妊娠期糖尿病患者胎盘miR-3127-5p、HOXA7表达与胎儿结局的关系

Expression of placental miR-3127-5p and HOXA7 expression in patients with gestational diabetes mellitus and their relationship with fetal outcome.

目的探讨微小RNA(miR)-3127-5p、同源盒基因A7(HOXA7)mRNA在妊娠期糖尿病(GDM)患者胎盘组织中的表达情况及其与胎儿结局的关系。方法前瞻性选取2020年2月至2022年5月于青岛市第八人民医院住院的95例GDM患者为GDM组,根据胎儿最终结局分为胎儿正常结局组(n=56)和胎儿不良结局组(n=39);同期收集本院行剖宫产的92例24周糖耐量试验正常孕产妇作为对照组。收集各组一般资料[年龄、孕周、孕前体重指数、胎盘质量、空腹血糖、空腹胰岛素(FINS)];采用实时荧光定量PCR(qRT-PCR)法检测胎盘组织miR-3127-5p、HOXA7 mRNA表达水平;Pearson相关性用于胎儿不良结局GDM患者胎盘miR-3127-5p、HOXA7 mRNA表达水平与一般资料的相关性分析;采用多因素Logistic回归分析影响GDM患者胎儿不良结局的因素。结果GDM组空腹血糖、FINS及胎儿窘迫、巨大儿、新生儿窒息、新生儿低血糖症等胎儿不良结局比例分别为(7.40±2.65)mmol/L、(14.02±3.10)mU/L、14.74%、7.37%、8.42%、10.53%、41.06%,均显著高于对照组[(4.72±2.03)mmol/L、(7.90±2.98)mU/L、1.09%、0.00%、0.00%、1.09%、2.18%],差异均有统计学意义(P<0.05)。胎儿不良结局组空腹血糖、FINS分别为(9.08±2.42)mmol/L、(10.13±2.95)mU/L,均显著高于胎儿正常结局组[1.01±0.21、(6.23±1.89)mmol/L、(19.60±3.30)mU/L],差异均有统计学意义(P<0.05)。胎儿不良结局组胎盘miR-3127-5p表达水平为1.95±0.24,显著高于胎儿正常结局组(1.01±0.21);胎儿不良结局组胎盘HOXA7 mRNA表达水平为0.58±0.19,显著低于胎儿正常结局组(1.01±0.22),差异均有统计学意义(P<0.05)。胎儿不良结局GDM患者胎盘miR-3127-5p与HOXA7 mRNA表达水平呈负相关(r=-0.516,P<0.05),miR-3127-5p与空腹血糖、FINS呈正相关(r=0.492、0.504,P<0.05),HOXA7 mRNA与空腹血糖、FINS呈负相关(r=-0.497、-0.490,P<0.05)。miR-3127-5p是GDM患者胎儿不良结局发生的独立危险因素(P<0.05),HOXA7 mRNA是GDM患者胎儿不良结局发生的保护因素(P<0.05)。结论GDM患者胎盘组织miR-3127-5p高表达,HOXA7 mRNA低表达,二者表达水平与胎儿不良结局有关。

Objective To investigate the expression of microRNA(miR)-3127-5p and homeobox A7(HOXA7)mRNA in placental tissue of patients with gestational diabetes mellitus(GDM)and their relationship with fetal outcomes.Methods Ninety-five GDM patients who were hospitalized in Qingdao Eighth People's Hospital from February 2020 to May 2022 were prospectively collected as the GDM group,and they were grouped into the normal fetal outcome group(n=56)and adverse fetal outcome group(n=39)according to the final outcome of the fetus;meantime,92 pregnant and lying-in women with normal 24-week glucose tolerance test who underwent cesarean section in the same hospital were collected as the control group.The general information[age,gestational age,pre-pregnancy body mass index,placental weight,fasting plasma glucose,fasting insulin(FINS)]for each group was collected;the expression levels of miR-3127-5p and HOXA7 mRNA in placental tissue were detected by real-time quantitative PCR(qRT-PCR)method;the correlation between placental miR-3127-5p and HOXA7 mRNA expression levels in GDM patients with adverse fetal outcomes and general data was analyzed using Pearson correlation;the factors affecting the adverse fetal outcomes of GDM patients was analyzed using multivariate Logistic regression analysis.Results The percentages of fasting blood glucose fasting blood glucose,fasting insulin(FINS),fetal distress,macroia,neonatal asphyxia,neonatal hypoglycemia and other adverse outcomes in GDM group were(7.40±2.65)mmol/L,(14.02±3.10)mU/L,14.74%,7.37%,8.42%,10.53%,which were significantly higher than those in the control group[(4.72±2.03)mmol/L,(7.90±2.98)mU/L,1.09%,0,0,1.09%,2.18%],the differences were statistically significant(P<0.05).The levels of fasting plasma glucose and FINS in the adverse fetal outcome group were(9.08±2.42)mmol/L and(10.13±2.95)mU/L,which were significantly higher than that of normal fetal outcome group[(6.23±1.89)mmol/L and(19.60±3.30)mU/L],the differences were statistically significant(P<0.05).The expression levels of miR-3127-5p in the placenta of the adverse fetal outcome group was 1.95±0.24,which was significantly higher than that of normal fetal outcome group(1.01±0.21),the mRNA expression level of HOXA7 in the placenta of the adverse fetal outcome group was 0.58±0.19,which was significantly lower than that of the normal fetal outcome group(1.01±0.22),the differences were statistically significant(P<0.05).The placental miR-3127-5p of GDM patients with adverse fetal outcome was negatively correlated with the expression level of HOXA7 mRNA(r=-0.516,P<0.05),miR-3127-5p was positively correlated with fasting plasma glucose and FINS(P<0.05),HOXA7 mRNA was negatively correlated with fasting plasma glucose and FINS(r=0.492,0.504,P<0.05).MiR-3127-5p was an independent risk factor for adverse fetal outcomes in GDM patients(r=-0.497,-0.490,P<0.05),and HOXA7 mRNA was a protective factor for adverse fetal outcomes in GDM patients(P<0.05).Conclusion The GDM patients have high expression of miR-3127-5p and low expression of HOXA7 mRNA in placental tissue,and the expression levels of both are associated with adverse fetal outcomes.