妊娠期糖尿病胎盘组织血管内皮生长因子、基质金属蛋白酶-9和Ⅳ型胶原的表达及意义

Expression and significance of vascular epithelial growth factor and matrix metalloproteinase-9 and type Ⅳ-collagen in gestational diabetic placenta

目的探讨血管内皮生长因子（VEGF）、基质金属蛋白酶-9（MMP-9）和Ⅳ型胶原（Ⅳ-C）在妊娠期糖尿病（GDM）胎盘中的表达及其与GDM治疗的关系。方法选择2007年6月至12月在太原市妇幼保健医院住院分娩的GDM孕妇48例为GDM组，取同期分娩的正常晚期妊娠妇女36例为对照组，用免疫组织化学法测定VEGF、MMP-9及Ⅳ-C在胎盘中的表达并比较其表达情况。结果（1）GDM组胎盘VEGF、MMP-9及Ⅳ-C的阳性表达率明显高于对照组（70．8％和30．6％，64．6％和30．6％，62．5％和27．8％，P值均〈0．05）；（2）GDM组内血糖控制不满意者胎盘VEGF、MMP-9及Ⅳ-c的阳性表达率分别为95．2％、80．9％和85．7％，明显高于对照组（P％0．05）；血糖控制满意组分别为51．9％、51．9％和44．4％，与对照组比较差异无统计学意义（P〉0．05）；（3）GDM组胎盘MMP-9的表达与VEGF和Ⅳ-C的表达均呈正相关（r=0．579，P〈0．01；F=0．596，P〈0．01）。结论GDM胎盘组织中VEGF、MMP-9及Ⅳ-C的高表达与孕妇血糖控制水平有关。

Objective To investigate the expression and clinical significance of vascular epithelial growth factor （VEGF） and matrix metalloproteinase-9 （MMP-9） and type Ⅳ-collagen（Ⅳ- C） in gestational diabetic placenta. Methods A case-control study was performed in 48 women with gestational diabetes mellitus （GDM） and 36 healthy pregnant women （control）, who delivered at Taiyuan Maternal and Infant Health Care Hospital from Jun. 2007 to Dec. 2007. The expressions of VEGF, MMP-9 and Ⅳ-C in placenta were detected by immunohistochemistry. Results The expression of VEGF, MMP-9 and Ⅳ-C in GDM placenta was significantly higher than that of control （70.80% vs 30.6%,64.6% vs 30. 6% ,62.5% vs 27.8%,all P〈0.05）. For those GDMs whose blood glucose levels were well controlled, the expression of VEGF, MMP-9 and Ⅳ-C （51.90%, 51.9% and 44. 4%） showed no difference from the control （P〉0.05）, however, those GDMs which were poor- controlled, the expression of the three indicators （95.2%, 80.9% and 85.7%） were higher than the control （P〈0.05）. The expression of MMP-9 was positively correlated with that of VEGF and Ⅳ-C in the GDM group（r= 0. 579, P〈0.01 ; r= 0. 596, P〈0.01）. Conclusions The high expression of VEGF, MMP-9 and Ⅳ-C in GDM placenta may be associated with blood glucose control. Early management of the blood sugar level might alleviate the pathological changes in placenta.