上海地区孕中期女性血清左旋肉碱及其肠道菌群代谢产物三甲胺与妊娠期糖尿病相关性的研究

Association of serum L-carnitine and intestinal flora metabolites trimethylamine with gestational diabetes mellitus in mid-pregnancy women in Shanghai

目的探讨上海地区孕中期女性血清左旋肉碱及三甲胺(TMA)、氧化三甲胺(TMAO)水平与GDM的相关性。方法选取2018年1月至2021年1月于上海中医药大学附属第七人民医院妇产科定期产检的孕18~23周孕妇280例,其中GDM患者134例(GDM组),其余BG正常的146名为对照(Con)组。采用超高效液相色谱-质谱定量检测血清左旋肉碱、TMA和TMAO水平。采用Logistic回归模型分析、分层分析和Spearman相关分析评估左旋肉碱、TMA和TMAO水平与GDM和糖脂代谢指标的关系。结果GDM组血清左旋肉碱水平低于Con组(P<0.01)。左旋肉碱最高分位组GDM患病风险较最低分位组降低70%(OR 0.30,95%CI 0.15~0.63)。血清左旋肉碱每增加1μmol/L,GDM风险下降14%(OR 0.86,95%CI 0.80~0.93)。血清左旋肉碱与1 hPG(r=-0.210,P<0.01)和2 hPG(r=-0.150,P<0.05)呈负相关,TMA与2 hPG呈负相关(r=-0.210,P<0.01)。结论较高水平血清左旋肉碱与GDM呈负相关。血清左旋肉碱及TMA水平与BG呈负相关。

Objective To investigate the relationship between serum L-carnitine and its related metabolites[trimethylamine(TMA)and trimethylamine N-oxide(TMAO)]levels and gestational diabetes mellitus(GDM)in the second trimester of pregnant women in Shanghai.Methods A case-control study was conducted in 280 pregnant women between 18 and 23 weeks of gestation from January 2018 to January 2021.Among them,134 cases of GDM were the case group(GDM),and 146 cases with normal blood glucose(BG)were the control group(Con).Serum L-carnitine,TMA and TMAO levels were quantified by ultra high performance liquid chromatography-mass spectrometry.Logistic regression analysis,stratified analysis and linear regression were used to explore the relationship between L-carnitine,TMA and TMAO levels and GDM and glucolipid metabolism.Results Serum L-carnitinelevelwas significantly lower in GDM group than that in Con group(P<0.01).After adjusting for confounders,logistic regression showed a 70%reduction in the risk of GDM in the group with highest tertile of L-carnitine compared with the group with lowest tertile(OR 0.30,95%CI 0.15~0.63).The risk of GDM decreased by 14%for each 1μmol/L increase in serum L-carnitine(OR 0.86,95%CI 0.80~0.93).Serum L-carnitine was negatively correlated with 1 h PG(r=-0.21,P<0.01)and 2 hPG(r=-0.15,P<0.05),respectively,TMA was negatively correlated with 2 hPG(r=-0.21,P<0.01).Conclusions Higher serum L-carnitine level may be negatively associated with GDM.Serum L-carnitine and TMA levels were negatively correlated with blood glucose levels.