妊娠糖尿病患者脂联素和肿瘤坏死因子-α的表达及其与妊娠结局的关系

Expression of adiponectin and tumor necrosis factor-αin patients with gestational diabetes mellitus and its relationship with pregnancy outcome

目的研究妊娠期糖尿病患者脂联素(ADP)及肿瘤坏死因子-α(TNF-α)表达与患者妊娠结局间的关系。方法回顾性将2018年1月至2021年1月间张家口市第一医院收治的60例GDM患者及30例正常孕妇纳为研究对象,于被研究者孕24~28周外周静脉血,检测血ADP、TNF-α、胰岛素抵抗指数(HOMA-IR)水平。分析血清ADP及TNF-α水平与患者HOMA-IR之间的相关性。统计2组妊娠结局,并将妊娠期糖尿病患者分为结局良好组与结局不良组,Logistic回归分析影响GDM孕妇不良妊娠结局的危险因素。结果观察组血清ADP水平[(5.43±1.12)μg/mL]显著低于对照组[(10.79±1.46)μg/mL],TNF-α、HOMA-IR水平为(3.94±0.45)ng/mL、2.78±0.37,均显著高于对照组[(2.74±0.36)ng/mL、1.12±0.04],差异均有统计学意义(P<0.05)。相关性分析提示,血清ADP水平与HOMA-IR呈负相关(r=-0.46,P<0.05),TNF-α水平与HOMA-IR水平呈正相关(r=0.41,P<0.05)。观察组妊娠不良结局发生率为43.33%,显著高于对照组的13.33%,差异有统计学意义(P<0.05)。多因素Logistic回归分析提示,孕前体重指数(OR=1.597)、血清TNF-α(OR=2.168)是影响GDM孕妇不良妊娠结局的独立危险因素,而血清ADP是GDM孕妇不良妊娠结局的保护因素(OR=0.706)。结论GDM孕妇血清ADP及TNF-α水平异于正常孕妇,血清ADP及TNF-α水平与胰岛素抵抗程度间呈线性相关。经Logsitic回归分析证实,血清ADP是GDM患者不良分娩结局的保护因素,血清TNF-α是不良分娩结局的危险因素。

Objective To investigate the expression of adiponectin(ADP)and tumor necrosis factor-α(TNF-α)in patients with gestational diabetes mellitus(GDM)and its relationship with pregnancy outcome.Methods A total of 60 women with GDM(observation group)and 30 healthy women(control group)in Zhangjiakou First Hospital from January 2018 to January 2021 were retrospectively enrolled.The levels of ADP,TNF-αand HOMA-IR in peripheral blood were detected at 24-28 gestational weeks.The pregnancy outcomes were recorded,and women with gestational diabetes were divided into good outcome group and poor outcome group.Logistic regression analysis of the risk factors affecting the adverse pregnancy outcome of GDM pregnant women.Results The serum ADP level of the observation group[(5.43±1.12)μg/mL]was significantly lower than that of the control group[(10.79±1.46)μg/mL],and the levels of TNF-αand HOMA-IR were(3.94±0.45)ng/mL,2.78±0.37,which were significantly higher than those of the control group[(2.74±0.36)ng/mL,1.12±0.04],the differences were statistically significant(P<0.05).Correlation analysis showed that serum ADP level was negatively correlated with insulin resistance index HOMA-IR(r=-0.46,P<0.05),and TNF-αlevel was positively correlated with HOMA-IR level(r=0.41,P<0.05).The incidence of adverse pregnancy outcomes in observation group was 43.33%,which was significantly higher than 13.33%in control group,the difference was statistically significant(P<0.05).Multivariate logistic regression analysis indicated that pre-pregnancy body mass index(OR=1.597)and serum TNF-α(OR=2.168)were independent risk factors affecting adverse pregnancy outcomes in GDM pregnant women,while serum ADP was a protective factor(OR=0.706).Conclusion The levels of serum ADP and TNF-αin GDM pregnant women are different from those in normal pregnant women,and serum ADP and TNF-αlevels are linearly correlated with the degree of insulin resistance.Logsitic regression analysis confirms that serum ADP is a protective factor for adverse pregnancy outcomes in GDM patients,and serum TNF-αis a risk factor for adverse pregnancy outcomes.