子痫前期-子痫患者糖脂代谢异常与妊娠结局的相关性研究

Correlation between pregnant outcome and disturbed glucose-lipid metabolism in preeclampsia-eclampsia patients

目的探讨子痫前期-子痫(preeclampsia-eclampsia,PE-E)患者糖脂代谢紊乱对妊娠结局的影响,及PE-E不良预后的危险因素。方法住院分娩的PE-E患者51例为PE-E组,健康孕妇40例为对照组,采用反转录PCR法检测2组过氧化物酶体增殖物激活受体-γ(peroxisome proliferation-activated receptor-γ,PPAR-γ)mRNA表达水平,计算2组胰岛素敏感指数(insulin sensitive index,ISI)和稳态模型胰岛素抵抗指数(homeostasis model assessment-insulin resistance index,HOMA-IR),并检测其他生化指标,记录母体并发症和新生儿结局,分析PE-E发病和不良结局的影响因素。结果 PE-E组ISI(-3.71±0.92)、红细胞压积[(0.35±0.05)%]和血小板计数[(184.14±76.83)×109/L]明显低于对照组[-2.98±0.55、(0.37±0.03)%、(216.63±54.05)×109/L](P<0.05),HOMA-IR[1.61(1.07,3.65)]、总胆固醇[(6.67±1.27)mmol/L]、三酰甘油[(4.74±2.46)mmol/L]、谷丙转氨酶[23.10(15.90,37.40)u/L]、谷草转氨酶[28.50(23.20,48.10)u/L]、乳酸脱氢酶[(506.37±358.58)u/L]、肌酐[(71.71±58.58)mmol/L]、尿酸[(429.60±109.17)mmol/L]水平明显高于对照组[0.76(0.61,1.37)、(6.07±1.94)mmol/L、(4.02±1.75)mmol/L、12.50(11.00,16.75)u/L、19.00(16.00,21.75)u/L、(180.48±31.56)u/L、(44.78±8.67)mmol/L、(324.80±79.69)mmol/L](P<0.05),PE-E组PPAR-γmRNA表达水平(0.53±0.28)与对照组(0.41±0.31)比较差异无统计学意义(P>0.05);总胆固醇增高和PPAR-γmRNA表达水平增高是PE-E发病的危险因素(OR=2.003,95%CI:1.156~3.469,P=0.013;OR=13.285,95%CI:1.743~101.271,P=0.013),ISI增高是PE-E发病的保护因素(OR=0.290,95%CI:0.129~0.653,P=0.003);ISI增高是严重并发症和胎儿生长受限的保护因素(OR=0.021,95%CI:0.003~0.155,P<0.001;OR=0.058,95%CI:0.003~0.966,P=0.047);孕前体质量指数增高是胎儿窘迫的危险因素(OR=1.701,95%CI:1.194~2.423,P=0.003);孕前体质量指数增高对新生儿出生Apgar评分和分娩孕周有负向影响(β=-0.168,95%CI:-0.265^-0.072,P=0.001;β=-0.221,95%CI:-0.406^-0.036,P=0.020)。结论胰岛素抵抗是PE-E发病、严重母胎并发症和胎儿生长受限的危险因素,高胆固醇和PPAR-γ高表达是PE-E发病的危险因素,减轻孕前肥胖有利于减少胎儿窘迫、新生儿窒息和早产发生。

Objective To explore the influence of disturbed glucose and lipid metabolism on the pregnant outcomes in patients with preeclampsia-eclampsia(PE-E)and the risk factors for poor prognosis of preeclampsia.Methods The expression of peroxisome proliferation-activated receptor-γ(PPAR-γ)mRNA was detected by reverse transcription PCR,and the levels of insulin sensitive index(ISI),homeostasis model assessment-insulin resistance index(HOMA-IR)and other laboratory indexes were tested in 51 PE-E patients(PE-E group)and 40 healthy pregnant women(control group).The maternal complications and neonatal outcomes were recorded to analyze the influencing factors for PE-E and its adverse outcomes.Results The ISI(-3.71±0.92),hematocrit((0.35±0.05)%)and platelet count((184.14±76.83)×109/L)in PE-E group were significantly lower than those in control group(-2.98±0.55,(0.37±0.03)%,(216.63±54.05)×109/L)(P<0.05),and HOMA-IR(1.61(1.07,3.65)),total cholesterol((6.67±1.27)mmol/L),triacylglycerol((4.74±2.46)mmol/L),glutamic pyruvic transaminase(23.10(15.90,37.40)u/L),glutamic oxaloacetic transaminase(28.50(23.20,48.10)u/L),lactate dehydrogenase((506.37±358.58)u/L),creatinine((71.71±58.58)mmol/L)and uric acid((429.6±109.17)mmol/L)in PE-E group were significantly higher than those in control group(0.76(0.61,1.37),(6.07±1.94)mmol/L,(4.02±1.75)mmol/L,12.50(11.00,16.75)u/L,19.00(16.00,21.75)u/L,(180.48±31.56)u/L,(44.78±8.67)mmol/L,(324.8±79.69)mmol/L)(P<0.05).There was no significant difference in PPAR-γ mRNA between PE-E group(0.53±0.28)and control group(0.41±0.31)(P>0.05).The elevated total cholesterol level(OR=2.003,95%CI:1.156 to 3.469,P=0.013)and PPAR-γmRNA(OR=13.285,95%CI:1.743 to 101.271,P=0.013)were the risk factors for PE-E,and the elevated ISI(OR=0.290,95%CI:0.129 to 0.653,P=0.003)was a protective factor for PE-E as well as for severe perinatal complications(OR=0.021,95%CI:0.003 to 0.155,P<0.001)and fetal growth retardation(OR=0.058,95%CI:0.003 to 0.966,P=0.047).The high body mass index before pregnancy was a risk factor for fetal distress(OR=1.701,95%CI:1.194 to 2.423,P=0.003),negatively correlated with neonatal Apgar score(β=-0.168,95%CI:-0.265 to-0.072,P=0.001)and delivering gestational age(β=-0.221,95%CI:-0.406 to-0.036,P=0.020).ConclusionInsulin resistance is a risk factor for PE-E,severe perinatal complications and fetal growth retardation.High levels of total cholesterol and PPAR-γmRNA are the risk factors for PE-E.To reduce the body mass before pregnancy contributes to reducing fetal distress,neonatal asphysia and premature delivery.