Lp-PLA2活性在妊娠期糖尿病中的变化及其临床意义

Change of Lp-PLA2 activity in gestational diabetes mellitus and its clinical significance

目的探讨妊娠期糖尿病(GDM)患者脂蛋白相关磷脂酶A2(Lp-PLA2)的活性变化及其与妊娠不良结局的关系。方法以该院产科门诊2012年9月-2014年1月收集的62例GDM孕妇作为研究对象,其中血糖控制良好的孕妇35例(A组)、血糖未良好控制孕妇27例(B组)。另选取同期正常妊娠妇女30例作为对照组。检测并比较3组研究对象Lp-PLA2活性及妊娠结局差异。结果 3组研究对象Lp-PLA2、空腹血糖值(FBG)、2 h餐后血糖值(2h BG)、胰岛素抵抗指数(HOMAIR)、甘油三酯(TG)值比较,差异均有统计学意义(P<0.05)。B组患者的Lp-PLA2、FBG、2h BG、HOMA-IR、TG值均显著高于A组及对照组(P<0.05);A组Lp-PLA2、FBG、2h BG、HOMA-IR值均显著高于对照组(P<0.05)。B组巨大儿发生率(33.33%)、胎膜早破率(22.22%)、早产率(37.04%)均显著高于A组和对照组(P<0.05)。GDM孕妇的FBG值与LpPLA2呈正相关(P<0.05)。结论 GDM患者的Lp-PLA2活性显著增强,并且与血糖控制水平具有相关性,同时妊娠期血糖控制不良可能导致妊娠不良结局发生率增加。

Objective To explore the change of lipoprotein-pregnancy associated phospholipase A2 （Lp-PLA2） activity in pa- tients with gestational diabetes melfitus （GDM） and its relationship with adverse pregnancy outcome. Methods Sixty-two GDM pregnant women were collected from Obstetric Outpatient in the hospital from September 2012 to January 2014, then they were divided into group A （35 pregnant women with well-controlled blood glucose） and group B （27 pregnant women without good blood glucose control） . Thirty nor- mal pregnant women during the same period were selected as control group. Lp-PLA2 activity and pregnancy outcomes in the three groups were detected and compared. Results There were statistically significant differences in Lp-PLA2 activity, fasting blood glucose （FBG）, 2-hour postprandial blood glucose （2 h BG） , insulin resistance index （HOMA-IR） , and tfiglyeeride （TG） levels among the three groups （P〈O. 05） . Lp-PLA2, FBG, 2 h BG, HOMA-IR, and TG levels in group B were statistically significantly higher than those in group A and control group （P〈0. 05） ; Lp-PLA2, FBG, 2 h BG, and HOMA-IR in group A were statistically significantly higher than those in con- trol group （ P〈0.05 ） . The incidence rates of macrosomia, premature rupture of fetal membrane （ PROM）, and premature birth in group B were 33.33% , 22. 22% , and 37.04% , respectively, which were statistically significantly higher than those in group A and control group （P〈0. 05） . Among the GDM pregnant women, FBG level was positively correlated with Lp-PLA2 （ P〈0. 05 ） . Conclusion Lp-PLA2 activity increases significantly among GDM patients, which is correlated with the level of blood glucose control; bad blood glucose control during pregnancy may lead to increase of incidence rate of adverse pregnancy outcomes.