妊娠期糖尿病对新生儿免疫功能的影响

Impact of gestational diabetes mellitus on the neonatal immunity

目的监测并比较妊娠期糖尿病孕妇在不同血糖控制情况下,其新生儿免疫球蛋白IgG、IgM、IgA与T淋巴细胞亚群CD 3+、CD 4+、CD 8+、CD 4+/CD 8+的值以及自然杀伤(natural killer,NK)细胞的含量值。方法选取凉山彝族自治州第二人民医院210例经确诊为妊娠期糖尿病(gestational diabetes mellitus,GDM)患者分娩的新生儿作为研究组,以及同时期100例由正常孕妇分娩的新生儿作为对照组。根据血糖控制水平,将GDM患者分为血糖控制理想组(GDM-A组)115例患者和血糖控制不理想组(GDM-B组)95例患者。采用流式细胞仪监测外周血T细胞亚群和NK细胞的含量;采用散射比浊度法检测免疫球蛋白的含量。结果经流式细胞仪检测,对于GDM-B组的新生儿,外周血中CD 3+细胞[(52.35±11.17)%]、CD 8+细胞[(15.69±5.58)%]水平均低于对照组和GDM-A组,CD 4+/CD 8+比值[(1.58±0.39)%]高于对照组;而NK细胞(6.37±1.29)%水平明显低于对照组与GDM-A组,差异均有统计学意义(P<0.05)。GDM-A组新生儿外周血中NK细胞水平为(8.44±2.05)%,低于对照组(11.19±1.74)%,差异有统计学意义(P<0.05)。而其他外周血T淋巴细胞亚群水平与对照组相比,差异无统计学意义(P>0.05)。经散射比浊法检测,GDM-B组新生儿外周血IgG水平为(6.45±1.25)g/L,低于对照组[(9.99±1.36)g/L]和GDM-A组[(9.47±1.58)g/L]水平,差异有统计学意义(P<0.05)。其他数据3组比较差异无统计学意义(P>0.05)。结论 GDM可能会影响新生儿非特异性免疫功能,若妊娠期间血糖控制不理想,则可能造成新生儿免疫功能低下。因此GDM孕妇应积极控制妊娠期间血糖水平。

Objective To observe and compare the levels of IgG, IgM, IgA, CD3 ＋ , CD4 ＋ , CD8 ＋ , CD4 ＋/CD8 ＋ and natural killer （NK） cell in the peripheral blood of newborns based on the different glycemic control level of the gestational diabetes mellitus （GDM）. Methods 100 healthy puerperas as well as their normal full - month neonatus in Liangshan Yi Autonomous Prefecture Second People＇s Hospital were selected as the control group, and 210 newborns of GDM puerperas were selected as the study group. According to the glycemic control level, 115 cases were divided into the satisfactory group of glycemic control level （GDM -A Group） and 95 cases were divided into the unsatisfactory group of glycemic control level （ GDM - B Group）. The mount of IgG, IgM, IgA were detected by immunoassay, while the mount of CD3 ＋ , CD4 ＋ , CD8 ＋ , CD4 ＋/CD8 ＋, NK cell were measured by flow cytometry. Results According to the test results of flow cytometry, the mounts of CD3 ＋ [ （ 52. 35 ± 11.17 ） % ] and CD8 ＋ [ （15. 69 ± 5.58）% ] of neonates in GDM -B Group were lower than those in control group and GDM -A Group, while the ratio of C D4 ＋/CD8 ＋ [ （1.58 ±0. 39） % ] was higher than that of the control group （P 〈0. 05）. The mount of NK cell[ （6. 37± 1.29） % ] of neonates in GDM - B group were obviously lower than that of the control group （P 〈 0. 01 ）, and also lower than that of GDM - A Group （ P 〈 0.05 ）. The mount of NK cell （ 8.44 ± 2. 05 ） % of neonates in GDM - A Group were obviously lower than that of the control group （ 11.19± 1.74） % （ P 〈 0. 05 ）. According to the test results of immunoassay, the level of IgG in the neonatal peripheral blood was （6. 45 ± 1.25） g/L in GDM - B Group, which was lower than that of the control group [ （9. 99 ± 1.36） g/L] and GDM - A Group [ （9.47 ±1.58 ） g/L ], and there were statistical differences （ P 〈 0.05 ）. Conclusion The gestational diabetes mellitus could impact the non - specific immunity of the neonatus. Control mother＇ s glycemic can improve the level of neonate＇ s immunity. Therefore, in the gestation period, the GDM mothers should control the blood glucose in the satisfied level actively.