妊娠期糖尿病及其相关因素对新生儿体脂含量的影响研究

发布时间：2018-06-06 17:53

本文选题：妊娠期糖尿病 + 脂肪酸水平　；参考：《安徽医科大学》2016年硕士论文

【摘要】：目的:探讨妊娠期糖尿病及其糖脂代谢对新生儿体脂含量的影响,为GDM母体及新生儿的管理提供参考依据。方法:选取2014年5月至2015年5月,在铜陵市妇幼保健院产前门诊做常规产检并在此院分娩的孕早期孕妇。按照纳入排除标准,取得知情同意后,建立前瞻性观察队列,收集孕妇及新生儿人口统计学资料及身体测量指标基本信息。于孕24-28周,进行75g口服葡萄糖耐量试验(OGTT试验),并根据国际妊娠与糖尿病研究组织(IADPSG)诊断标准:空腹血糖≥5.1mm/L,负荷后1h血糖≥10.0mm/L,负荷后2h血糖≥8.5mm/L,任意一点血糖值达到或超过上述界值,即可诊断为GDM。采集孕妇孕晚期的肘静脉血及新生儿脐带血,并将血清放在-81℃冰箱保存备用。采用气相色谱-质谱(GC-MS)联用技术,检测孕妇孕晚期血清及脐带血清中脂肪酸的种类及其水平。用Dauncey法计算新生儿体脂含量。结果:(1)GDM组与对照组一般人口学特征:本研究共632例孕妇,其中GDM组189例,对照组443例,平均年龄27.1±4.0岁,其中最大年龄43岁,最小年龄17岁;GDM组平均年龄27.8±4.0岁,对照组平均年龄26.8±4.0岁。GDM组平均身高160.8±4.4cm,对照组平均身高161.0±4.5cm。GDM组与对照组相比,孕前BMI(21.0±3.0kg/m2 vs.20.1±2.4 kg/m2,P=0.001)、胎盘重量(577.0±100.4g vs.554.0±91.3g,P=0.039),差异有统计学意义。GDM组孕期增重为15.5±5.3kg,低于对照组16.8±5.0kg,差异有统计学意义(P0.05)。(2)GDM组和对照组新生儿体格测量资料的比较:GDM组新生儿出生体重3397.1±500.8g、身长50.1±2.0cm、顶臀长32.1±1.9cm、头围34.7±1.7cm、胸围34.0±1.8cm、上臂围11.9±1.0cm、大腿围15.9±1.3cm、小腿围11.7±1.1cm,与对照组相比,差异均无统计学意义;而全臂长15.3±1.3cm、肱三头肌皮褶厚度6.4±1.5mm、肩胛下皮褶厚度6.0±1.4 mm,均高于对照组,差异均有统计学意义(P0.05)。GDM组新生儿总脂肪质量平均为0.65±0.29kg、体脂百分比含量为18.37±5.92%,对照组分别为0.53±0.22kg、15.45±4.89%,GDM组新生儿总脂肪质量及体脂百分比含量均高于对照组,两组之间的差异有统计学意义(P0.05)。(3)GDM组和对照组孕妇孕期血糖、血脂及脂肪酸水平的比较:(1)GDM组孕妇孕早期血糖、血脂水平的比较,GDM孕早期空腹血糖(FPG)为5.16±0.48mmol/L、TG为1.57±0.68mmol/L、HDL为1.61±0.39mmol/L、LDL为2.20±0.46mmol/L均高于对照组孕妇,差异均有统计学意义(P0.05)。(2)孕中期孕妇孕24-28周口服75g葡糖糖耐量试验,GDM组空腹血糖、餐后1h血糖及餐后2小时血糖分别为5.19±0.46 mmol/L、9.84±1.74 mmol/L、7.51±1.43 mmol/L,对照组三个时间点血糖值分别为4.57±0.28 mmol/L、7.74±1.50 mmol/L、6.28±4.06mmol/L。结果显示GDM组每个时间点的血糖值均高于对照组,两组之间每个时间点血糖值差异均有统计学意义(P0.001)。(3)GDM组孕妇孕晚期FPG为5.03±0.54 mmol/L,TG为3.94±1.52 mmol/L、均高于对照组孕妇,差异具有统计学意义(P0.05)。(4)GDM组和对照组孕妇孕晚期血清SOD、MDA、GSH-Px、8-异前列腺素差异均无统计学意义。(4)(1)GDM组与对照组孕晚期母血血清及脐血血清脂肪酸组成谱的比较。GDM组n-6PUFA中C20:2,n-6低于对照组(0.37±0.06%vs.0.39±0.07%,P=0.049),差异有统计学意义;而GDM组单不饱和脂肪酸(MUFA)总量、C18:1,n-9均高于对照组(21.97±2.50%vs.21.04±2.45%,P=0.010;18.09±2.40%vs.17.10±2.19%,P=0.003),差异有统计学意义。然而,GDM组与对照组脐血中的脂肪酸含量差异均无统计学意义(P0.05)。(2)GDM组血清脂肪酸含量在孕晚期母血和脐血中的差异分析,GDM组母血中LC-PUFA总量、n-3PUFA中α-亚麻酸(C18:3,n-3)、C20:5,n-3(EPA)、n-6 PUFA总量、亚油酸(C18:2,n-6)、C20:2,n-6、MUFA总量、C18:1,n-9、C24:1,n-9、SFA中C14:0脂肪酸水平及omega-6:omega-3均高于脐血,差异有统计学意义。而脐血中n-3 PUFA总量、C22:6,n-3(DHA)、n-6 PUFA中γ-亚麻酸(C18:3,n-6)、C20:3,n-6、C20:4,n-6(AA)、C22:4,n-6、单不饱和脂肪酸(MUFA)中C16:1,n-7;饱和脂肪酸(SFA)中SFA总量、C18:0、C20:0、C22:0、C24:0脂肪酸水平、omega-3指数及AA:EPA均显著高于母血,差异具有统计学意义(P0.001)。而n-3PUFA中C22:5,n-3、MUFA中C20:1,n-9、SFA中C16:0,母血和脐血中的脂肪酸水平差异均无统计学意义(P0.05)。(5)新生儿体脂含量影响因素的多元线性回归分析:患有妊娠期糖尿病(β=3.509,P0.001))、分娩孕周(β=1.505,P0.001)、C18:1,n-9(β=1.259,P=0.001)、孕前BMI(β=0.259,P=0.019)、DHA(β=0.980,P=0.031)与新生儿体脂百分比含量呈正相关,而MUFA总量(β=-0.713,P=0.039)与新生儿体脂百分比含量呈负相关。结论:妊娠期糖尿病孕妇所分娩的新生儿体脂含量增多。妊娠期糖尿病患者体内糖脂代谢紊乱,引起宫内环境异常,进而引起新生儿体脂集聚。
[Abstract]:Objective: To investigate the effect of gestational diabetes and its glycolipid metabolism on the body fat content of the newborn, and to provide reference for the management of GDM mother and newborn. Methods: to select the pregnant women in the early pregnancy in the outpatient clinic of Tongling maternal and child health care hospital from May 2014 to May 2015. After 24-28 weeks of pregnancy, the 75g oral glucose tolerance test (OGTT test) was carried out, and the diagnostic criteria of international pregnancy and diabetes research organization (IADPSG): fasting blood glucose was more than 5.1mm/L, and 1H blood sugar was more than 10.0mm after load. /L, after the load, the blood sugar of 2H is more than 8.5mm/L, and any point of blood sugar reaches or exceeds the above boundary value, it can be diagnosed as GDM. to collect the elbow vein blood and newborn umbilical cord blood in the late pregnancy of pregnant women, and put the serum in the -81 refrigerator to keep the reserve. The gas chromatography mass spectrometry (GC-MS) technique is used to detect the fatty acids in the serum and umbilical cord serum of pregnant women in the late pregnancy. Dauncey method was used to calculate the body fat content of the newborn. Results: (1) the general demographic characteristics of group GDM and control group: there were 632 cases of pregnant women in this study, including 189 cases in group GDM and 443 cases in control group, the average age was 27.1 + 4 years old, the maximum age was 43 years and the minimum age was 17 years old; the average age of the group GDM was 27.8 + 4 years, the average age of the control group was 26.8 + 4. The average height of.0 year old.GDM group was 160.8 + 4.4cm, and the average height of the control group was 161 + 4.5cm.GDM. Compared with the control group, the pre pregnancy BMI (21 + 3.0kg/m2 vs.20.1 + 2.4 kg/m2, P=0.001) and the placental weight (577 + 100.4g vs.554.0 91.3g) were 15.5 +. Study significance (P0.05). (2) comparison of the physical measurement data between the GDM group and the control group: the birth weight of the GDM group was 3397.1 + 500.8g, the length of the body was 50.1 + 2.0cm, the length of the top hip was 32.1 + 1.9cm, the head circumference was 34.7 + 1.7cm, the chest circumference was 34 + 1.8cm, the upper arm circumference was 11.9 + 1.0cm, the thigh circumference was 15.9 + 1.3cm, and the leg circumference was 11.7 + 1.1cm. The difference was not statistically significant compared with the control group. The total arm length was 15.3 + 1.3cm, the skin fold thickness of the triceps brachii was 6.4 + 1.5mm, and the thickness of the subscapular skin pleats was 6 + 1.4 mm, which were all higher than the control group. The difference was statistically significant (P0.05) in the.GDM group, the total fat of the newborn was 0.65 + 0.29kg, the percentage of body fat was 18.37 + 5.92%, and the control group was 0.53 + 0.22kg, 15.45 + 4.89%, GDM new birth. The total fat mass and body fat percentage were higher than those of the control group, the difference between the two groups was statistically significant (P0.05). (3) the blood glucose, blood lipid and fatty acid levels of pregnant women in group GDM and control group were compared: (1) in group GDM, blood glucose and blood lipid levels were compared in group GDM, 5.16 + 0.48mmol/L in early stage of pregnancy (FPG) and 1.57 + 0.68 in TG. Mmol/L, HDL was 1.61 + 0.39mmol/L, and LDL was 2.20 + 0.46mmol/L higher than the control group, the difference was statistically significant (P0.05). (2) 24-28 weeks pregnant women were given oral 75g glucose tolerance test, GDM group fasting blood glucose, postprandial 1H blood sugar and 2 hours postprandial blood sugar 5.19 + 0.46 mmol/L, 9.84 + 1.74 mmol/L, 7.51 + 1.43 mmol/L, control group The blood glucose values at three time points were 4.57 + 0.28 mmol/L, 7.74 + 1.50 mmol/L and 6.28 + 4.06mmol/L. respectively. The blood glucose values at each time point in group GDM were higher than those in the control group. The blood sugar values at each time point between the two groups were statistically significant (P0.001). (3) the FPG in the late pregnant women of group GDM was 5.03 + 0.54 mmol/L, TG was 3.94 + 1.52 mmol/L, both high In the control group, the difference was statistically significant (P0.05). (4) there was no significant difference in serum SOD, MDA, GSH-Px, 8- isoprostaglandins in the late pregnancy of the GDM group and the control group. (1) the composition of the serum and umbilical blood fatty acids in the GDM group and the control group was compared to the.GDM group n-6PUFA C20:2, n-6 lower than the control group (0.37 + 0.06%vs.). 0.39 + 0.07%, P=0.049), the difference was statistically significant, but the total amount of MUFA, C18:1, N-9 in group GDM were higher than those in the control group (21.97 + 2.50%vs.21.04 + 2.45%, P=0.010, 18.09 + 2.40%vs.17.10 + 2.19%, P=0.003), and the difference was statistically significant (P0.0) (P0.0) (2) the difference between the serum fatty acid content in the GDM group and the difference in the maternal and umbilical blood in the late pregnancy, the total amount of LC-PUFA in the mother blood of the group GDM, the C18:3, n-3, C20:5, n-3 (EPA) and n-6 PUFA in n-3PUFA. The total amount of n-3 PUFA in umbilical cord blood, C22:6, n-3 (DHA), C18:3, n-6 in n-6 PUFA, C20:3, n-6, C20:4. There were statistical significance (P0.001). But there was no significant difference in the levels of fatty acids in C22:5, n-3, MUFA, C20:1, N-9, SFA in MUFA, N-9, SFA, and maternal and umbilical blood (P0.05). (5) multivariate linear regression analysis of factors affecting body fat content in newborns: gestational diabetes mellitus (beta =3.509, P0.001)) =1.259, P=0.001), pre pregnancy BMI (beta =0.259, P=0.019), DHA (beta =0.980, P=0.031) and newborn body fat percentage content positive correlation, but the total amount of MUFA (beta =-0.713, P=0.039) is negatively correlated with the percentage of body fat in newborn babies. Conclusion: gestational diabetes pregnant women born with increased body fat content. Gestational diabetes patients with Glycolipid Xie's disorder causes abnormal intrauterine environment, which leads to body fat accumulation in newborns.
【学位授予单位】：安徽医科大学
【学位级别】：硕士
【学位授予年份】：2016
【分类号】：R714.256

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