孕晚期FGF-21水平與糖脂代謝異常之間的交互作用對GDM的影響
發(fā)布時間：2018-09-19 16:36
【摘要】：目的1檢測孕晚期GDM與正常孕婦血清成纖維細(xì)胞生長因子-21濃度(FGF-21)及糖脂代謝指標(biāo),觀察兩組的差異及影響FGF-21的相關(guān)因素。2探討糖、脂代謝指標(biāo)和FGF-21之間交互作用對妊娠期糖尿病發(fā)病的影響。方法1收集在2015年4月至2016年4月期間來到華北理工大學(xué)附屬醫(yī)院分娩并且始終在本院定期規(guī)律產(chǎn)檢的足月孕婦150例。于24-28周OGTT的篩查,根據(jù)婦產(chǎn)科學(xué)第八版的GDM,將孕婦分為妊娠期糖尿病組(GDM組)67例、非妊娠期糖尿病組(對照組)83例。2以問卷調(diào)查及采訪的形式收集研究對象的姓名、年齡、文化程度、孕產(chǎn)次及生育方式、家族史、飲食習(xí)慣、實際孕前體重或妊娠8周內(nèi)第一次孕檢時記錄的體重等,收集實驗孕婦入院待產(chǎn)之后的身高、體重,計算受試者妊娠之前的體重指數(shù)(BMI)及懷孕后增長的體重指數(shù)(△BMI)。3所有納入研究的孕婦于分娩前采集空腹肘靜脈血,采用葡萄糖氧化酶法測量空腹血糖水平;采用電化學(xué)發(fā)光免疫分析法檢測空腹胰島素水平;采用酶法檢測空腹總膽固醇(TC)、甘油三脂(TG)、高密度脂蛋白膽固醇(HDL-C)、低密度脂蛋白膽固醇(LDL-C)水平;采用酶聯(lián)免疫吸附法(ELISA)檢測血清成纖維細(xì)胞生長因子-21(FGF-21)水平。根據(jù)空腹血糖水平及空腹胰島素水平計算HOMA穩(wěn)態(tài)模型中的胰島素抵抗指數(shù)(HOMA-IR)、胰島β細(xì)胞功能指數(shù)(HOMA-β)。4應(yīng)用SPSS 22.0軟件進(jìn)行統(tǒng)計分析,計量資料使用t檢驗;單因素與因變量的關(guān)系用Pearson相關(guān)分析,1個因變量與多個自變量的關(guān)系用多元逐步回歸法;從定性及定量兩方面分析交互作用定性分析通過相加模型判斷,定量分析通過計算超相對危險度、歸因比及交互作用指數(shù)來判斷。結(jié)果1妊娠期糖尿病組的年齡、孕周、身高、孕前體重、孕前體重指數(shù)、孕晚期體重與正常對照組相比差異無統(tǒng)計學(xué)意義(t=0.180,-0.679,-0.234,0.004,0.201,P0.05);妊娠期糖尿病組的孕期體重指數(shù)增加、空腹?fàn)顟B(tài)下的血糖水平和胰島素水平、HOMA穩(wěn)態(tài)模型中的胰島素抵抗指數(shù)、甘油三酯、低密度脂蛋白、總膽固醇、成纖維細(xì)胞生長因子-21均明顯高于正常對照組,并且差異是具有統(tǒng)計學(xué)意義的(t=10.280,9.384,9.996,9.208,5.849,6.455,3.279,P0.05);妊娠期糖尿病組的高密度脂蛋白、HOMA穩(wěn)態(tài)模型中的胰島β細(xì)胞功能指數(shù)較正常對照組是偏低的,并且差異存在統(tǒng)計學(xué)意義(t=-5.967,-2.920,P0.05);2經(jīng)Pearson相關(guān)分析法分析后表明,非妊娠期糖尿病孕婦空腹血清中的成纖維細(xì)胞生長因子-21濃度與空腹血糖、胰島素抵抗指數(shù)、甘油三酯、低密度脂蛋白呈正相關(guān)(r=0.767,0.352,0.808,0.768,P0.05);與孕期體重指數(shù)增加、胰島β細(xì)胞功能指數(shù)、高密度脂蛋白呈負(fù)相關(guān)(r=-0.341,-0.385,-0.763,P0.05);與年齡、身高、孕前體重、孕前BMI、孕晚期體重、空腹胰島素、總膽固醇均沒有相關(guān)性。甘油三酯、高密度脂蛋白和空腹血糖是成纖維細(xì)胞生長因子-21的獨立影響因素。妊娠期糖尿病組的女性空腹血清中的成纖維細(xì)胞生長因子-21濃度與妊娠前體重、妊娠前的體重指數(shù)、孕后期體重、空腹血糖、空腹胰島素、胰島素抵抗的指數(shù)、甘油三酯、低密度脂蛋白、總膽固醇水平呈正向相關(guān)(r=0.535,0.600,0.535,0.815,0.661,0.749,0.798,0.773,0.410,P0.05);與高密度脂蛋白的水平呈負(fù)向相關(guān)(r=-0.701,P0.01);和年齡、孕周、身高、孕期體重指數(shù)差值、胰島素抵抗指數(shù)均沒有相關(guān)性�？崭寡�、甘油三酯、胰島素抵抗指數(shù)是成纖維細(xì)胞生長因子-21的獨立影響因素;3交互作用分析顯示成纖維細(xì)胞生長因子-21水平升高與胰島素抵抗指數(shù)、胰島細(xì)胞損傷、甘油三酯異常、總膽固醇異常、低密度脂蛋白異�；蚋呙芏戎鞍桩惓５纫蛩芈�(lián)合作用時會導(dǎo)致妊娠期糖尿病的發(fā)病風(fēng)險升高,經(jīng)定量分析得出成纖維細(xì)胞生長因子-21與總膽固醇的交互作用AP=0.89(0.76,1.03),有統(tǒng)計學(xué)意義。結(jié)論1妊娠期糖尿病婦女血清成纖維細(xì)胞生長因子-21水平高于普通健康孕婦,其可能參與了妊娠期糖尿病的發(fā)生和進(jìn)展。2妊娠期糖尿病孕婦的血清成纖維細(xì)胞生長因子-21水平受到孕期體重增值、空腹血糖、空腹胰島素、胰島素抵抗指數(shù)及脂質(zhì)代謝指標(biāo)水平的影響;其可能參與了妊娠期糖尿病糖脂代謝的過程。3高成纖維細(xì)胞生長因子-21水平與糖代謝和脂代謝指標(biāo)異常同時存在的情況下,產(chǎn)生的聯(lián)合作用會導(dǎo)致妊娠期糖尿病發(fā)病風(fēng)險升高。成纖維細(xì)胞生長因子-21水平升高與總膽固醇異常存在協(xié)同作用,二者同時存在時會使妊娠期糖尿病的發(fā)病風(fēng)險增加。
[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.
【學(xué)位授予單位】：華北理工大學(xué)
【學(xué)位級別】：碩士
【學(xué)位授予年份】：2017
【分類號】：R714.256
本文編號：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.
【學(xué)位授予單位】：華北理工大學(xué)
【學(xué)位級別】：碩士
【學(xué)位授予年份】：2017
【分類號】：R714.256
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