血糖水平对妊娠糖尿病孕妇心脏功能的影响

Effect of Blood Glucose Level on Cardiac Function in Pregnant Women with Gestational Diabetes Mellitus

目的分析血糖水平对妊娠糖尿病孕妇心脏功能影响。方法选择2014年9月至2015年10月诊断妊娠糖尿病孕妇120例,依据患者妊娠期血糖控制水平分为优控组67例,差控组53例。另取同期正常妊娠孕产妇40例作为对照组。分别于确诊时与临产前,采用免疫放射比浊法检测血清C反应蛋白、酶联免疫吸附法检测血清白细胞介素-6水平变化。采用心脏超声检测心脏二维超声结构变化,采用心脏血流多普勒、组织多谱勒分析心脏舒张功能指数E/A,E/Ea比值变化。免疫荧光比浊法检测血浆钠尿肽(BNP,pg/m L)水平。比较3组孕妇指标差异。结果确诊时,3组孕妇年龄、体质量指数、血脂水平、血清C反应蛋白(CRP,mg/L)、白细胞介素-6(IL-6,ng/m L)、BNP(pg/m L)水平无统计学意义(P>0.05)。临产前,对照组、优控组、差控组孕妇血清CRP、IL-6水平逐渐升高,3组比较差异有统计学意义(P<0.05),其中,优控组与对照组差异无统计学意义(P>0.05)。对照组、优控组、差控组孕妇二维超声结构左心房直径、左心室舒张期内径、室间隔厚度、左心室后壁厚度、左室射血分数差异无统计学意义(P>0.05)。E/A比值逐渐下降,E/Ea比值以及血清BNP水平逐渐升高,3组间比较差异有统计学意义(P<0.05)。其中,优控组与对照组比较差异无统计学意义(P>0.05)。结论妊娠期孕产妇血糖增加可以激发机体微炎性反应,导致孕产妇临产前心脏舒张功能下降,可能增加孕产妇围生期并发症发生率。

Objective To analyze the effect of blood glucose level on cardiac function in pregnant women with gestational diabetes mellitus. Methods The 120 cases of pregnant women with gestational diabetes were selected from September 2014 to October 2015.According to the level of blood glucose, the patients were divided into sixty-seven cases in the control group and forty-three cases in the control group. Meanwhile, another forty cases of normal pregnant women were taken in as control group. Respectively at diagnosis and before labor, the radio immunity turbidity method was used to detect serum C reaction protein, enzyme linked immunosorbent assay for the detection of serum interleukin-6 levels change.Using echocardiography to analyze the two dimensional echocardiogram structural changes, the cardiac blood flow Doppler and tissue Doppler analysis of cardiac diastolic function index of E/A, E/Ea ratio changes. The levels of BNP in plasma was detected by immunofluorescence assay. The differences of three groups of pregnant women were compared. Results At the time of diagnosis, the maternal age, body mass index, lipid levels, serum C-reactive protein, interleukin-6 and BNP levels had no statistical significance among three groups（P〉0.05）. Prior to the onset of labor, the serum CRP and IL-6 levels of pregnant women among the control group, optimal control group and poor control group increased gradually, the differences among the three groups have statistical significance（P〈0.05）. The difference was not statistically significant between the control group and control group（P〉0.05）. In the control group,and control group, control group of pregnant women with two-dimensional ultrasound structure of left atrium diameter, left ventricular diastolic diameter, interventricular septum thickness, left ventricular posterior wall thickness, left ventricular ejection fraction were no statistical significance（P〈0.05）. The E/A ratio gradually decreased, E/Ea ratio and serum BNP level gradually increased, the difference among the three groups was statistically significant（P〈0.05）. There had no significant difference between the optimal control group and the control grou（P〉0.05）. Conclusion The high blood glucose level of pregnancy maternal can stimulate inflammation reaction and lead to cardiac diastolic function decreased before the onset of labor, which may increase the incidence of perinatal period complications of pregnant women.