【摘要】：目的1檢測(cè)孕婦血清IGF-1、空腹血糖、空腹胰島素及臍血IGF-1水平,分析IGF-1與妊娠期糖尿病胰島素抵抗的關(guān)系;2分析GDM新生兒NABA評(píng)分與IGF-1、HOMA-IR等因素的關(guān)系,探討影響妊娠期糖尿病新生兒神經(jīng)行為發(fā)育的因素;方法隨機(jī)選取2015年10月至2016年4月在華北理工大學(xué)附屬醫(yī)院定期孕檢且分娩的妊娠期糖尿病孕婦47例作為GDM組,同時(shí)選取同期分娩的正常孕婦55例作為對(duì)照組。于分娩前抽取兩組孕婦的空腹肘靜脈血,于分娩時(shí)抽取兩組孕婦胎兒的臍靜脈血。應(yīng)用酶聯(lián)免疫(ELISA)法對(duì)兩組孕婦及其臍血中的IGF-1進(jìn)行測(cè)定,分別應(yīng)用葡萄糖氧化酶法和電化學(xué)發(fā)光免疫分析法對(duì)孕婦空腹血糖和空腹胰島素進(jìn)行測(cè)定,并根據(jù)新生兒神經(jīng)行為測(cè)定(NBNA)評(píng)分法評(píng)估新生兒神經(jīng)系統(tǒng)發(fā)育的情況,胰島素抵抗程度用胰島素抵抗指數(shù)(HOMA-IR)來(lái)衡量。整理數(shù)據(jù),計(jì)量資料采用t檢驗(yàn),計(jì)數(shù)資料采用c2檢驗(yàn),采用Pearson相關(guān)分析法判斷兩指標(biāo)間的關(guān)系,一個(gè)因變量和多個(gè)自變量間的關(guān)系采用多元線性回歸分析法。結(jié)果1 GDM組孕婦血清IGF-1(176.03±15.98pg/ml)低于對(duì)照組孕婦血清IGF-1(190.14±33.34pg/ml),且差異有統(tǒng)計(jì)學(xué)意義(t=-2.786,P=0.007);GDM組臍血IGF-1(181.85±16.49pg/ml)高于對(duì)照組臍血IGF-1(169.34±18.92pg/ml),差異有統(tǒng)計(jì)學(xué)意義(t=3.531,P=0.001);GDM孕婦血清IGF-1與其胎兒臍血IGF-1呈負(fù)相關(guān)(r=-0.323,P=0.027)。2 GDM孕婦的空腹血糖、空腹胰島素、胰島素抵抗指數(shù)明顯高于對(duì)照組,差異有統(tǒng)計(jì)學(xué)意義(P0.01);GDM組孕婦血清IGF-1與HOMA-IR呈負(fù)相關(guān)(r=-0.446,P=0.002),GDM組臍血IGF-1與HOMA-IR呈正相關(guān)(r=0.586,P=0.000)。3 GDM組新生兒NABA評(píng)分(36.13±1.63分)低于對(duì)照組(37.49±1.48分),差異有統(tǒng)計(jì)學(xué)意義(t=-4.403,P=0.000)。4經(jīng)Pesrson相關(guān)分析可得,妊娠期糖尿病組新生兒NABA評(píng)分與孕婦空腹血糖、空腹胰島素、HOMA-IR、臍血IGF-1呈負(fù)相關(guān)關(guān)系(P0.05),與母血IGF-1呈正相關(guān)關(guān)系(P0.05);經(jīng)多元線性回歸分析可得,母血IGF-1、臍血IGF-1與新生兒NABA評(píng)分有密切關(guān)系,母兒血清IGF-1水平異常可能會(huì)影響妊娠期糖尿病新生兒神經(jīng)行為發(fā)育情況。結(jié)論1妊娠期糖尿病孕婦血清中IGF-1水平顯著降低,而其臍血中IGF-1水平顯著升高;二者呈負(fù)相關(guān)。2妊娠期糖尿病孕婦血清IGF-1的低水平、臍血IGF-1的高水平與胰島素抵抗有關(guān),說(shuō)明IGF-1可能參與了GDM的胰島素抵抗。3妊娠期糖尿病孕婦新生兒神經(jīng)行為評(píng)分明顯降低,主要表現(xiàn)在行為能力、主動(dòng)肌張力及被動(dòng)肌張力方面;母血IGF-1降低、臍血IGF-1升高與妊娠期糖尿病新生兒神經(jīng)行為發(fā)育異常關(guān)系密切。
[Abstract]:Objective 1 to detect the levels of serum IGF-1, fasting blood glucose, fasting insulin and IGF-1 in pregnant women, and to analyze the relationship between IGF-1 and insulin resistance in gestational diabetes mellitus (GDM). Methods 47 pregnant women with gestational diabetes mellitus (GDM) were randomly selected as GDM group from October 2015 to April 2016 in the affiliated hospital of North China University of Technology. At the same time, 55 normal pregnant women were selected as control group. Fasting cubitus vein blood was drawn from two groups of pregnant women before delivery and umbilical vein blood from fetus of two groups of pregnant women during delivery. The levels of IGF-1 in two groups of pregnant women and their umbilical blood were determined by enzyme linked immunosorbent assay (Elisa), and fasting blood glucose and fasting insulin were measured by glucose oxidase method and electrochemiluminescence immunoassay, respectively. The neonatal neurobehavioral test (NBNA) was used to evaluate the development of neonatal nervous system. The degree of insulin resistance was measured by the insulin resistance index (HOMA-IR). The data are sorted out by t test, count data by c2 test, Pearson correlation method is used to judge the relationship between two indexes, and the relationship between one dependent variable and several independent variables is analyzed by multivariate linear regression analysis. 緇撴灉1 GDM緇勫瓡濡囪娓匢GF-1(176.03鹵15.98pg/ml)浣庝簬瀵圭収緇勫瓡濡囪娓匢GF-1(190.14鹵33.34pg/ml),涓斿樊寮傛湁緇熻瀛︽剰涔，

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