激素水平对GDM患者妊娠结局的预测价值

The Predictive Value of Hormone Level for Pregnancy Outcome in Patients with GDM

目的促甲状腺激素(thyroid stimulating hormone,TSH)、胰岛素样生长因子-I(insulin-like growth factor-I,IGF-I)、血管内皮生长因子(vascular endothelial growth factor,VEGF)以及单核细胞趋化蛋白-1(monocyte chemoattractant protein-1,MCP-1)水平对妊娠糖尿病(gestational diabetes mellitus,GDM)产妇妊娠结局的预测价值。方法选取GDM产妇60例,根据妊娠结局,妊娠结局不良产妇为A组(40例),妊娠结局良好产妇为B组(20例)。另选同期分娩正常的30例产妇为C组。分析3组产妇产前血清中TSH、IGF-I、VEGF、MCP-1水平与妊娠结局的相关性。结果产前,A组TSH为(2.43±0.30)mIU·L^-1、IGF-I为(78.40±9.63)mg·L^-1、VEGF为(28.06±3.31)ng·L^-1、MCP-1为(501.32±105.39)ng·L^-1,B组(2.25±0.34)mIU·L^-1、(69.53±8.51)mg·L^-1、(20.06±3.01)ng·L^-1、(423.08±121.54)ng·L^-1,C组(2.09±0.27)mIU·L^-1、(56.66±7.49)mg·L^-1、(12.34±1.85)ng·L^-1、(301.61±41.38)ng·L^-1,3组TSH、IGF-I、VEGF、MCP-1水平比较,差异有统计学意义(P<0.05)。3组产妇妊娠结局中,A组剖宫产、产后出血、巨大儿及新生儿窒息的发生率为30.00%、52.50%、20.00%及7.50%,B组为20.00%、25.00%、15.00%及6.67%,C组为16.67%、6.67%、6.67%及5.00%,A组各指标值高于B组与C组,同时B组各指标值高于C组,差异有统计学意义(P<0.05)。据Spearman分析,3组产妇产前血清中TSH、IGF-I、VEGF、MCP-1水平与妊娠结局剖宫产、产后出血、巨大儿、新生儿窒息、新生儿体质量呈正相关(P<0.05)。结论TSH、IGF-I、VEGF、MCP-1水平与GDM产妇妊娠结局具有相关性和预测价值,能够为临床上GDM的治疗提供相关参考。

Objective To evaluate the predictive value of thyroid stimulating hormone(TSH),insulinlike growth factor-I(IGF-I),vascular endothelial growth factor(Vascular endothelial growth factor,VEGF)and monocyte chemoattractant protein-1(MCP-1)levels on pregnancy outcome in patients with gestational diabetes mellitus(GDM).Methods 60 pregnant women with GDM were divided into group A:40 women with poor pregnancy outcome and group B:20 women with good pregnancy outcome.Another 30 normal parturients were selected as group C.The levels of TSH,IGF-I,VEGF and MCP-1 in prenatal serum,the comparison of pregnancy outcome and the correlation between the levels of TSH,IGF-I,VEGF,MCP-1 and pregnancy outcome were analyzed.Results Before delivery,group A:TSH(2.43±0.30)mIU·L^-1、IGF-I(78.40±9.63)mg·L^-1、VEGF(28.06±3.31)ng·L^-1、MCP-1(501.32±105.39)ng·L^-1;group B:(2.25±0.34)mIU·L^-1、(69.53±8.51)mg·L^-1、(20.06±3.01)ng·L^-1、(423.08±121.54)ng·L^-1;group C:(2.09±0.27)mIU·L^-1、(56.66±7.49)mg·L^-1、(12.34±1.85)ng·L^-1、(301.61±41.38)ng·L^-1,comparison of the levels of TSH,IGF-I,VEGF and MCP-1 in the three groups,the difference was statistically significant(P<0.05).Among the three groups of maternal pregnancy outcomes,the incidence of cesarean section,postpartum hemorrhage,macrosomia,and neonatal asphyxia in group A were 30.00%,52.50%,20.00%,and 7.50%,group B were 20.00%,25.00%,15.00%and 6.67%,group C were 16.67%,6.67%,6.67%and 5.00%.The index values of group A were higher than those of group B and C,and the index values of group B were higher than those of group C.The difference was statistically significant(P<0.05).According to the analysis of Spearman,the prenatal serum TSH,IGF-I,VEGF,and MCP-1 levels of the three groups were positively correlated with the pregnancy outcome of cesarean section,postpartum hemorrhage,macrosomia,neonatal asphyxia,and newborn weight(P<0.05).Conclusion The levels of TSH,IGF-I,VEGF,and MCP-1 have correlation and predictive value with the pregnancy outcome of patients with GDM,which can provide relevant references for the clinical treatment of GDM.