妊娠期糖尿病患者肠道微生态失衡与炎症因子的相关性

Relationship between intestinal microecological imbalance and inflammatory factors in gestational diabetes mellitus

目的探讨妊娠期糖尿病(GDM)妊娠妇女肠道微生态失衡与炎症因子的相关性。方法选择2017年3月至2018年8月于我院产科门诊建立产检完整档案的妊娠妇女,其中确诊为GDM妊娠妇女78例作为研究组,正常妊娠妇女99例作为对照组;定性、定量分析2组妊娠妇女肠道肠杆菌、肠球菌、双歧杆菌、乳杆菌、拟杆菌和梭杆菌数量,分析肠道微生态失衡情况并比较肠道失衡组、非肠道失衡组临床资料,分析肠道失衡发生危险因素;Spearman相关分析明确肠道微生态失衡与炎性因子白细胞介素-2(IL-2)、肿瘤坏死因子-α(TNF-α)、C-反应蛋白(CRP)水平相关性。结果研究组SBP(收缩压)、DBP(舒张压)、FBG(空腹血糖)、HbA1c(糖化血红蛋白)、IL-2、CRP、TNF-α水平高于对照组(均P<0.05),肠杆菌、肠球菌、拟杆菌、梭杆菌数量大于对照组,而双歧杆菌、乳杆菌数量小于对照组(均P<0.05)。研究组发生肠道微生态失衡例数23例(29.49%),对照组发生肠道微生态失衡例数10例(10.10%),研究组肠道微生态失衡发生率高于对照组(P<0.05)。IL-2≥34.10 pg/mL、CRP≥19.33 mg/L、TNF-α≥89.96 ng/L、肠杆菌≥8.42 logN/g、肠球菌≥7.46 logN/g、双歧杆菌<8.49 logN/g、乳杆菌<6.32 logN/g、拟杆菌≥8.87 logN/g、梭杆菌≥3.13 logN/g是GDM妊娠妇女妊娠期发生肠道微生态失衡危险因素(均P<0.05)。GDM妊娠妇女IL-2、CRP、TNF-α水平均与双歧杆菌、乳杆菌数量呈负相关(均P<0.05),与肠杆菌、肠球菌、拟杆菌和梭杆菌数量呈正相关(均P<0.05)。结论高炎性应激状态下的GDM患者表现出更明显的肠道微生态失调,可导致或加剧GDM发生或发展;妊娠期注意益生菌补充对防治GDM有重要价值。

Objective To investigate the relationship between intestinal microecological imbalance and inflammatory factors in gestational diabetes mellitus(GDM). Methods A total of 78 GDM women(Observation group) and 99 healthy pregnant women(control group) in our hospital from March 2017 to August 2018 were enrolled. The amounts of Enterobacter, Enterococcus, Bifidobacterium, Lactobacillus, Bacteroides and Fusobacterium were analyzed qualitatively and quantitatively. The clinical data were compared between intestinal imbalance group and non intestinal imbalance group, and the risk factors of intestinal imbalance were analyzed. Spearman correlation analysis was used to determine the correlation between intestinal microecological imbalance and levels of inflammatory factors interleukin-2(IL-2), tumor necrosis factor-α(TNF-α), and C-reactive protein(CRP). Results The levels of SBP(systolic blood pressure), DBP(diastolic blood pressure), FBG(fasting blood glucose), HbA1 c(glycosylated hemoglobin), IL-2, CRP and TNF-α in the observation group were higher than those in the control group(all P<0.05). The amounts of Enterobacter, Enterococcus, Bacteroides and Fusobacterium were higher, while those of Bifidobacteria and Lactobacillus were lower in the observation group than in the control group, respectively(all P<0.05). The incidence of intestinal micro-ecological imbalance in the observation group was higher than that in the control group [29.49%(23 cases) vs 10.10%(10 cases), P<0.05]. IL-2≥34.10 pg/mL, CRP≥19.33 mg/L, TNF-α≥89.96 ng/L, Enterobacteria≥8.42 logN/g, Enterococcus≥7.46 logN/g, Bifidobacterium<8.49 logN/g, Lactobacillus<6.32 logN/g, Bacteroides≥8.87 logN/g, and Fusobacterium≥3.13 logN/g were the risk factors for intestinal micro-ecological imbalance in GDM women(all P<0.05). The levels of IL-2, CRP and TNF-α in GDM pregnant women were negatively correlated with the amounts of Bifidobacteria and Lactobacillus(all P<0.05), and positively correlated with the amounts of Enterobacter, Enterococcus, Bacteroides and Fusobacterium(all P<0.05). Conclusion GDM patients with hyperinflammatory stress have high risk of intestinal microecological imbalance, which may lead to or aggravate the occurrence or development of GDM;probiotics supplementation during pregnancy is of great value in the prevention and treatment of GDM.