妊娠期糖尿病合并妊娠期高血压疾病孕妇血清外泌体微小RNA-27微小RNA-34c表达与胰岛素抵抗的相关性

Correlation between expression of serum exosome microRNA-27 and microRNA-34c and insulin resistance in pregnant women with gestational diabetes mellitus complicated with hypertensive disorder complicating pregnancy

目的 探究妊娠期糖尿病(GDM)合并妊娠期高血压疾病(HDCP)孕妇血清外泌体微小RNA-27(miR-27)、微小RNA-34c(miR-34c)表达水平,并分析miR-27、miR-34c与GDM合并HDCP孕妇胰岛素抵抗的相关性。方法 选取2018年3月—2020年1月在台州市路桥区第二人民医院医疗服务共同体和温州医科大学附属第二医院产科收治的114例GDM患者为研究对象,根据GDM是否并发HDCP分为GDM合并HDCP组(47例)和未并发HDCP组(67例)。采用实时荧光定量PCR(qRT-PCR)法检测所有研究对象血清外泌体miR-27、miR-34c表达水平。检测两组患者血清空腹血糖(FPG)、空腹胰岛素(FINS)水平并计算胰岛素抵抗指数(HOMA-IR)。Pearson法分析血清外泌体miR-27、miR-34c水平与FPG、FINS等指标的相关性。采用多元线性逐步回归模型分析影响GDM合并HDCP患者HOMA-IR的相关因素。结果 GDM合并HDCP组患者血清外泌体miR-27表达水平、miR-34c表达水平、血清FPG、FINS水平及HOMA-IR水平[(1.83±0.43)、(2.02±0.48)、(6.11±1.25)mmol/L、(13.67±1.49)mmol/L及(3.95±0.66)]均高于未并发HDCP组[(1.03±0.31)、(1.04±0.33)、(5.23±1.16)mmol/L、(12.30±1.32)mmol/L及(3.21±0.54)],差异均有统计学意义(t=10.914、12.926、3.861、5.171及6.567,均P<0.05)。Pearson分析结果显示,血清外泌体miR-27、miR-34c水平与FPG、FINS及HOMA-IR均呈正相关关系(均P<0.05)。多元线性逐步回归结果显示,血清外泌体miR-27、miR-34c变量与HOMA-IR相关(均P<0.05)。结论 GDM合并HDCP孕妇血清外泌体miR-27、miR-34c呈高表达,其高表达与胰岛素抵抗程度相关。

Objective To investigate the expression levels of serum exosome microRNA-27(miR-27) and microRNA-34 C(miR-34 c) in pregnant women with gestational diabetes mellitus(GDM) complicated with hypertensive disorder complicating pregnancy(HDCP).The correlation between miR-27 and miR-34 c and insulin resistance in pregnant women with GDM combined with HDCP was analyzed.Methods A total of 114 patients with GDM who were admitted to the Medical Service Community of the Second People’s Hospital of Luqiao District of Taizhou city and the Obstetrics Department of the Second Affiliated Hospital of Wenzhou Medical University from March 2018 to January 2020 were selected as the research subjects. According to whether GDM was concurrent with HDCP, the patients were divided into GDM combined with HDCP group(47 cases) and no concurrent HDCP group(67 cases). The serum of all subjects was detected by real-time fluorescence quantitative PCR(qRT-PCR).Expression levels of miR-27 and miR-34 c in exosomes. Serum fasting blood glucose(FPG) and fasting insulin(FINS) levels were detected and HOMA-IR index was calculated. The correlation between serum exosome miR-27, miR-34 c levels and FPG, FINS and other parameters was analyzed by Pearson method. Multiple linear stepwise regression model was used to analyze the related factors of HOMA-IR in GDM patients with HDCP.Results The expression levels of miR-27, miR-34 c, FPG, FINS and HOMA-IR in GDM combined with HDCP group [(1.83±0.43),(2.02±0.48),(6.11±1.25) mmol/L,(13.67±1.49) mmol/L and(3.95±0.66)] were higher than those in no concurrent HDCP group [(1.03±0.31),(1.04±0.33),(5.23±1.16) mmol/L,(12.30±1.32) mmol/L and(3.21±0.54)], the differences were statistically significant(t=10.914, 12.926, 3.861, 5.171 and 6.567, all P<0.05). Pearson analysis showed that serum exosome miR-27, miR-34 c levels were positively correlated with FPG, FINS and HOMA-IR(all P<0.05). Multiple linear stepwise regression results showed that serum exosome miR-27 and miR-34 c were correlated with HOMA-IR(all P<0.05).Conclusion The high expression of miR-27 and miR-34 c in serum of pregnant women with GDM combined with HDCP was correlated with the degree of insulin resistance.