体质指数对妊娠中期羊水炎性细胞因子和基质金属蛋白酶水平的影响

Effect of body mass index on inflammatory cytokines and matrix metalloproteinases in amniotic fluid during the second trimester

目的探讨体质指数(Body Mass Index,BMI)对妊娠中期羊水炎症标志物和基质金属蛋白酶(Matrix Metalloproteinases,MMPs)的影响,了解肥胖产妇胎儿的炎症环境暴露情况。方法自2017年4月一2019年5月,在上海交通大学附属国际和平妇幼保健院选取妊娠16-24周单胎孕妇进行选择性羊膜腔穿剌术行核型分析的羊水样本中采集102例样本,用于白细胞介素-1R(IL-邛)、白细胞介素-6(IL-6),基质金属蛋白酶-l(MMP-l)、基质金属蛋白酶-6(MMP-6)和基质金属蛋白酶-13(MMP-13)的检测。根据世界卫生组织(WHO)的BMI标准确定每组的分类:第1组:正常体质量(BMI 18.5〜24.9),24例;第2组:超重(BMI 25.0—29.9),28例;第3组:I级肥胖(BMI 30—35),26例;第4组:H〜皿级肥胖(BMI 35〜40和〉40),24例。记录每例产妇羊膜穿刺术的年龄、胎次、BMI、孕龄、围产期并发症以及新生儿结局。采用SPSS 23.0软件比较各组羊水细胞因子、MMPs、孕妇一般情况、妇婴围产期结局的差异。结果n^IH级肥胖患者的IL-1R水平显著高于I级肥胖、超重和正常体质量患者(P V0.05)。正常体质量组的IL-邛水平显著低于其他各组(P<0.05)o IL-6水平在正常体质量组中最低,在n^ni级肥胖患者中最高,I级肥胖和u〜in级肥胖组患者的il-6水平显著高于正常组和超重组(Pvo.o5)。n^m级肥胖患者羊水MMP-1,MMP-6和MMP-13显著高于其他各组(P V0.05)。正常体质量组中MMP-6和MMP-13水平显著低于所有其各组(P<0.05)0 U〜皿级肥胖患者产前先兆子痫和妊娠期糖尿病(Gestational Diabetes Mellitus,GDM)发生率明显高于其他组(P<0.05)o I级和U〜皿级肥胖患者的新生儿出生体质量明显高于其他组。n〜ID类肥胖患者新生儿第5分钟阿普加评分(Apgar Score)评分低于7分的例数最多,且新生儿重症监护病房(Neonatal Intensive Care Unit,NICU)入住率最高。结论肥胖孕妇的胎儿在子宫内接触的促炎细胞因子和MMPs水平高于正常体质量孕妇,这种高水平的暴露可能与妊娠期肥胖相关的不良围产期结局有关。

Objective To investigate the effect of obesity on inflammatory markers in amniotic fluid in the second trimester and the relationship between pregnant women's Body Mass Index(BMI)and fetal inflammatory exposure.Methods During April 2017 to May 2019,102 cases of single pregnant women at 16—24 weeks of gestation were collected from amniotic fluid samples of selective amniocentesis in the hospital forthe detection of IL-lp, IL-6, Matrix Metalloproteinase (MMP-1, MMP-6 and MMP-13). The classificationof each group was determined according to the BMI standard of The World Health Organization. Group 1:Normal body mass (BMI 18.5〜24.9), 24 cases;Group 2, overweight (BMI 25〜29.9), 28 cases;Group3, grade I obesity (BMI 30~35), 26 cases;Group 4, grade U ~ DI obesity (BMI 35〜40 and >40) , 24cases・ Age, gestational age, BMI, gestational age, perinatal complications and neonatal outcome were recordedfor every patient. To compare the statistical differences of amniotic fluid cytokines, general conditionsof pregnant women, and perinatal outcomes between groups. Results The IL-10 level of grade H 〜HI obesity is significantly higher than that of grade I obesity, overweight and normal weight patients (PVO.05)・ The IL-1(3 levels were significantly lower in the normal weight group than that in the other groups(P <0.05). The lowest of IL-6 level was in the normal weight group and the highest of it was in grade U〜JU obesity group. The level of IL-6 in the obese patients of grade I and grade H 〜ID were significantlyhigher than that in the normal group and the overweight group (P <0.05). Amniotic fluid MMP-1, MMP-6 and MMP-13 in the obese patients with grade U ~ DI were significantly higher than those in the othergroups (P <0.05). MMP-6 and MMP-13 levels in the normal weight group were significantly lower thanthose in the other groups (P V0・05). The incidences of prenatal preeclampsia and Gestational DiabetesMellitus (GDM) in grade U 〜ID obese patients were significantly higher than those in the other groups (PV0.05). The birth weight of newborns of grade I and grade H 〜DI obesity patients were significantlyhigher than that of the other groups. The highest number of neonates with grade U ~ ID obesity patientswere those with Apgar Score below 7 at 5 min, and the NICU occupancy rate was the highest. ConclusionFetuses of obese women were exposed to higher levels of pro-inflammatory cytokines and MMPs inuteri than those of normal BMI women, and this high level exposure may be associated with poor perinataloutcomes due to obesity during pregnancy.