血糖对于妊娠期糖尿病孕妇心脏功能影响

Effect of blood glucose on cardiac function of pregnant women with gestational diabetes mellitus

目的探讨不同的血糖控制水平对于妊娠期糖尿病孕产妇心脏功能影响。方法选择2013年1月-2016年3月诊断妊娠期糖尿病患者110例,依据患者血糖控制水平分为升高组与正常组,取同期血糖水平正常孕产妇40例作为对照组。分别与孕中期（24周）与临产前给予超声检查心脏超声指标：左室舒张末期内径、左室收缩末期内径、左室后壁厚度、室间隔厚度、左室射血分数以及左室二尖瓣舒张早期血流充盈速度/二尖瓣舒张晚期血流充盈速度比（E/A）、二尖瓣舒张早期血流充盈速度/心肌舒张早期二尖瓣环根部运动速度峰值比（E/Ea）。采用免疫比浊法检测血清高敏C反应蛋白（hs-CRP）,酶联免疫吸附法检测血清肿瘤坏死因子-α（TNF-α）,免疫荧光法检测患者血浆钠尿肽水平（BNP）,全自动生化分析仪检测患者血脂代谢指标。结果孕末期,血糖升高组与正常组比较,患者E/A比值减少,E/Ea比值增加,两组比较差异有统计学意义（P〈0.05）。正常组与对照组患者E/A、E/Ea比值差异无统计学意义（P〉0.05）。3组患者左室舒张末期内径、左室收缩末期内径、左室后壁厚度、室间隔厚度、左室射血分数指标差异无统计学意义（P〈0.05）。血糖升高组患者血清hs-CRP、TNF-α、BNP水平以及血脂代谢指标高于正常组与对照组,组间比较差异有统计学意义（P〈0.05）。而正常组与对照组相关指标比较差异无统计学意义（P〉0.05）。结论孕期血糖控制不良可以导致妊娠期糖尿病患者心脏舒张功能减退,脂质代谢紊乱。分析原因与高血糖刺激机体炎性反应水平升高有关。

Objective To explore the effect different levels of blood glucose control to cardiac function of pregnant women with gestational diabetes mellitus. Methods 110 cases of patients with gestational diabetes mellitus dignosed in our hospital from January 2013 to March 2016 were selected and divided into elevated group and normal group according to the level of blood glucose control. 40 cases with normal blood glucose level were selected as control group. Ultrasound echocardiographic indexes were given on the second trimester（24 weeks） and before labor respectively, including left ventricular end diastolic diameter, left ventricular end systolic diameter, left ventricular posterior wall thickness, interventricular septum thickness, left ventricular ejection fraction, Left ventricular early diastolic filling velocity/Late diastolic filling velocity（E/A）, Left ventricular early diastolic filling velocity/Early diastolic peak velocity of mitral annulus（E/Ea）. Immune Turbidimetry was used to detect serum high-sensitivity C reactive protein（hs-CRP）. Enzyme linked immunosorbent assay was used to detect serum tumor necrosis factor-α（TNF-α）. Immunofluorescence assay was used to detect plasma natriuretic peptide levels（BNP）. Automatic biochemical analyzer was used to detect lipid metabolism index. Results At the end of pregnancy, compared with the normal group, the E/A ratio and the E/Ea ratio increased, the difference between the 2 groups was statistically significant（P 〈 0.05）. There was no significant difference in E/A and E/Ea between normal group and control group（P 〉 0.05）. There was no significant difference between the 3 groups in left ventricular end diastolic diameter, left ventricular end systolic diameter, left ventricular posterior wall thickness, interventricular septum thickness, left ventricular ejection fraction（P 〈 0.05）. The serum levels of hs-CRP, TNF-α, BNP and lipid metabolism in patients with elevated blood glucose were higher than those in normal group and control group, and the difference was statistically significant（P 〈 0.05）. There was no significant difference between the normal group and the control group（P 〉 0.05）. Conclusion Poor glycemic control during pregnancy can lead to impaired cardiac diastolic function in patients with gestational diabetes mellitus and lipid metabolism disorder. By analyzing the reason, it is associated with elevated levels of inflammatory response to hyperglycemia.