妊娠期糖尿病孕妇并发妊娠期高血压疾病的临床特点及血清CRP、IL-6、TNF-α的水平分析

Analysis on the clinical characteristics of pregnant women with gestational diabetes mellitus combined with hypertensive disorder complicating pregnancy and the serum levels of C-reactive protein,interleukin-6,and tumor necrosis factor-α

目的:探讨妊娠期糖尿病(GDM)并发妊娠期高血压疾病患者的临床特点,检测血清中C-反应蛋白(CRP)、白细胞介素-6(IL-6)、肿瘤坏死因子-α(TNF-α)的水平。方法:前瞻性观察2007年12月～2009年1月在北京妇产医院定期检查的孕妇,Ⅰ组为正常组(55例),Ⅱ组为GDM组(168例),Ⅲ组为GDM合并妊娠期高血压疾病组(32例)。检测空腹血清中CRP,IL-6,TNF-α、胰岛素、C-肽、糖化血红蛋白及血糖水平,并记录相关临床资料。结果:①三组CRP、IL-6、TNF-α水平差别有统计学意义(P<0.01),其中Ⅲ组CRP、IL-6、TNF-α水平最高。Ⅲ组孕前BMI、平均每周增长BMI、空腹血糖、胰岛素、C肽及糖化血红蛋白(HbA1c)水平及胰岛素治疗比例均高于Ⅱ组(P<0.05)。②CRP、IL-6均与空腹血糖呈正相关(r=0.229,0.216,P<0.01),CRP,IL-6,TNF-α与孕前体重指数呈正相关(r=0.288,0.260,0.194,P<0.01),CRP与IL-6呈正相关(r=0.388,P<0.01)。③Logistic回归分析及多元逐步回归分析显示,对GDM合并妊娠期高血压疾病意义最大的为IL-6(R2=0.358)。④CRP、IL-6、TNF-α对GDM合并妊娠期高血压疾病的预测切点分别为7.0 mg/L、294.0 pg/ml、123.5 pg/ml,ROC曲线下面积分别为0.715、0.884、0.627(P<0.01)。结论:孕前高BMI、血糖控制欠佳、需要胰岛素治疗将增加GDM并发妊娠期高血压疾病的风险,CRP、IL-6、TNF-α水平可能对GDM并发妊娠期高血压疾病有一定预测价值。

Objective： To explore the clinical characteristics of pregnant women with gestational diabetes mellitus （GDM） combined with hypertensive disorder complicating pregnancy （HDCP）, detect the levels of Creactive protein （CRP）, interleukin- 6 （IL- 6）, and tumor necrosis factor-α （TNF-α） in serum. Methods： The pregnant women who received prenatal examination regularly in the hospital from December 2007 to January 2009 were observed, then they were divided into normal group （group Ⅰ , 55 cases）, GDM group （group Ⅱ, 168 cases）, and GDM combined with HDCP group （group 19,32 cases） . The serum levels of CRP, IL -6, TNF -α, insulin, Cpeptide, glycated hemoglobin, and blood glucose were detected, related clinical data were recorded. Results： There was significant difference in the serum levels of CRP, IL -6, and TNF -α among the three groups （P 〈0.01 ）, the serum levels of CRP, IL -6, and TNF -α in group Ⅰ were the highest. The pregestational body mass index （.BMI）, the mean increase of BMI every week, fasting blood glucose, insulin level, Cpeptide level, glycated hemoglobin level, and the proportion of insulin treatment in group 19 were significantly higher than those in group Ⅱ （P 〈 0. 05 ） . CRP and IL - 6 were positively correlated with fasting blood glucose （T = 0. 229, P 〈 O. 01 ; γ = 0. 216, P 〈 0. 01 ） . CRP, IL - 6, and TNF -αwere positively correlated with pregestational BMI （γ= 0. 288, P 〈 0. 01 ; γ= 0. 260, P 〈 0. 01 ; γ= 0. 194, P 〈 0. 01 ） . There was positive correlation between CRP and IL - 6 γ = 0. 388, P 〈 0. 01 ） . Logistic regression analysis and multivariate stepwise regression analysis showed that IL -6 was the most important index for GDM combined with HDCP （ R^2 = 0. 358 ） . The tangent points of CRP, IL - 6, and TNF -αto predict GDM combined with HDCP were 7.0 mg/L, 294. 0 pg/ml, and 123.5 pg/ml, respectively, the areas under ROC curve were 0. 715, 0. 884, and 0. 627, respectively （P 〈 0. 01 ） . Conclusion： High progestational BMI, poor control of blood glucose, and needing insulin treatment may increase the risk of GDM combined with HDCP, the levels of CRP, IL - 6, and TNF -α have a certain values for prediction of GDM combined with HDCP.