孕晚期FGF-21水平与糖脂代谢异常之间的交互作用对GDM的影响
发布时间：2018-09-19 16:36
【摘要】：目的1检测孕晚期GDM与正常孕妇血清成纤维细胞生长因子-21浓度(FGF-21)及糖脂代谢指标,观察两组的差异及影响FGF-21的相关因素。2探讨糖、脂代谢指标和FGF-21之间交互作用对妊娠期糖尿病发病的影响。方法1收集在2015年4月至2016年4月期间来到华北理工大学附属医院分娩并且始终在本院定期规律产检的足月孕妇150例。于24-28周OGTT的筛查,根据妇产科学第八版的GDM,将孕妇分为妊娠期糖尿病组(GDM组)67例、非妊娠期糖尿病组(对照组)83例。2以问卷调查及采访的形式收集研究对象的姓名、年龄、文化程度、孕产次及生育方式、家族史、饮食习惯、实际孕前体重或妊娠8周内第一次孕检时记录的体重等,收集实验孕妇入院待产之后的身高、体重,计算受试者妊娠之前的体重指数(BMI)及怀孕后增长的体重指数(△BMI)。3所有纳入研究的孕妇于分娩前采集空腹肘静脉血,采用葡萄糖氧化酶法测量空腹血糖水平;采用电化学发光免疫分析法检测空腹胰岛素水平;采用酶法检测空腹总胆固醇(TC)、甘油三脂(TG)、高密度脂蛋白胆固醇(HDL-C)、低密度脂蛋白胆固醇(LDL-C)水平;采用酶联免疫吸附法(ELISA)检测血清成纤维细胞生长因子-21(FGF-21)水平。根据空腹血糖水平及空腹胰岛素水平计算HOMA稳态模型中的胰岛素抵抗指数(HOMA-IR)、胰岛β细胞功能指数(HOMA-β)。4应用SPSS 22.0软件进行统计分析,计量资料使用t检验;单因素与因变量的关系用Pearson相关分析,1个因变量与多个自变量的关系用多元逐步回归法;从定性及定量两方面分析交互作用定性分析通过相加模型判断,定量分析通过计算超相对危险度、归因比及交互作用指数来判断。结果1妊娠期糖尿病组的年龄、孕周、身高、孕前体重、孕前体重指数、孕晚期体重与正常对照组相比差异无统计学意义(t=0.180,-0.679,-0.234,0.004,0.201,P0.05);妊娠期糖尿病组的孕期体重指数增加、空腹状态下的血糖水平和胰岛素水平、HOMA稳态模型中的胰岛素抵抗指数、甘油三酯、低密度脂蛋白、总胆固醇、成纤维细胞生长因子-21均明显高于正常对照组,并且差异是具有统计学意义的(t=10.280,9.384,9.996,9.208,5.849,6.455,3.279,P0.05);妊娠期糖尿病组的高密度脂蛋白、HOMA稳态模型中的胰岛β细胞功能指数较正常对照组是偏低的,并且差异存在统计学意义(t=-5.967,-2.920,P0.05);2经Pearson相关分析法分析后表明,非妊娠期糖尿病孕妇空腹血清中的成纤维细胞生长因子-21浓度与空腹血糖、胰岛素抵抗指数、甘油三酯、低密度脂蛋白呈正相关(r=0.767,0.352,0.808,0.768,P0.05);与孕期体重指数增加、胰岛β细胞功能指数、高密度脂蛋白呈负相关(r=-0.341,-0.385,-0.763,P0.05);与年龄、身高、孕前体重、孕前BMI、孕晚期体重、空腹胰岛素、总胆固醇均没有相关性。甘油三酯、高密度脂蛋白和空腹血糖是成纤维细胞生长因子-21的独立影响因素。妊娠期糖尿病组的女性空腹血清中的成纤维细胞生长因子-21浓度与妊娠前体重、妊娠前的体重指数、孕后期体重、空腹血糖、空腹胰岛素、胰岛素抵抗的指数、甘油三酯、低密度脂蛋白、总胆固醇水平呈正向相关(r=0.535,0.600,0.535,0.815,0.661,0.749,0.798,0.773,0.410,P0.05);与高密度脂蛋白的水平呈负向相关(r=-0.701,P0.01);和年龄、孕周、身高、孕期体重指数差值、胰岛素抵抗指数均没有相关性。空腹血糖、甘油三酯、胰岛素抵抗指数是成纤维细胞生长因子-21的独立影响因素;3交互作用分析显示成纤维细胞生长因子-21水平升高与胰岛素抵抗指数、胰岛细胞损伤、甘油三酯异常、总胆固醇异常、低密度脂蛋白异常或高密度脂蛋白异常等因素联合作用时会导致妊娠期糖尿病的发病风险升高,经定量分析得出成纤维细胞生长因子-21与总胆固醇的交互作用AP=0.89(0.76,1.03),有统计学意义。结论1妊娠期糖尿病妇女血清成纤维细胞生长因子-21水平高于普通健康孕妇,其可能参与了妊娠期糖尿病的发生和进展。2妊娠期糖尿病孕妇的血清成纤维细胞生长因子-21水平受到孕期体重增值、空腹血糖、空腹胰岛素、胰岛素抵抗指数及脂质代谢指标水平的影响;其可能参与了妊娠期糖尿病糖脂代谢的过程。3高成纤维细胞生长因子-21水平与糖代谢和脂代谢指标异常同时存在的情况下,产生的联合作用会导致妊娠期糖尿病发病风险升高。成纤维细胞生长因子-21水平升高与总胆固醇异常存在协同作用,二者同时存在时会使妊娠期糖尿病的发病风险增加。
[Abstract]:Objective 1 To detect the serum levels of fibroblast growth factor-21 (FGF-21) and glucose and lipid metabolism in late pregnancy GDM and normal pregnant women, and to observe the differences between the two groups and the related factors affecting the expression of FGF-21.2 To explore the effects of the interaction of glucose, lipid metabolism and FGF-21 on the incidence of gestational diabetes mellitus (GDM). During 24-28 weeks of OGTT screening, according to the eighth edition of Obstetrics and Gynecology GDM, pregnant women were divided into gestational diabetes mellitus group (GDM group) 67 cases, non-gestational diabetes mellitus group (control group) 83 cases. Name, age, education level, prenatal and reproductive style, family history, dietary habits, actual pre-pregnancy weight or body weight recorded during the first pregnancy check-up within 8 weeks of pregnancy were collected. Height and body weight of experimental pregnant women after admission to hospital were collected. Body mass index (BMI) before pregnancy and body mass index (BMI) after pregnancy were calculated. 3. The fasting elbow venous blood was collected from all the pregnant women before delivery, and fasting blood glucose was measured by glucose oxidase method; fasting insulin was detected by electrochemiluminescence immunoassay; fasting total cholesterol (TC), triglyceride (TG), high density lipoprotein cholesterol (HDL-C), low density lipoprotein cholesterol (LDL-C) was detected by enzyme method. Serum fibroblast growth factor-21 (FGF-21) levels were measured by enzyme-linked immunosorbent assay (ELISA). Insulin resistance index (HOMA-IR) and islet beta cell function index (HOMA-beta) in HOMA homeostasis model were calculated according to fasting blood glucose level and fasting insulin level. Data were analyzed by t test; the relationship between single factor and dependent variable was analyzed by Pearson correlation analysis; the relationship between one dependent variable and multiple independent variables was analyzed by multiple stepwise regression method; qualitative and quantitative analysis of interaction was analyzed by adding model; quantitative analysis was judged by calculating super relative risk, attribution ratio and interaction index. Results 1 There were no significant differences in age, gestational age, height, weight before pregnancy, body mass index before pregnancy and body weight during the third trimester between the gestational diabetes group and the normal control group (t = 0.180, - 0.679, - 0.234, 0.004, 0.201, P 0.05); BMI increased during pregnancy, fasting blood glucose and insulin levels, and HOMA was stable in the gestational diabetes group. Insulin resistance index, triglyceride, low density lipoprotein, total cholesterol, fibroblast growth factor-21 in the state model were significantly higher than those in the normal control group, and the differences were statistically significant (t = 10.280, 9.384, 9.996, 9.208, 5.849, 6.455, 3.279, P 0.05); high density lipoprotein, HOMA homeostasis model in the gestational diabetes mellitus group The islet beta cell function index of non-gestational diabetes mellitus pregnant women was lower than that of the normal control group, and the difference was statistically significant (t=-5.967, -2.920, P 0.05). 2 By Pearson correlation analysis, the concentration of fibroblast growth factor-21 in the fasting serum and fasting blood glucose, insulin resistance index, triglyceride, low density were found in non-gestational diabetes mellitus pregnant women. Degree lipoprotein was positively correlated (r = 0.767, 0.352, 0.808, 0.768, P 0.05); negatively correlated with gestational body mass index, islet beta cell function index, and high density lipoprotein (r = - 0.341, - 0.385, - 0.763, P 0.05); but not with age, height, pre-pregnancy weight, BMI, late pregnancy weight, fasting insulin, and total cholesterol. The concentration of fibroblast growth factor-21 in the fasting serum of women with gestational diabetes mellitus was associated with pre-pregnancy weight, pre-pregnancy body mass index, post-pregnancy weight, fasting blood glucose, fasting insulin, insulin resistance index, triglyceride, and low density. Lipoprotein and total cholesterol levels were positively correlated (r = 0.535, 0.600, 0.535, 0.815, 0.661, 0.749, 0.798, 0.773, 0.410, P 0.05); and negatively correlated with high-density lipoprotein levels (r = - 0.701, P 0.01); and age, gestational age, height, BMI difference during pregnancy, insulin resistance index were not correlated. The interaction analysis showed that the elevated level of fibroblast growth factor-21 combined with insulin resistance index, islet cell injury, triglyceride abnormality, total cholesterol abnormality, low density lipoprotein abnormality or high density lipoprotein abnormality could lead to pregnancy. The risk of gestational diabetes mellitus increased. The quantitative analysis showed that the interaction between fibroblast growth factor-21 and total cholesterol AP = 0.89 (0.76, 1.03), with statistical significance. Conclusion 1 The serum level of fibroblast growth factor-21 in gestational diabetes mellitus women was higher than that in normal healthy pregnant women, which may be involved in the occurrence of gestational diabetes mellitus. 2. The serum levels of fibroblast growth factor-21 in gestational diabetes mellitus pregnant women were affected by weight gain during pregnancy, fasting blood glucose, fasting insulin, insulin resistance index and lipid metabolism. 3. High levels of fibroblast growth factor-21 and glucose metabolism. In the case of abnormal metabolism of lipid metabolism and metabolism, the combined effect will lead to an increased risk of gestational diabetes mellitus.
【学位授予单位】：华北理工大学
【学位级别】：硕士
【学位授予年份】：2017
【分类号】：R714.256
本文编号：2250705
[Abstract]:Objective 1 To detect the serum levels of fibroblast growth factor-21 (FGF-21) and glucose and lipid metabolism in late pregnancy GDM and normal pregnant women, and to observe the differences between the two groups and the related factors affecting the expression of FGF-21.2 To explore the effects of the interaction of glucose, lipid metabolism and FGF-21 on the incidence of gestational diabetes mellitus (GDM). During 24-28 weeks of OGTT screening, according to the eighth edition of Obstetrics and Gynecology GDM, pregnant women were divided into gestational diabetes mellitus group (GDM group) 67 cases, non-gestational diabetes mellitus group (control group) 83 cases. Name, age, education level, prenatal and reproductive style, family history, dietary habits, actual pre-pregnancy weight or body weight recorded during the first pregnancy check-up within 8 weeks of pregnancy were collected. Height and body weight of experimental pregnant women after admission to hospital were collected. Body mass index (BMI) before pregnancy and body mass index (BMI) after pregnancy were calculated. 3. The fasting elbow venous blood was collected from all the pregnant women before delivery, and fasting blood glucose was measured by glucose oxidase method; fasting insulin was detected by electrochemiluminescence immunoassay; fasting total cholesterol (TC), triglyceride (TG), high density lipoprotein cholesterol (HDL-C), low density lipoprotein cholesterol (LDL-C) was detected by enzyme method. Serum fibroblast growth factor-21 (FGF-21) levels were measured by enzyme-linked immunosorbent assay (ELISA). Insulin resistance index (HOMA-IR) and islet beta cell function index (HOMA-beta) in HOMA homeostasis model were calculated according to fasting blood glucose level and fasting insulin level. Data were analyzed by t test; the relationship between single factor and dependent variable was analyzed by Pearson correlation analysis; the relationship between one dependent variable and multiple independent variables was analyzed by multiple stepwise regression method; qualitative and quantitative analysis of interaction was analyzed by adding model; quantitative analysis was judged by calculating super relative risk, attribution ratio and interaction index. Results 1 There were no significant differences in age, gestational age, height, weight before pregnancy, body mass index before pregnancy and body weight during the third trimester between the gestational diabetes group and the normal control group (t = 0.180, - 0.679, - 0.234, 0.004, 0.201, P 0.05); BMI increased during pregnancy, fasting blood glucose and insulin levels, and HOMA was stable in the gestational diabetes group. Insulin resistance index, triglyceride, low density lipoprotein, total cholesterol, fibroblast growth factor-21 in the state model were significantly higher than those in the normal control group, and the differences were statistically significant (t = 10.280, 9.384, 9.996, 9.208, 5.849, 6.455, 3.279, P 0.05); high density lipoprotein, HOMA homeostasis model in the gestational diabetes mellitus group The islet beta cell function index of non-gestational diabetes mellitus pregnant women was lower than that of the normal control group, and the difference was statistically significant (t=-5.967, -2.920, P 0.05). 2 By Pearson correlation analysis, the concentration of fibroblast growth factor-21 in the fasting serum and fasting blood glucose, insulin resistance index, triglyceride, low density were found in non-gestational diabetes mellitus pregnant women. Degree lipoprotein was positively correlated (r = 0.767, 0.352, 0.808, 0.768, P 0.05); negatively correlated with gestational body mass index, islet beta cell function index, and high density lipoprotein (r = - 0.341, - 0.385, - 0.763, P 0.05); but not with age, height, pre-pregnancy weight, BMI, late pregnancy weight, fasting insulin, and total cholesterol. The concentration of fibroblast growth factor-21 in the fasting serum of women with gestational diabetes mellitus was associated with pre-pregnancy weight, pre-pregnancy body mass index, post-pregnancy weight, fasting blood glucose, fasting insulin, insulin resistance index, triglyceride, and low density. Lipoprotein and total cholesterol levels were positively correlated (r = 0.535, 0.600, 0.535, 0.815, 0.661, 0.749, 0.798, 0.773, 0.410, P 0.05); and negatively correlated with high-density lipoprotein levels (r = - 0.701, P 0.01); and age, gestational age, height, BMI difference during pregnancy, insulin resistance index were not correlated. The interaction analysis showed that the elevated level of fibroblast growth factor-21 combined with insulin resistance index, islet cell injury, triglyceride abnormality, total cholesterol abnormality, low density lipoprotein abnormality or high density lipoprotein abnormality could lead to pregnancy. The risk of gestational diabetes mellitus increased. The quantitative analysis showed that the interaction between fibroblast growth factor-21 and total cholesterol AP = 0.89 (0.76, 1.03), with statistical significance. Conclusion 1 The serum level of fibroblast growth factor-21 in gestational diabetes mellitus women was higher than that in normal healthy pregnant women, which may be involved in the occurrence of gestational diabetes mellitus. 2. The serum levels of fibroblast growth factor-21 in gestational diabetes mellitus pregnant women were affected by weight gain during pregnancy, fasting blood glucose, fasting insulin, insulin resistance index and lipid metabolism. 3. High levels of fibroblast growth factor-21 and glucose metabolism. In the case of abnormal metabolism of lipid metabolism and metabolism, the combined effect will lead to an increased risk of gestational diabetes mellitus.
【学位授予单位】：华北理工大学
【学位级别】：硕士
【学位授予年份】：2017
【分类号】：R714.256
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