本文選題：巨大兒 + 補(bǔ)體C1q/腫瘤壞死因子3　； 參考：《承德醫(yī)學(xué)院》2017年碩士論文

【摘要】：巨大兒發(fā)生率近年來有逐年增多的趨勢。巨大兒會增加難產(chǎn)、肩難產(chǎn)和臂叢神經(jīng)損傷等不良分娩結(jié)局的發(fā)生風(fēng)險,手術(shù)助產(chǎn)率、剖宮產(chǎn)率高,遠(yuǎn)期還會使兒童發(fā)生超重和肥胖的風(fēng)險顯著增加。巨大兒的發(fā)生與遺傳、孕齡過長、營養(yǎng)過剩、代謝異常等因素有關(guān),但其作用的機(jī)制仍不清楚。胎兒的生長主要依靠母體透過胎盤供給的氧和營養(yǎng)物質(zhì),母體孕期營養(yǎng)物質(zhì)的供給與代謝狀況,以及胎兒自身對于營養(yǎng)物質(zhì)的利用,都將對胎兒的生長發(fā)育產(chǎn)生重要影響。有研究顯示,脂肪組織可以分泌多種活性蛋白,即脂肪因子,其中脂聯(lián)素具有調(diào)節(jié)糖脂代謝和胰島素敏感性等作用,母體靜脈血清、臍靜脈血清脂聯(lián)素均與新生兒出生體重和巨大兒有關(guān)。補(bǔ)體C1q/腫瘤壞死因子(complement-C1q/tumor necrosis factor-related protein,CTRP)3、CTRP9作為脂肪因子CTRPs超家族的兩位重要成員,其結(jié)構(gòu)與脂聯(lián)素有高度同源性,且CTRP3、CTRP9均可與脂聯(lián)素形成異源多聚體復(fù)合物,因此推測CTRP3、CTRP9具有與脂聯(lián)素相似的生物學(xué)功能或與脂聯(lián)素有協(xié)同作用,參與胎兒生長發(fā)育的過程。CTRP3及CTRP9與胎兒生長發(fā)育及巨大兒的發(fā)生是否相關(guān)?能否作為預(yù)測巨大兒的指標(biāo)?國內(nèi)外尚未見報道。目的:1檢測產(chǎn)婦靜脈血清、臍靜脈血清CTRP3、CTRP9水平,分析其與新生兒出生體重的相關(guān)性及與巨大兒的關(guān)系。2檢測胎盤組織中CTRP3、CTRP9基因mRNA的表達(dá)量,分析其與新生兒出生體重的相關(guān)性及與巨大兒的關(guān)系。3構(gòu)建CTRP影響因素的模型,為巨大兒預(yù)測提供理論證據(jù)。方法:隨機(jī)選取2015年12月~2016年12月在承德醫(yī)學(xué)院附屬醫(yī)院產(chǎn)科足月分娩出生體重≥4000 g新生兒的產(chǎn)婦31例作為巨大兒組,分娩正常出生體重兒的產(chǎn)婦31例作為出生體重正常組。納入標(biāo)準(zhǔn):正常妊娠、單胎、足月分娩,糖耐量試驗(yàn)正常,新生兒無先天畸形;排除標(biāo)準(zhǔn):患有妊娠合并癥及并發(fā)癥,如妊娠期高血壓疾病、心臟病、妊娠期甲狀腺功能減退癥、胎盤異常等、孕前患有嚴(yán)重內(nèi)外科疾病。通過問卷調(diào)查、體格檢查及查閱病歷收集產(chǎn)婦的一般人口學(xué)特征、常見慢性病史、孕前身高和體重、孕期有無合并癥及并發(fā)癥、產(chǎn)前體重、分娩孕齡、分娩方式及分娩并發(fā)癥、以及新生兒的性別、出生體重、生長發(fā)育情況等,收集產(chǎn)婦靜脈血清、胎兒臍靜脈血清和胎盤組織,應(yīng)用酶聯(lián)免疫吸附法(elisa)測定產(chǎn)婦靜脈血清及胎兒臍靜脈血清ctrp3、ctrp9水平;應(yīng)用實(shí)時聚合酶鏈?zhǔn)椒磻?yīng)(rt-pcr)檢測胎盤組織中ctrp3、ctrp9基因mrna的表達(dá)量。血清ctrp3、ctrp9水平采用均數(shù)±標(biāo)準(zhǔn)差或中位數(shù)(第25百分位數(shù),第75百分位數(shù))描述,組間比較采用兩獨(dú)立樣本t檢驗(yàn)或wilcoxon秩和檢驗(yàn),兩變量間的相關(guān)性采用spearman法行相關(guān)分析;血清ctrp水平的影響因素采用多元線性回歸分析。結(jié)果:1巨大兒組與出生體重正常組產(chǎn)婦的年齡(歲)(30.26±4.84vs29.03±3.87,t=1.101,p=0.275)、分娩孕齡(周)(39.78±0.85vs39.55±0.99,t=0.987,p=0.328)差異均無統(tǒng)計(jì)學(xué)意義;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)差異均有統(tǒng)計(jì)學(xué)意義。2巨大兒組與出生體重正常組產(chǎn)婦靜脈血清ctrp3(ng/ml)(107.5±18.27vs108.79±20.01,t=0.256,p=0.799)差異無統(tǒng)計(jì)學(xué)意義;臍靜脈血清ctrp3(ng/ml)(102.18±23.66vs70.92±25.96,t=4.955,p0.001)差異有統(tǒng)計(jì)學(xué)意義。3巨大兒組與出生體重正常組的產(chǎn)婦靜脈血清ctrp9(pg/ml)[239.96(114.78~443.92)vs195.67(79.79~383.36),z=0.781,p=0.435]、臍靜脈血清ctrp9(pg/ml)[263.10(197.51~342.15)vs284.51(219.58~469.45),z=1.056,p=0.291]差異均無統(tǒng)計(jì)學(xué)意義。4出生體重與產(chǎn)婦靜脈血清ctrp3(rs=0.020,p=0.876)、出生體重與產(chǎn)婦靜脈血清ctrp9(rs=0.045,p=0.728)、出生體重與臍靜脈血清ctrp9(rs=0.134,p=0.298)的相關(guān)性均無統(tǒng)計(jì)學(xué)意義;出生體重與臍靜脈血清ctrp3(rs=0.599,p0.001)的相關(guān)性有統(tǒng)計(jì)學(xué)意義;產(chǎn)婦靜脈血清CTRP3與臍靜脈血清CTRP3(rs=0.016,P=0.900)、產(chǎn)婦靜脈血清CTRP9與臍靜脈血清CTRP9(rs=0.205,P=0.111)的相關(guān)性均無統(tǒng)計(jì)學(xué)意義。5不同性別(男vs女)新生兒的臍靜脈血清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]差異均無統(tǒng)計(jì)學(xué)意義。6多元線性回歸分析結(jié)果顯示,是否分娩巨大兒、分娩孕齡與臍靜脈血清CTRP3水平的的回歸關(guān)系有統(tǒng)計(jì)學(xué)意義。7巨大兒組胎盤組織CTRP3基因mRNA表達(dá)量高于出生體重正常組(2-△△Ct=2.27,P0.001);而胎盤組織CTRP9基因mRNA的表達(dá)量在兩組間差異無統(tǒng)計(jì)學(xué)意義(2-△△Ct=0.77,P=0.430)。結(jié)論:1臍靜脈血清CTRP3水平與巨大兒的發(fā)生有關(guān),產(chǎn)婦靜脈血清CTRP3、CTRP9水平及臍靜脈血清CTRP9水平與巨大兒的發(fā)生不具有相關(guān)性。2胎盤組織中存在CTRP3、CTRP9基因mRNA的表達(dá)。胎盤組織中CTRP3基因mRNA表達(dá)上調(diào)與巨大兒發(fā)生有關(guān)。胎盤組織中CTRP9基因mRNA表達(dá)量與巨大兒不具有相關(guān)性。3是否分娩巨大兒、分娩孕齡是臍靜脈血清CTRP3水平的獨(dú)立影響因素。
[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.

【學(xué)位授予單位】：承德醫(yī)學(xué)院
【學(xué)位級別】：碩士
【學(xué)位授予年份】：2017
【分類號】：R714.7

【參考文獻(xiàn)】

相關(guān)期刊論文 前10條

1 張正偉;劉明;;腫瘤壞死因子相關(guān)蛋白9與冠心病的關(guān)系[J];中華老年醫(yī)學(xué)雜志;2016年05期

2 王媛;劉戈力;;C1q/腫瘤壞死因子相關(guān)蛋白3和9在肥胖相關(guān)疾病中的作用[J];繼續(xù)醫(yī)學(xué)教育;2016年02期

3 宋延彬;李華;趙博;陶凌;;CTRP-3水平和肥胖癥的相關(guān)性研究[J];心血管康復(fù)醫(yī)學(xué)雜志;2016年01期

4 王蔥;李生兵;;2型糖尿病合并冠心病患者血漿CTRP9水平和胰島素抵抗的相關(guān)性研究[J];現(xiàn)代醫(yī)藥衛(wèi)生;2016年01期

5 張保華;馮曉丹;沈衛(wèi);徐文怡;李嵐;王琴;季靜;鐘燕波;聶啟勤;趙愛民;;血清RBP4和胰島素抵抗指數(shù)與非糖尿病性巨大兒的相關(guān)分析[J];醫(yī)藥論壇雜志;2015年12期

6 劉云濤;簡磊;潘敬芳;;肥胖及2型糖尿病患者血清腫瘤壞死因子相關(guān)蛋白9水平及二甲雙胍對其的影響[J];廣東醫(yī)學(xué);2015年09期

7 胡矩鋒;馬玉燕;;妊娠糖尿病母親血清視黃醇結(jié)合蛋白4水平與巨大兒發(fā)生率的相關(guān)性研究[J];現(xiàn)代婦產(chǎn)科進(jìn)展;2015年04期

8 豐貴香;陳婉秋;;妊娠期糖尿病孕婦產(chǎn)前血清網(wǎng)膜素1表達(dá)與圍生兒結(jié)局關(guān)系[J];中外醫(yī)學(xué)研究;2014年33期

9 李雪峰;孟軍;;網(wǎng)膜素在妊娠糖尿病患者中表達(dá)的臨床意義[J];現(xiàn)代中西醫(yī)結(jié)合雜志;2014年32期

10 李紅艷;王蓓;代聰偉;霍琰;焦榮紅;;網(wǎng)膜素1在妊娠期糖尿病孕婦血漿及臍血中的表達(dá)研究[J];現(xiàn)代中西醫(yī)結(jié)合雜志;2014年29期

相關(guān)碩士學(xué)位論文 前1條

1 孫竹林;脂聯(lián)素和瘦素與巨大兒的相關(guān)性研究[D];山西醫(yī)科大學(xué);2011年

，

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