新生儿脐带血IGF-Ⅰ水平与妊娠期糖代谢异常母体HbAlc的关系

Relationship between plasma IGF-Ⅰ level in neonatal umbilical cord blood and serum HbAlc level in patients with gestational abnormal glucose metabolism

目的观察和分析新生儿脐带血胰岛素样生长因子-Ⅰ(IGF-Ⅰ)水平与妊娠期糖代谢异常母体糖化血红蛋白(HbAlc)的关系。方法选取130例足月分娩产妇作为研究对象,根据其妊娠期血糖代谢情况其分为对照组(妊娠期糖耐量正常,49例)、GIGT组(妊娠期糖耐量减低患者,61例)和GDM组(妊娠期糖尿病患者,20例),对三组产妇血浆HbAlc水平、新生儿脐带血IGF-Ⅰ水平及新生儿体重进行观察和分析。结果三组产妇的血浆HbAlc水平和新生儿脐带血IGF-Ⅰ水平、出生体重的差异均有统计学意义(F值分别为9.637、26.697、59.223,均P<0.05),进一步采用LSD法两两比较后发现,GDM组产妇的血浆HbAlc水平显著高于对照组和GIGT组(均P<0.05),GIGT组新生儿脐带血IGF-Ⅰ水平、出生体重均高于对照组和GDM组(均P<0.05)。各组新生儿脐带血IGF-Ⅰ水平与产妇血浆HbAlc水平和新生儿出生体重均呈正相关关系(r=0.612~0.881,均P<0.05)。巨大儿的发生与新生儿脐带血IGF-Ⅰ水平具有相关性(OR=1.848,P<0.05)。结论在妊娠晚期糖代谢异常产妇中,GDM产妇表现为HbAlc水平的显著升高,而GIGT产妇表现为新生儿脐带血IGF-Ⅰ水平和出生体重的显著升高,且IGF-Ⅰ水平与巨大儿的发生具有独立相关性可将产妇HbAlc水平和新生儿脐带血IGF-Ⅰ水平作为预测糖代谢异常产妇母儿结局的重要参考指标。

Objective To observe and analyze the relationship between plasma insulin like growth factor I（ IGF-I） level in neonatal umbilical cord blood and serum glycosylated hemoglobin（ HbAlc） level in mother with gestational abnormal glucose metabolism. Methods Altogether 130 women with full-term delivery were selected as research objects and divided into control group（ patients with gestational normal glucose tolerance,49 cases）,GIGT group（ patients with gestational impaired glucose tolerance,61 cases） and GDM group（ patients with gestational diabetes mellitus,20 cases） according to blood glucose metabolism status during pregnancy. Maternal plasma HbAlc level and serum IGF-Ⅰ level in neonatal umbilical cord blood as well as birth weight of newborns in three groups were observed and analyzed. Results There was significant difference in maternal plasma HbAlc level,neonatal umbilical cord blood IGF-Ⅰ level and birth weight among three groups（ F value was 9. 637,26. 697 and 59. 223,respectively,all P〈0. 05）. Further data comparison between each two groups by using LSD revealed that level of plasma HbAlc of mothers in GDM group was significantly higher than that in the control group and GIGT group（ all P〈0. 05）,and serum IGF-Ⅰ level in neonatal umbilical cord blood as well as birth weight of newborns in GIGT group were higher than those in the control group or GDM group（ all P〈0. 05）. Serum IGF-Ⅰ level in neonatal umbilical cord blood was positively correlated with maternal plasma HbAlc level or birth weight of newborns in three groups（ r value ranged from 0. 612 to0. 881,all P〈0. 05）. Occurrence of fetal macrosomia was correlated with serum IGF-Ⅰ level in neonatal umbilical cord blood（ OR =1. 848,P〈0. 05）. Conclusion In parturient women with abnormal glucose metabolism in late pregnancy,patients with GDM show significant increase of HbAlc level,while patients with GIGT show significant increase of IGF-Ⅰ level in neonatal umbilical cord blood and birth weight,and IGF-Ⅰ level is independently related with occurrence of fetal macrosomia. Maternal Hb A1 c level and IGF-Ⅰ level in neonatal umbilical cord blood should be taken as important reference indexes in prediction of maternal and neonatal outcome of patients with gestational abnormal glucose metabolism by clinicians.