糖代谢异常母亲的新生儿心肌肥厚与内分泌因子的关系

Relationship between Endocrine Factors and Myocardial Hypertrophy in Infants Born to Gestational Diabetic Mothers

目的了解妊娠期母亲糖代谢异常对胎儿心脏结构的影响,并探讨心肌肥厚与内分泌因子的相关性。方法对23例糖尿病母亲的新生儿(GDM组)、16例糖耐量受损母亲的新生儿(GIGT组)及30例血糖正常母亲的新生儿(健康对照组)出生2 d内取静脉血测定其胰岛素、生长激素(GH)、胰岛素样生长因子-1(IGF-1)及瘦素水平,并对各组新生儿于出生2～4 d进行超声心动图检查了解心脏结构及功能情况。结果 1.GDM组及GIGT组新生儿室间隔厚度[(2.86±0.21)mm,(2.87±0.28)mm]明显高于健康对照组[(2.56±0.57)mm];左室心肌重量[(28.75±1.08)g,(27.99±0.94)g]明显大于健康对照组[(22.61±1.55)g];GDM组及GIGT组之间比较均无统计学差异。2.GDM组及GIGT组新生儿血清胰岛素、IGF-1及瘦素水平明显高于健康对照组(F=42.573、414.941、333.81,Pa=0.000);3组GH水平比较无统计学差异(F=0.615,P=0.544)。糖代谢异常组室间隔厚度与IGF-1水平呈正相关(r=0.46,P<0.05);与胰岛素、GH及瘦素水平均无相关性。结论妊娠期糖代谢异常可对胎儿及新生儿心脏左室形态造成较大影响,其中IGF-1可能参与心脏发育调节,并与心肌肥厚的发生有关。

Objective To observe the influence of glycometabolic abnormality on function and structure of the fetal heart,and study the relationship between serum level of endocrine factors and myocardial hypertrophy.Methods Twenty-three neonates of gestational diabetic mothers（GDM group）,16 neonates born to gestational impaired glucose tolerance mothers（GIGT group） and 30 neonates of non-diabetic mothers（healthy control group） were selected within 4 days after birth by real-time three-dimensional echocardiography（RT-3DE）.The serum levels of growth hormone（GH）,insulin,insulin-like growth factor-1（IGF-1） and leptin were assayed by enzyme-linked immunosorbent assay（ELISA） also.Results The interventricular septum thickness（IVS） was significantly greater in GDM group and GIGT group[（2.86±0.21） mm and（2.87±0.28） mm,respectively] than that in healthy control group[（2.56±0.57） mm].The left ventricular mass（LVM） of the neonates in GDM and GIGT groups were also significantly greater[（28.75±1.08） g and（27.99±0.94） g,respectively] than that in healthy control group[（22.61±1.55） g].Serum levels of insulin,IGF-1 and leptin of neonates in GDM and GIGT groups were higher than that in healthy control group（F=42.57,414.941,333.81,Pa=0.000）.But the GH concentration had no significant diffe-rence in the 3 groups（F=0.615,P=0.544）.There was a positive correlation between IVS and IGF-1 level（r=0.46,P0.05）,but there was no correlation between IVS and insulin,GH or leptin level.Conclusions Glycometabolic abnormality in gestational period may have influence on the hearts of fetus and neonates.IGF-1 may play a role in the occurrence of myocardial hypertrophy.