妊娠期糖尿病患者血清氨基酸水平和肠道菌群变化对妊娠结局的影响

Influences of serum amino acid levels and intestinal flora changes on pregnancy outcome in patients with gestational diabetes mellitus

目的探讨妊娠期糖尿病(GDM)患者血清氨基酸水平和肠道菌群变化对妊娠结局的影响。方法选取2015年1月至2022年12月在我院接受产前检查并分娩的256例GDM患者作为GDM组,另选同期253例健康妊娠妇女作为对照组。检测两组对象血清氨基酸水平和肠道菌群数量,统计两组对象不良妊娠结局。依照GDM患者妊娠结局分为正常妊娠结局组和不良妊娠结局组,比较两组患者血清氨基酸水平和肠道菌群分布情况,分析血清氨基酸水平、肠道菌群对妊娠结局的影响。结果GDM组和对照组对象血清丙氨酸、甘氨酸、蛋氨酸、精氨酸水平以及肠道拟杆菌、双歧杆菌、肠球菌、乳杆菌、肠杆菌分布情况差异均有统计学意义(t=7.090、7.789、20.762、10.124、17.995、21.134、14.989、18.189、4.428,均P<0.05)。与对照组相比,GDM组患者不良妊娠结局总发生率显著升高(χ^(2)=14.047,P<0.05)。不良妊娠结局组患者血清丙氨酸、蛋氨酸水平显著高于正常妊娠结局组,甘氨酸、精氨酸水平显著低于正常妊娠结局组;同时肠道乳杆菌、双歧杆菌数量显著低于正常妊娠结局组,肠道拟杆菌、肠球菌、肠杆菌数量显著高于正常妊娠结局组(t=3.541、3.790、2.596、4.605、3.434、14.049、7.165、3.839、4.612,均P<0.05)。多因素Logistic回归分析结果显示,丙氨酸、蛋氨酸是不良妊娠结局的独立危险因素,甘氨酸、精氨酸、乳杆菌、双歧杆菌是不良妊娠结局的独立保护因素(均P<0.05)。结论GDM患者血清氨基酸水平升高,肠道致病菌增加、益生菌减少。血清氨基酸水平及肠道菌群变化会对妊娠结局造成较大影响,临床应加强重视并采取有关干预对策。

Objective To observe the effects of serum amino acid levels and intestinal flora changes on pregnancy outcomes in patients with gestational diabetes mellitus(GDM).Methods A total of 256 GDM patients who received prenatal examination and delivered in our hospital from January 2015 to December 2022 were selected as the GDM group,and 253 healthy pregnant women in the same period were selected as the control group.Serum amino acid levels and intestinal flora were detected in the two groups.The adverse pregnancy outcomes in the two groups were statistically analyzed.The GDM patients were classified into the normal pregnancy outcome group and the adverse pregnancy outcome group.The serum amino acid levels and intestinal floral distributions in the two groups were analyzed,and the influences of serum amino acid level and intestinal flora on pregnancy outcome were analyzed.Results The differences in levels of serum alanine,glycine,methionine and arginine and in the distribution of Bacteroides,Bifidobacterium,Enterococcus,Lactoba-cillus and Enterobacteriaceae between GDM group and control group were statistically significant(t=7.090,7.789,20.762,10.124,17.995,21.134,14.989,18.189,4.428;all P<0.05).Compared with the control group,the total incidence of adverse pregnancy outcomes in the GDM group was significantly higher(χ^(2)=14.047,P<0.05).The levels of alanine and methionine in the adverse pregnancy outcome group were significantly higher,and those of glycine and arginine were significantly lower;the counts of intestinal Lactobacillus and Bifidobacterium were significantly lower,and those of Bacteroides,Enterococcus and Enterobacteriaceae were significantly higher than those in the normal pregnancy outcome group,respectively(t=3.541,3.790,2.596,4.605,3.434,14.049,7.165,3.839,4.612;all P<0.05).Logistic multifactorial regression analysis showed that alanine and methionine were independent risk factors for adverse pregnancy outcomes,and glycine,arginine,Lactobacillus and Bifidobacterium were independent protective factors for adverse pregnancy outcomes(all P<0.05).Conclusion In GDM patients,serum amino acid levels increased,intestinal pathogenic bacteria increased and probiotics decrease.Changes in serum amino acid levels and intestinal flora can greatly affect the outcome of pregnancy,so clinical attention should be paid to this issue,and relevant intervention measures should be taken.