妊娠期糖尿病合并幽门螺杆菌感染患者毒力因子分布及与不良妊娠结局的关联

Correlation between the distribution of virulence factors and adverse pregnancy outcomes in patients with gestational diabetes mellitus complicated with Helicobacter pylori infection

目的研究妊娠期糖尿病(GDM)合并幽门螺杆菌(Hp)感染患者毒力因子分布及与不良妊娠结局(APO)的关联性。方法选取2018年3月-2021年3月天津市第五中心医院GDM伴Hp感染患者98例(研究组)和单纯GDM患者94例(对照组)为样本进行横断面研究,采集两组基本信息并随访妊娠结局,检测GDM合并Hp感染患者妊娠24周时的细胞毒素相关蛋白A(CagA)、空泡毒素相关蛋白(VacA)、血型抗原结合黏附素(BabA)、前炎症外膜蛋白A(OipA)以及尿素酶(Ure)等毒力因子表达情况,分析GDM合并Hp感染患者血糖和APO影响因素。结果研究组空腹血糖(FPG)、餐后1 h血糖(1hPBG)和餐后2 h血糖(2hPBG)高于对照组(P<0.05);研究组和对照组APO发生率分别为31.63%和17.02%(P<0.05);APO组CagA、VacA和OipA阳性率高于非APO组(P<0.05);多元线性回归分析显示毒力因子CagA和VacA阳性为导致GDM合并Hp感染患者FPG水平升高的影响因素(P<0.05);多因素Logistic回归分析显示,FPG、孕前BMI、孕期体质量增长以及毒力因子CagA和VacA阳性为APO影响因素(P<0.05)。结论GDM合并Hp感染可导致APO发生风险升高,其中毒力因子CagA和VacA不仅与FPG升高有关,同时还是APO的影响因素。

OBJECTIVE To study the distribution of virulence factors in patients with gestational diabetes mellitus(GDM)complicated with Helicobacter pylori(Hp)infection and its association with adverse pregnancy outcomes(APO).METHODS GDM patients in Tianjin Fifth Central Hospital between Mar 2018 and Mar 2021 were recruited as samples for cross-sectional study.98 GDM patients with Hp infection were divided in to the observation group,and 94 GDM patients without Hp infection were in the control group.Basic information of the two groups were collected and the pregnancy outcomes were followed up.The expression levels of virulence factors such as cytotoxin-associated antigen A(CagA),vacuolated cytotoxin antigen(VacA),bloodgroup antigen binding adhesin(BabA),outer inflammatory protein A(OipA)and urease(Ure)were detected in GDM patients with Hp infection at 24 weeks of gestation.and the correlation between blood glucose and APO in pregnant women with GDM complicated with Hp infection were analyzed.RESULTS The fasting plasma glucose(FPG),1 hour postprandial blood glucose(1 hPBG)and 2 hour postprandial blood glucose(2 hPBG)in the observation group were significantly higher than those in the control group(P<0.05).The incidence rates of APO in the observation group and control group were 31.63%and 17.02%,respectively(P<0.05).The positive rates of CagA,VacA and OipA in the APO group were significantly higher than those in the non-APO group(P<0.05).Multivariate linear regression analysis showed that the positive virulence factors CagA and VacA were important risk factors for the increase of FPG level in patients with GDM complicated with Hp infection(P<0.05).Multivariate Logistics regression analysis showed that FPG,BMI before pregnancy,weight gain during pregnancy and positive virulence factors CagA and VacA were independent risk factors for APO(P<0.05).CONCLUSION GDM with Hp infection can increase the risk of APO.The virulence factors CagA and VacA are not only closely related to the increase of FPG,but also independent risk factors for APO.