妊娠期糖尿病合并子痫前期血清Lipocalin-2、sFlt-1、PIGF水平变化及其临床意义

Changes and clinical significance of serum Lipocalin-2,sFlt-1 and PIGF levels in patients with gestational diabetes mellitus and preeclampsia

目的:探讨妊娠期糖尿病(GDM)合并子痫前期(PE)血清可溶性血管内皮生长因子受体1(sFlt-1)、脂质运载蛋白2(Lipocalin-2)、胎盘生长因子(PIGF)水平变化及其临床意义。方法:选取196例行孕前定期检查并分娩的单胎妊娠孕妇为研究对象,根据妊娠合并症情况分为A组(正常妊娠,n=51)、B组(妊娠合并GDM,n=74)和C组(GDM合并PE,n=71);C组再根据病情分为轻度PE组(n=39)和重度PE组(n=32)。比较各组间患者血清sFlt-1、Lipocalin-2、PIGF、游离脂肪酸(FFAs)、尿酸(UA)、三酰甘油(TG)水平及24 h尿蛋白、胰岛素抵抗指数(HOMA-IR),分析sFlt-1、Lipocalin-2及PIGF水平的临床意义及其与24 h尿蛋白、FFAs、UA、TG的相关性。结果:血清sFlt-1、Lipocalin-2水平:C组>B组>A组(P<0.05);血清PIGF水平:A组>B组>C组(P<0.05)。24 h尿蛋白、FFAs:C组>B组>A组(P<0.05);C组UA、TG及HOMA-IR水平高于A、B组(P<0.05),但A、B组比较,差异无统计学意义(P>0.05)。重度PE组患者sFlt-1、Lipocalin-2、24h尿蛋白、FFAs、UA、TG及HOMA-IR水平高于合并轻度PE组(P<0.05);PIGF水平低于轻度PE组(P<0.05)。相关性分析显示,患者血清sFlt-1、Lipocalin-2水平与24 h尿蛋白、FFAs、UA、TG及HOMA-IR呈正相关(P<0.05);血清PIGF水平与上述指标呈负相关(P<0.05)。结论:GDM合并PE患者血清sFlt-1、Lipocalin-2水平升高,PIGF水平降低,其水平与胰岛素抵抗、脂代谢紊乱相关,三者联合检测对早期预测肾功能损伤、GDM合并PE疾病具有重要意义。

Objective:To study the changes and clinical significance of serum Lipocalin-2,soluble vascular endothelial growth factor receptor 1(sFlt-1)and Placental growth factor(PIGF)levels in patients with gestational diabetes mellitus(GDM)and preeclampsia(PE).Methods:A total of 196 pregnant women with singleton pregnancy who were regularly checked and delivered before pregnancy were selected,among them,51 cases of normal pregnant women were group A,74 cases of pregnant women with gestational diabetes were group B,and 71 cases of pregnant women with gestational diabetes and preeclampsia were group C.Group C was divided into mild PE group(n=39)and severe PE group(n=32)according to the condition.The serum sFlt-1,Lipocalin-2 and PIGF levels,free fatty acids(FFAs),uric acid(UA)and triacylglycerol(TG)level,and 24h urine protein,the insulin resistance index(HOMA-IR)were compared between the groups.The clinical significance of sFlt-1,Lipocalin-2 and PIGF levels and their correlation with 24 h urine protein,FFAs,UA and TG were analyzed.Results:Serum sFlt-1 and Lipocalin-2 levels in groups B and C were significantly higher than those in group A,and group C was significantly higher than group B(P<0.05),serum PIGF levels in groups B and C were significantly lower than those in group A,and group C was significantly lower than group B(P<0.05).The 24h urine protein and FFAs in groups B and C were significantly higher than those in group A,and group C was significantly higher than group B.The levels of UA,TG,and HOMA-IR in group C were significantly higher than those in groups A and B(P<0.05),but there was no significant difference in the levels of UA,TG and HOMA-IR in groups A and B(P>0.05).The sFlt-1,Lipocalin-2,24h urinary protein,FFAs,UA,TG and HOMA-IR in patients with severe PE and GDM were significantly higher than those in patients with mild PE and GDM,PIGF levels were significantly lower than those in patients with mild PE and GDM(P<0.05).Pearson correlation analysis showed that serum sFlt-1 and Lipocalin-2 levels were positively correlated with 24h urine protein,FFAs,UA,TG and HOMA-IR(P<0.05),and serum PIGF levels was negatively correlated with 24h urine protein,FFAs,UA,TG and HOMA-IR(P<0.05).Conclusion:The levels of sFlt-1 and Lipocalin-2 in gestational diabetes mellitus with preeclampsia patients are significantly increased,and the level of PIGF is significantly reduced,the levels are related to insulin resistance and dyslipidemia,the joint detection of the three is of great significance for early prediction of renal impairment and gestational diabetes mellitus with preeclampsia disease.