本文選題：巨大兒 + 補體C1q/腫瘤壞死因子3�。� 參考：《承德醫(yī)學院》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)損傷等不良分娩結局的發(fā)生風險,手術助產(chǎn)率、剖宮產(chǎn)率高,遠期還會使兒童發(fā)生超重和肥胖的風險顯著增加。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,但其作用的機制仍不清楚。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,母體孕期營養(yǎng)物質的供給與代謝狀況,以及胎兒自身對于營養(yǎng)物質的利用,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。補體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,其結構與脂聯(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合物,因此推測CTRP3、CTRP9具有與脂聯(lián)素相似的生物學功能或與脂聯(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?能否作為預測巨大兒的指標?國內外尚未見報道。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性及與巨大兒的關系。2檢測胎盤組織中CTRP3、CTRP9基因mRNA的表達量,分析其與新生兒出生體重的相關性及與巨大兒的關系。3構建CTRP影響因素的模型,為巨大兒預測提供理論證據(jù)。方法:隨機選取2015年12月~2016年12月在承德醫(yī)學院附屬醫(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。納入標準:正常妊娠、單胎、足月分娩,糖耐量試驗正常,新生兒無先天畸形;排除標準: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、孕前患有嚴重內外科疾病。通過問卷調查、體格檢查及查閱病歷收集產(chǎn)婦的一般人口學特征、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;應用實時聚合酶鏈式反應(rt-pcr)檢測胎盤組織中ctrp3、ctrp9基因mrna的表達量。血清ctrp3、ctrp9水平采用均數(shù)±標準差或中位數(shù)(第25百分位數(shù),第75百分位數(shù))描述,組間比較采用兩獨立樣本t檢驗或wilcoxon秩和檢驗,兩變量間的相關性采用spearman法行相關分析;血清ctrp水平的影響因素采用多元線性回歸分析。結果: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)計學意義;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)計學意義。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)計學意義;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)計學意義。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)計學意義。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)的相關性均無統(tǒng)計學意義;出生體重與臍靜脈血清ctrp3(rs=0.599,p0.001)的相關性有統(tǒng)計學意義;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)的相關性均無統(tǒng)計學意義。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)計學意義。6多元線性回歸分析結果顯示,是否分娩巨大兒、分娩孕齡與臍靜脈血清CTRP3水平的的回歸關系有統(tǒng)計學意義。7巨大兒組胎盤組織CTRP3基因mRNA表達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的表達量在兩組間差異無統(tǒng)計學意義(2-△△Ct=0.77,P=0.430)。結論:1臍靜脈血清CTRP3水平與巨大兒的發(fā)生有關,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)生不具有相關性。2胎盤組織中存在CTRP3、CTRP9基因mRNA的表達。胎盤組織中CTRP3基因mRNA表達上調與巨大兒發(fā)生有關。胎盤組織中CTRP9基因mRNA表達量與巨大兒不具有相關性。3是否分娩巨大兒、分娩孕齡是臍靜脈血清CTRP3水平的獨立影響因素。
[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.

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

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