胎盘质膜脂肪酸结合蛋白与非妊娠糖尿病巨大儿发生的关联性

Association between the expression level of placental plasma membrane fatty acid binding protein and non-gestational diabetes mellitus macrosomia

目的:探讨胎盘质膜脂肪酸结合蛋白(FABPpm)表达水平与非妊娠糖尿病(非GDM)巨大儿发生的关联性。方法:采用病例对照研究方法,连续收集2015年6月至2016年6月在温州医科大学附属第二医院育英儿童医院产科正常妊娠并足月分娩的40例巨大儿(出生体质量≥4000g)为巨大儿组,对照组(出生体质量2?500~3999g)为随机选择的与巨大儿分娩时间相差3d以内的新生儿40例。采用自行设计的调查表收集产妇和新生儿的基本信息,并采集胎盘和脐血样品。采用qPCR及Western blot检测胎盘组织中FABPpm mRNA和蛋白的表达水平,采用比色法检测脐血游离脂肪酸(NEFA)水平,并运用logistic回归分析巨大儿发生的影响因素。结果:巨大儿组胎盘FABPpm mRNA和蛋白表达水平均高于对照组(P<0.05)。2组胎盘FABPpm表达水平与出生体质量都呈正相关(对照组:rs=0.337,P=0.033;巨大儿组:rs=0.493,P=0.002),与脐血NEFA浓度在对照组呈正相关(rs=0.334,P=0.046)。多因素logistic回归分析发现,胎盘FABPpm mRNA高表达可增加巨大儿发生风险(OR=3.138,95%CI=1.050~9.382,P=0.041),且与胎儿性别(OR=3.229,95%CI=1.002~10.403,P=0.049)、孕期体质量增加过多(OR=3.573,95%CI=1.018~12.543,P=0.047)共同影响巨大儿的发生。结论:胎盘FABPpm表达上调可增加非GDM巨大儿发生风险,提示其可能通过影响脂肪酸转运影响巨大儿发生。

Objective: To investigate the association between the expression level of placental plasma membrane fatty acid binding protein (FABPpm) and non-gestational diabetes mellitus (non-GDM) macrosomia.Methods: A case-control study was performed. Forty macrosomia newborns (birth weight≥4 000 g) with normal pregnancy and full-term delivery were collected as case group from June 2015 to June 2016 continuously in the obstetric department of the Second Affiliated Hospital & Yuying Children’s Hospital of Wenzhou Medical University. And 40 normal-birth-weight newborns (birth weight ranging from 2 500 to 3 999 g) were randomly selected as control group from those delivered within 3 days of macrosomia delivery. Self-designed questionnaires were used to collect maternal and fetal information, the placenta and cord blood samples were obtained. We detected the placental mRNA and protein expression levels of FABPpm by real-time quantitative PCR and western blotting, and determined the non-esterified fatty acids levels in umbilical cord blood by colorimetry. Logistic regression analysis was used to analyze the influencing factors of macrosomia. Results: The expression levels of FABPpm mRNA and protein in the placenta of macrosomia group were higher than those of control group (P<0.05). The FABPpm mRNA expression in placenta was positively correlated with birth weight in both groups (control group: rs=0.337, P=0.033;macrosomia group: rs=0.493, P=0.002). And FABPpm mRNA expression was positively correlated with NEFA level of umbilical cord blood in the control group (rs=0.334, P=0.046), but not in the macrosomia group. Multivariate logistic regression analysis showed that the higher FABPpm expression in placenta could increase the risk of macrosomia (OR=3.138, 95%CI=1.050-9.382, P=0.041), and the occurrence of macrosomia was also influenced by the fetal gender (OR=3.229, 95%CI=1.002-10.403, P=0.049) and gestational weight gain (OR=3.573, 95%CI=1.018-12.543, P=0.047). Conclusion: The up-regulation of FABPpm expression in placenta may increase the risk of non-GDM macrosomia, suggesting that FABPpm may affect the occurrence of macrosomia by affecting fatty acid transport.