妊娠期肥胖女性血清ANGPTL8水平变化及其与心脏代谢谱的关系

Changes in serum ANGPTL8 levels in obese pregnant women and their relationship with cardiometabolic profiles

目的探讨妊娠期肥胖女性血清人血管生成素样蛋白8(ANGPTL8)水平变化及其与心脏代谢谱的相关性。方法选取2018年3月至2020年5月在该院进行产检并成功分娩的281例单胎足月妊娠孕产妇作为研究对象。孕前体重指数(BMI)正常(18.5~24.9 kg/m^(2))且孕期体重增加<16 kg的孕妇被纳入体重正常组(n=130);孕前BMI正常(18.5~24.9 kg/m^(2))但孕期体重增加≥16 kg的被纳入孕期肥胖组(n=51);孕期BMI>24.9 kg/m^(2)但孕期体重增加<16 kg的孕妇被纳入孕前肥胖组(n=74);孕期BMI>24.9 kg/m^(2)且孕期体重增加≥16 kg的孕妇被纳入孕前+孕期肥胖组(n=26)。采用酶联免疫吸附试验测定血清ANGPTL8水平,并检测常规心脏代谢指标。结果孕前肥胖组、孕期肥胖组和孕前+孕期肥胖组血清ANGPTL8水平均低于体重正常组(P<0.05),且孕前+孕期肥胖组和孕期肥胖组血清ANGPTL8水平亦低于孕前肥胖组(P<0.05)。在孕前+孕期肥胖组中,血清ANGPTL8水平与收缩压(SBP)、舒张压、C反应蛋白(CRP)、糖化血红蛋白(HbA1c)、空腹胰岛素、胰岛素抵抗指数、C肽、非酯化脂肪酸(NEFA)、游离睾酮呈负相关,与高分子脂联素(HMWA)、孕妇BMI呈正相关(P<0.05)。而这些相关性在体重正常组、孕前或孕期肥胖组的女性中大多数并不明显。此外,孕前+孕期肥胖组血清ANGPTL8水平与新生儿出生体重SDS、头围SDS呈负相关(P<0.05)。多元线性回归分析结果显示,孕前+孕期肥胖组血清ANGPTL8水平是SBP、CRP、HbA1c、C肽、HMWA、HEFA水平的独立影响因素(P<0.05)。结论妊娠期肥胖女性血清ANGPTL8水平普遍降低,且孕前+孕期肥胖女性低血清ANGPTL8水平与不良心脏代谢指标有关。

Objective To investigate the change of serum human angiopoietin-like protein 8(ANGPTL8)level in obese pregnant women and its correlation with cardiometabolic profile.Methods A total of 281 pregnant women with single full-term pregnancy who underwent prenatal examination and successfully delivered in the hospital from March 2018 to May 2020 were selected as the research objects.Pregnant women with normal pre-pregnancy body mass index(BMI,18.5-24.9 kg/m^(2))and weight gain<16 kg during pregnancy were included in the normal weight group(n=130).Pregnant women with normal pre-pregnancy BMI(18.5-24.9 kg/m^(2))but weight gain≥16 kg during pregnancy were included in the pregnancy obesity group(n=51).Pregnant women with BMI>24.9 kg/m^(2) but gestational weight gain<16 kg were included in the pre-pregnancy obesity group(n=74).Pregnant women with BMI>24.9 kg/m^(2) and weight gain≥16 kg during pregnancy were included in the pre-pregnancy+pregnancy obesity group(n=26).Serum ANGPTL8 level was measured by enzyme-linked immunosorbent assay,and routine cardiometabolic indicators were detected.Results Compared with the normal weight group,the pre-pregnancy obesity group,the pregnancy obesity group and the pre-pregnancy+pregnancy obesity group had a significantly lower serum level of ANGPTL8(P<0.05).The pre-pregnancy+pregnancy obesity group and the pregnancy obesity group had a significantly lower serum level of ANGPTL8 than the pre-pregnancy obesity group(P<0.05).In the pre-pregnancy+pregnancy obesity group,serum ANGPTL8 levels were negatively correlated with systolic blood pressure(SBP),diastolic blood pressure,C-reactive protein(CRP),glycated hemoglobin A1c(HbA1c),fasting insulin,insulin resistance index,C-peptide,non-esterified fatty acid(NEFA)and free testosterone,it was positively correlated with high molecular weight adiponectin(HMWA)and BMI in pregnant women(P<0.05).However,most of these associations were not evident among women with normal weight or obesity before or during pregnancy.In addition,the serum level of ANGPTL8 in the pre-pregnancy+pregnancy obesity group was negatively correlated with the SDS of birth weight and head circumference of the newborn(P<0.05).The results of multiple linear regression analysis showed that the serum level of ANGPTL8 was an independent influencing factor of SBP,CRP,HbA1c,C-peptide,HMWA and HEFA in pre-pregnancy+pregnancy obesity group(P<0.05).Conclusion The serum ANGPTL8 level in obese pregnant women is generally decreased,and the lower serum ANGPTL8 level in obese women before and during pregnancy is associated with adverse cardiometabolic indexes.