妊娠期糖尿病的高血压临床特点及血清炎症因子水平研究

Analysis of clinical features of hypertensive pressure and serum levels of inflammatory cytokines in patients with gestational diabetes mellitus

目的探讨妊娠期糖尿病(GDM)并发妊娠期高血压疾病孕妇的临床特点及血清炎症因子水平的变化。方法选取2016年1至12月在首都医科大学附属北京妇产医院围产医学部规律进行孕检的孕妇103例,其中正常孕妇39例(正常组),GDM患者31例(GDM组),GDM合并妊娠高血压33例(合并组)。检测三组孕妇空腹血清中炎症因子的表达,并进行比较分析。结果 (1)合并组的白介素(IL)-6、C反应蛋白(CRP)、肿瘤坏死因子(TNF)-α均高于GDM组及正常组(t=4.243~5.174,均P<0.05),合并组的IL-6、CRP、TNF-α、糖化血红蛋白(HbA1c)、C肽、胰岛素及空腹血糖(FBG)水平均高于GDM组(t=4.043~4.947,均P<0.05),且随着孕前体质量指数(BMI)的增加,合并组的IL-6、CRP、TNF-α水平均有显著升高的趋势(t值分别为12.396、5.578、4.946,均P<0.05);(2)相关性结果显示,CRP、IL-6、TNF-α与孕前BMI均呈正相关(r值分别为0.305、0.258、0.203,均P<0.01),CRP、IL-6均与FBG呈正相关(r值分别为0.243、0.221,均P<0.01);(3)Logistic回归分析显示,对GDM合并妊娠期高血压疾病意义最大的为IL-6(R2=0.462)。结论炎症因子CRP、IL-6及TNF-α在GDM合并高血压疾病中水平显著上升,对GDM孕妇及早检测炎症因子可能有助于预测高血压疾病的发生,值得临床推广和应用。

Objective To investigate the clinical features and serum levels of inflammatory cytokines in pregnant women with gestational diabetes mellitus （GDM） complicated with hypertensive disorder complicating pregnancy （HDCP）. Methods A total of 103 pregnant women in Perinatal Medical Department of Beijing Obstetrics and Gynecology Hospital were included in this study, including 39 cases of normal controls （normal group）, 31cases of GDM （GDM group） and 33 cases of GDM complicating HI）CP （combined group）. The expression of inflammatory factors in serum of three groups of pregnant women were detected and compared. Results The levels of IL-6, CRP, TNF-α of the combined group were higher than those in the GDM group and the normal group （t value ranged 4.243 to 5.174, all P〈0.05）, and the levels of IL-6, CRP, TNF-α, HbAlc, C peptide, insulin and Fig5 were higher than those of the GDM group （t value ranged 4.043 to 4.947, all P〈0.05）. With the increase of pre-pregnancy BM1, IL-6, CRP, and TNF- α level had a significant increasing trend in the combined group （t value was 12.396, 5.578 and 4.946, respectively, all P〈0.05）. CRP, IL-6 and TNF-α were positively correlated with pre-pregnaney BMI （r value was 0.305, 0.258 and 0.203, respectively, all P〈0.01）, and CRP and II-6 were positively correlated with FBG （r value was 0. 243 and 0. 221, respectively, both P 〈0.01）. Logistic regression analysis showed that IL-6 was most important to cases of GDM complicating HDCP （R2=0. 462）. Conclusion Levels of CRP, IL-6 and TNF-α in cases of GDM with HDCP increase significantly. Early detection of inflammatory cytokines may help to predict HDCP in women with GDM, and it is worthy of promotion and application.