脂肪因子CTRP3、CTRP9与巨大儿的相关性研究

发布时间：2018-04-24 18:51

本文选题：巨大儿 + 补体C1q/肿瘤坏死因子3　；参考：《承德医学院》2017年硕士论文

【摘要】：巨大儿发生率近年来有逐年增多的趋势。巨大儿会增加难产、肩难产和臂丛神经损伤等不良分娩结局的发生风险,手术助产率、剖宫产率高,远期还会使儿童发生超重和肥胖的风险显著增加。巨大儿的发生与遗传、孕龄过长、营养过剩、代谢异常等因素有关,但其作用的机制仍不清楚。胎儿的生长主要依靠母体透过胎盘供给的氧和营养物质,母体孕期营养物质的供给与代谢状况,以及胎儿自身对于营养物质的利用,都将对胎儿的生长发育产生重要影响。有研究显示,脂肪组织可以分泌多种活性蛋白,即脂肪因子,其中脂联素具有调节糖脂代谢和胰岛素敏感性等作用,母体静脉血清、脐静脉血清脂联素均与新生儿出生体重和巨大儿有关。补体C1q/肿瘤坏死因子(complement-C1q/tumor necrosis factor-related protein,CTRP)3、CTRP9作为脂肪因子CTRPs超家族的两位重要成员,其结构与脂联素有高度同源性,且CTRP3、CTRP9均可与脂联素形成异源多聚体复合物,因此推测CTRP3、CTRP9具有与脂联素相似的生物学功能或与脂联素有协同作用,参与胎儿生长发育的过程。CTRP3及CTRP9与胎儿生长发育及巨大儿的发生是否相关?能否作为预测巨大儿的指标?国内外尚未见报道。目的:1检测产妇静脉血清、脐静脉血清CTRP3、CTRP9水平,分析其与新生儿出生体重的相关性及与巨大儿的关系。2检测胎盘组织中CTRP3、CTRP9基因mRNA的表达量,分析其与新生儿出生体重的相关性及与巨大儿的关系。3构建CTRP影响因素的模型,为巨大儿预测提供理论证据。方法:随机选取2015年12月~2016年12月在承德医学院附属医院产科足月分娩出生体重≥4000 g新生儿的产妇31例作为巨大儿组,分娩正常出生体重儿的产妇31例作为出生体重正常组。纳入标准:正常妊娠、单胎、足月分娩,糖耐量试验正常,新生儿无先天畸形;排除标准:患有妊娠合并症及并发症,如妊娠期高血压疾病、心脏病、妊娠期甲状腺功能减退症、胎盘异常等、孕前患有严重内外科疾病。通过问卷调查、体格检查及查阅病历收集产妇的一般人口学特征、常见慢性病史、孕前身高和体重、孕期有无合并症及并发症、产前体重、分娩孕龄、分娩方式及分娩并发症、以及新生儿的性别、出生体重、生长发育情况等,收集产妇静脉血清、胎儿脐静脉血清和胎盘组织,应用酶联免疫吸附法(elisa)测定产妇静脉血清及胎儿脐静脉血清ctrp3、ctrp9水平;应用实时聚合酶链式反应(rt-pcr)检测胎盘组织中ctrp3、ctrp9基因mrna的表达量。血清ctrp3、ctrp9水平采用均数±标准差或中位数(第25百分位数,第75百分位数)描述,组间比较采用两独立样本t检验或wilcoxon秩和检验,两变量间的相关性采用spearman法行相关分析;血清ctrp水平的影响因素采用多元线性回归分析。结果:1巨大儿组与出生体重正常组产妇的年龄(岁)(30.26±4.84vs29.03±3.87,t=1.101,p=0.275)、分娩孕龄(周)(39.78±0.85vs39.55±0.99,t=0.987,p=0.328)差异均无统计学意义;孕前bmi(kg/m2)(23.40±3.38vs21.57±2.83,t=2.310,p=0.024)、孕期增重(kg)(19.26±6.00vs15.50±5.60,t=2.549,p=0.013)差异均有统计学意义。2巨大儿组与出生体重正常组产妇静脉血清ctrp3(ng/ml)(107.5±18.27vs108.79±20.01,t=0.256,p=0.799)差异无统计学意义;脐静脉血清ctrp3(ng/ml)(102.18±23.66vs70.92±25.96,t=4.955,p0.001)差异有统计学意义。3巨大儿组与出生体重正常组的产妇静脉血清ctrp9(pg/ml)[239.96(114.78~443.92)vs195.67(79.79~383.36),z=0.781,p=0.435]、脐静脉血清ctrp9(pg/ml)[263.10(197.51~342.15)vs284.51(219.58~469.45),z=1.056,p=0.291]差异均无统计学意义。4出生体重与产妇静脉血清ctrp3(rs=0.020,p=0.876)、出生体重与产妇静脉血清ctrp9(rs=0.045,p=0.728)、出生体重与脐静脉血清ctrp9(rs=0.134,p=0.298)的相关性均无统计学意义;出生体重与脐静脉血清ctrp3(rs=0.599,p0.001)的相关性有统计学意义;产妇静脉血清CTRP3与脐静脉血清CTRP3(rs=0.016,P=0.900)、产妇静脉血清CTRP9与脐静脉血清CTRP9(rs=0.205,P=0.111)的相关性均无统计学意义。5不同性别(男vs女)新生儿的脐静脉血清CTRP3(ng/ml)(86.62±30.54 vs 94.78±25.03,t=1.548,P=0.127)、CTRP9(pg/ml)[269.81(195.91~390.99)vs 288.29(219.26~404.90),z=0.550,P=0.583]差异均无统计学意义。6多元线性回归分析结果显示,是否分娩巨大儿、分娩孕龄与脐静脉血清CTRP3水平的的回归关系有统计学意义。7巨大儿组胎盘组织CTRP3基因mRNA表达量高于出生体重正常组(2-△△Ct=2.27,P0.001);而胎盘组织CTRP9基因mRNA的表达量在两组间差异无统计学意义(2-△△Ct=0.77,P=0.430)。结论:1脐静脉血清CTRP3水平与巨大儿的发生有关,产妇静脉血清CTRP3、CTRP9水平及脐静脉血清CTRP9水平与巨大儿的发生不具有相关性。2胎盘组织中存在CTRP3、CTRP9基因mRNA的表达。胎盘组织中CTRP3基因mRNA表达上调与巨大儿发生有关。胎盘组织中CTRP9基因mRNA表达量与巨大儿不具有相关性。3是否分娩巨大儿、分娩孕龄是脐静脉血清CTRP3水平的独立影响因素。
[Abstract]:The incidence of giant infants in recent years has been increasing year by year. The risk of dystocia, dystocia and brachial plexus injury, such as dystocia and brachial plexus injury, the risk of adverse delivery, the rate of operation, the high rate of caesarean section, the risk of overweight and obesity in children will be increased significantly in the long term. Xie Yichang and other factors are related, but the mechanism of its effect is still unclear. The growth of the fetus mainly depends on the oxygen and nutrients that the mother body supplies through the placenta. The supply and metabolism of the mother body during pregnancy, as well as the use of the fetus itself for nutrition, will have an important effect on the growth and development of the fetus. The tissue can secrete a variety of active proteins, that is, fat factors, in which adiponectin has the role of regulating glucose metabolism and insulin sensitivity. The maternal serum and umbilical vein serum adiponectin are related to the birth weight and giant newborn of the newborn. Complement C1q/ tumor necrosis factor (complement-C1q/tumor necrosis factor-related protein, CTRP) 3, CTRP9 is the two important member of the fat factor CTRPs superfamily, its structure is highly homologous with adiponectin, and CTRP3, CTRP9 can form a hetero polymer complex with adiponectin. Therefore, it is presumed that CTRP3, CTRP9 has a biological function similar to adiponectin, or has a synergistic effect with adiponectin, and participates in the process of fetal growth and development,.CTRP3 Whether or not CTRP9 is related to the development of fetal growth and the occurrence of giant infants? Can it be used as an indicator for predicting giant children? There is no report at home and abroad. Objective: 1 detection of maternal venous serum, umbilical vein serum CTRP3, CTRP9 level, analysis of the correlation with newborn birth weight and the relationship with the newborn infant.2 detection of CTRP3, CTRP9 base in placenta tissue The relationship between the expression of mRNA and the correlation between the birth weight of the newborn and the relationship with the giant infant and the model of the influence of.3 on the factors of CTRP were analyzed to provide theoretical evidence for the prediction of the giant infants. Methods: 31 cases of pregnant women who were born in the obstetrics Department of Affiliated Hospital of Chengde Medical College at full birth weight of 4000 g in December December 2015 were randomly selected. 31 cases of parturients delivered to the normal birth weight infants were included in the normal birth weight group as the normal birth weight group. The standard: normal pregnancy, single fetus, full term delivery, normal glucose tolerance test and no congenital malformation of the newborn; exclusion criteria: pregnancy complications and complications such as pregnancy induced hypertension, heart disease, and hypothyroidism during pregnancy, The general demographic characteristics of parturients, common chronics, height and weight before pregnancy, without complications and complications during pregnancy, prenatal weight, birth gestational age, childbirth and childbirth complications, and sex, birth body of the newborn, were collected through questionnaires, physical examination and medical records. The maternal venous serum, fetal umbilical vein serum and placenta tissue were collected, and the serum ctrp3 and ctrp9 levels of maternal venous serum and fetal umbilical vein were measured by enzyme linked immunosorbent assay (ELISA), and the expression of ctrp3, ctrp9 gene mRNA in placenta tissue was detected by real-time polymerase chain reaction (RT-PCR). Serum ctrp3, CTR The level of p9 was described with mean number + standard deviation or median (twenty-fifth percentile, seventy-fifth percentile), two independent samples t test or Wilcoxon rank test, correlation between two variables and correlation analysis, and the factors influencing the level of serum CTRP were analyzed by multivariate linear regression analysis. Results: 1 gigantic group and birth The age of the normal weight group (30.26 + 4.84vs29.03 + 3.87, t=1.101, p=0.275), the difference of birth gestational age (39.78 + 0.85vs39.55 + 0.99, t=0.987, p=0.328) was not statistically significant, BMI (kg/m2) before pregnancy (23.40 + 3.38vs21.57 + 2.83, t=2.310, p= 0.024), and the difference in pregnancy (kg) (19.26 + 5.60 + 5.60,) There was no significant difference in the difference of ctrp3 (ng/ml) (107.5 + 18.27vs108.79 + 20.01, t=0.256, p=0.799) between the.2 giant and the normal birth weight group. The difference between the umbilical vein serum ctrp3 (ng/ml) (102.18 + 23.66vs70.92 + 25.96, t=4.955, p0.001) was statistically significant for the puerperal vein in the.3 gigantic group and the normal birth weight group. Serum ctrp9 (pg/ml) [239.96 (114.78~443.92) vs195.67 (79.79~383.36), z=0.781, p=0.435], umbilical vein serum ctrp9 (pg/ml) [263.10 (197.51~342.15). 045, p=0.728), the correlation between birth weight and umbilical vein serum ctrp9 (rs=0.134, p=0.298) was not statistically significant; the correlation between birth weight and umbilical vein serum ctrp3 (rs=0.599, p0.001) was statistically significant; maternal serum CTRP3 and umbilical vein serum CTRP3 (rs=0.016, P=0.900), maternal venous serum CTRP9 and umbilical vein serum The correlation of.205, P=0.111) was not statistically significant. The umbilical vein serum of different sex (male vs female) was CTRP3 (ng/ml) (86.62 + 30.54 vs 94.78 + 25.03, t=1.548, P=0.127), CTRP9 (pg/ml) 288.29, 0.550. Whether the birth giant, the birth gestational age and the serum CTRP3 level of the umbilical vein were statistically significant, the expression of CTRP3 gene mRNA in the placental tissue of the group.7 was higher than that of the normal birth weight group (2- Delta Delta Ct=2.27, P0.001), but the expression of CTRP9 gene mRNA in the placenta tissue was not statistically significant between the two groups (2- Delta Delta Ct=0.77, P=0) .430) conclusion: 1 the serum level of CTRP3 in the umbilical vein is related to the occurrence of giant infants. The serum CTRP3, CTRP9 level and the CTRP9 level of the umbilical vein serum are not associated with the occurrence of giant infants. The expression of CTRP3, CTRP9 gene mRNA in.2 placenta tissue. The up regulation of mRNA expression of CTRP3 gene in placenta is related to the occurrence of giant infants. There was no correlation between the expression level of CTRP9 gene mRNA and macrosomia in the tissues. Whether.3 was delivered to macrosomia, the gestational age of delivery was the independent influence factor of CTRP3 level in umbilical vein serum.

【学位授予单位】：承德医学院
【学位级别】：硕士
【学位授予年份】：2017
【分类号】：R714.7

【参考文献】