妊娠期糖尿病患者血管内皮功能和氧化应激水平与早发型胎儿生长受限的相关性分析

Correlation Analysis of Vascular Endothelial Function and Oxidative Stress Levels with Early-Onset Fetal Growth Restriction in Patients with Gestational Diabetes Mellitus

目的:探究血管内皮功能受损和氧化应激失衡与妊娠期糖尿病(GDM)伴发早发型胎儿生长受限(FGR)的相关性。方法:收集同胎龄段的GDM伴发早发型FGR孕妇(FGR组)、单纯GDM孕妇(GDM组)和常规产检均正常的孕妇(正常组)各35例为研究对象。测定比较各组孕妇空腹血糖(FBG)、空腹胰岛素(FINS)、胰岛素抵抗指数(HOMA-IR)、脐动脉血流[脐动脉收缩期与舒张期血流指数比(S/D)、脐动脉阻力指数(RI)]、血管内皮功能[血流介导的血管舒张功能(FMD)]、氧化应激水平[血清活性氧(ROS)和总抗氧化能力(T-AOC)];分析GDM伴发早发型FGR孕妇血管内皮功能、氧化应激水平与血糖、胰岛素、脐动脉血流状态的相关性。结果:FGR组孕妇FBG、FINS、HOMA-IR水平均高于GDM组和正常组(P<0.05);脐动脉S/D、RI高于GDM组和正常组;母体FMD低于GDM组和正常组(P<0.05);ROS水平高于GDM组和正常组,T-AOC水平低于GDM组和正常组(P<0.05)。Pearson相关系数分析显示,FGR组孕妇FMD、T-AOC与FBG、FINS、HOMA-IR、S/D、RI均呈明显负相关(P<0.05);ROS与FBG、FINS、HOMA-IR、S/D、RI均呈明显正相关(P<0.05)。结论:GDM患者体内血管内皮功能受损及氧化应激失衡与FGR发生有关,可能是高血糖及其引发的氧化应激失衡损伤血管内皮功能,影响脐动脉血流状态所致。

Objective:To investigate the correlation between impaired vascular endothelial function and oxidative stress imbalance with early-onset fetal growth restriction(FGR)in patients with gestational diabetes mellitus(GDM).Methods:Pregnant women with GDM and early-onset FGR(FGR group),pregnant women with GDM(GDM group)and normal pregnant women(normal group)in the same gestational stage were selected,with 35 cases in each group.Fasting blood glucose(FBG),fasting insulin(FINS),insulin resistance index(HOMA-IR),umbilical artery blood flow[umbilical artery systolic to diastolic ratio(S/D),umbilical artery resistance index(RI)],vascular endothelial function[flow-mediated dilation(FMD)],oxidative stress level[reactive oxygen species(ROS)and total antioxidant capacity(T-AOC)]were compared between the three groups.The correlation was analyzed between vascular endothelial function,oxidative stress and blood glucose,insulinm,umbilical artery flow status in pregnant women with GDM and early-onset FGR.Results:The levels of FBG,FINS and HOMA-IR of pregnant women in the FGR group were higher than those in the GDM group and normal group(P<0.05).The umbilical artery S/D and RI in the FGR group were higher than those in the GDM group and normal group,and the maternal FMD in the FGR group was lower than that in the GDM group and normal group(P<0.05).The ROS level of FGR group was higher than that of GDM group and normal group,and the T-AOC level was lower than that of GDM group and normal group(P<0.05).Pearson correlation coefficient analysis showed that,in pregnant women in the FGR group,the levels of FMD and T-AOC were negatively correlated with the levels of FBG,FINS,HOMA-IR,S/D,IR(P<0.05),and the level of ROS was positively correlated with the levels of FBG,FINS,HOMA-IR,S/D and IR(P<0.05).Conclusion:The impaired vascular endothelial function and oxidative stress imbalance in GDM patients are related to the occurrence of FGR,which may be caused by hyperglycemia and the resulting oxidative stress imbalance that damages vascular endothelial function and affects the blood flow of the umbilical artery.