meta-analysis[J]. J Family Med Prim Care, 2022, 11(9):5569-5580. doi:10.4103/jfmpc.jfmpc_107_22.
[20]	陈国新, 龙振洪. 同型半胱氨酸、叶酸和维生素B12检测在妊娠高血压综合征诊断中的价值[J]. 中国实用医药, 2018, 13(21):21-22.
	CHEN G X, LONG Z H. The value of homocysteine,folic acid and vitamin B12 in the diagnosis of pregnancy induced hypertension syndrome[J]. China Practical Medicine, 2018, 13(21):21-22. doi:10.14163/j.cnki.11-5547/r.2018.21.009.
[21]	曹孟, 徐琴, 阮婷婷, 等. 叶酸联合维生素B₁₂对妊娠期糖尿病患者糖代谢及妊娠结局的影响[J]. 中国食物与营养, 2022, 28(8):87-89.
	CAO M, XU Q, RUAN T T, et al. Effects of folic acid combined with vitamin B₁₂ on glucose metabolism and pregnancy outcomes in patients with gestational diabetes mellitus[J]. China Food and Nutrition, 2022, 28(8):87-89. doi:10.19870/j.cnki.11-3716/ts.2022.08.005.

组别		年龄/ 岁		孕周/ 周			孕前BMI/ （kg/m²）		收缩压/ mmHg
正常对照组		27.31±2.37		38.26±1.30			23.37±2.45		122.38±14.70
GDM组		27.47±2.08		38.18±1.57			23.43±2.50		130.30±8.04^a
PE组		27.35±2.51		38.41±1.68			23.67±2.54		146.43±5.48^ab
F		0.138		0.633			0.437		156.617^＊＊
组别	舒张压/ mmHg				TG/ （mmol/L）	TC/ （mmol/L）		LDL-C/（mmol/L）
正常对照组	75.85±6.19				4.51±0.46	5.87±0.86		2.86±0.74
GDM组	84.27±4.36^a				4.60±0.53	6.01±0.89		2.78±0.74
PE组	108.56±10.54^ab				6.59±0.87^ab	6.72±1.02^ab		2.81±0.62
F	554.964^＊＊				358.499^＊＊	26.163^＊＊		0.358
组别			HDL-C/ （mmol/L）		HbA1c/ %			FBG/ （mmol/L）		FINS/ （mU/L）
正常对照组			1.54±0.41		5.27±0.61			4.10±0.42		6.84±0.71
GDM组			1.55±0.30		5.32±0.73			4.67±0.57^a		11.76±1.57^a
PE组			1.20±0.21^ab		5.92±0.78^ab			5.34±0.69^ab		15.81±2.76^ab
F			42.564^＊＊		28.010^＊＊			127.702^＊＊		617.551^＊＊

组别		年龄/ 岁		孕周/ 周			孕前BMI/ （kg/m²）		收缩压/ mmHg
正常对照组		27.31±2.37		38.26±1.30			23.37±2.45		122.38±14.70
GDM组		27.47±2.08		38.18±1.57			23.43±2.50		130.30±8.04^a
PE组		27.35±2.51		38.41±1.68			23.67±2.54		146.43±5.48^ab
F		0.138		0.633			0.437		156.617^＊＊
组别	舒张压/ mmHg				TG/ （mmol/L）	TC/ （mmol/L）		LDL-C/（mmol/L）
正常对照组	75.85±6.19				4.51±0.46	5.87±0.86		2.86±0.74
GDM组	84.27±4.36^a				4.60±0.53	6.01±0.89		2.78±0.74
PE组	108.56±10.54^ab				6.59±0.87^ab	6.72±1.02^ab		2.81±0.62
F	554.964^＊＊				358.499^＊＊	26.163^＊＊		0.358
组别			HDL-C/ （mmol/L）		HbA1c/ %			FBG/ （mmol/L）		FINS/ （mU/L）
正常对照组			1.54±0.41		5.27±0.61			4.10±0.42		6.84±0.71
GDM组			1.55±0.30		5.32±0.73			4.67±0.57^a		11.76±1.57^a
PE组			1.20±0.21^ab		5.92±0.78^ab			5.34±0.69^ab		15.81±2.76^ab
F			42.564^＊＊		28.010^＊＊			127.702^＊＊		617.551^＊＊

组别	维生素A/ （mg/L）	维生素E/ （mg/L）	维生素D/ （ng/L）	叶酸/ （nmol/L）
正常对照组	0.73±0.13	18.37±3.76	3.66±0.59	21.49±3.48
GDM组	0.56±0.12^a	16.49±3.37^a	3.38±0.61^a	18.78±3.20^a
PE组	0.37±0.05^ab	12.09±2.79^ab	2.60±0.55^ab	14.60±2.99^ab
F	310.899^＊＊	101.145^＊＊	95.592^＊＊	124.753^＊＊

组别	维生素A/ （mg/L）	维生素E/ （mg/L）	维生素D/ （ng/L）	叶酸/ （nmol/L）
正常对照组	0.73±0.13	18.37±3.76	3.66±0.59	21.49±3.48
GDM组	0.56±0.12^a	16.49±3.37^a	3.38±0.61^a	18.78±3.20^a
PE组	0.37±0.05^ab	12.09±2.79^ab	2.60±0.55^ab	14.60±2.99^ab
F	310.899^＊＊	101.145^＊＊	95.592^＊＊	124.753^＊＊

组别	n	维生素A/ （mg/L）	维生素E/ （mg/L）	维生素D/ （ng/L）	叶酸/ （nmol/L）
轻中度PE组	62	0.46±0.07	14.37±3.05	2.97±0.59	16.72±3.14
重度PE组	46	0.26±0.03	9.01±2.45	2.11±0.50	11.75±2.79
t		18.163^＊＊	9.799^＊＊	7.983^＊＊	8.523^＊＊