GDM母亲婴儿脐血脂联素与糖脂代谢、胎儿生长发育的关系

目的 探讨妊娠期糖尿病（gestational diabetes mellitus，GDM）母亲婴儿脐血脂联素与糖脂代谢、胎儿生长发育的关系。 方法 选取148例GDM母亲婴儿作为研究对象，根据胎儿出生体重和胎龄分为小于胎龄（small for gestational age，SGA）组48例、适于胎龄（appropriate gestational age，AGA）组59例、大于胎龄（large than gestational age，LGA）组41例。检测其脐血中血清脂联素及血糖、血脂指标水平，分析脐血中脂联素水平与糖脂代谢、胎儿生长发育各指标的关系。 结果 3组胎龄、出生体重、出生体重指数、脐血脂联素、脐血糖化血红蛋白（glycated hemoglobin，HbA1c）、脐血胰岛素、母血胰岛素等差异有统计学意义（P＜0.05），3组性别、脐血血糖、脐血三酰甘油、脐血胆固醇、脐血低密度脂蛋白胆固醇、脐血高密度脂蛋白胆固醇、脐血胰岛素抵抗指数（homeostasis model assessment-insulin resistance，HOMA-IR）差异无统计学意义（P＞0.05）；GDM母亲年龄、孕前体重、分娩时体重、孕前体重指数、孕期体重指数增加量、母血血糖、母血HbA1c、母血HOMA-IR等差异均无统计学意义（P＞0.05）。Pearson相关性分析结果显示，胎儿脐血中脂联素与新生儿胎龄、新生儿出生体重、新生儿出生体量指数、脐血HOMA-IR呈正相关，与脐血HbA1c、脐血胰岛素呈负相关（P＜0.05）。多元线性回归分析结果显示，新生儿出生体重指数、脐血脂联素、脐血HbA1c、脐血胰岛素是胎儿生长发育的影响因素（P＜0.05）。 结论 脐血脂联素与胎儿糖脂代谢及生长发育呈正相关关系，其水平可反映胎儿糖脂代谢及生长发育情况，可为促进胎儿正常生长发育提供指导依据，减少胎儿发生胰岛素抵抗。

The relationship of umbilical cord blood adiponectin with glucose and lipid metabolism,fetal growth and development in infants of mothers with gestational diabetes mellitus

Objective To explore the relationship of umbilical cord blood adiponectin with glucose and lipid metabolism, fetal growth and development in infants of mothers with gestational diabetes mellitus(GDM).Methods In total, 148 infants of GDM mothers were selected as the research subjects. According to fetal birth weight and gestational age, they were divided into small for gestational age(SGA) group(n=48), appropriate gestational age(AGA) group(n=59), and large than gestational age(LGA) group(n=41). The serum adiponectin, blood glucose and blood lipid index levels in the cord blood were detected, and the relationship between the adiponectin level in the cord blood and the glucose and lipid metabolism, fetal growth and development indicators was analyzed.Results There were significant differences in gestational age, birth weight, birth weight index, cord blood adiponectin, cord blood glycated hemoglobin(HbA1c), cord blood insulin, and maternal blood insulin among the three groups(P＜0.05). No significant difference was found in sex, cord blood glucose, cord blood triglyceride, cord blood cholesterol, cord blood low-density lipoprotein cholesterol, cord blood high-density lipoprotein cholesterol, and cord blood homeostasis model assessment-insulin resistance(HOMA-IR)(P＞0.05). GDM maternal age, pre-pregnancy body weight, body weight at delivery, pre-pregnancy body mass index(BMI), increase in BMI during pregnancy, maternal blood glucose, maternal blood HbA1c, and maternal blood HOMA-IR were not statistically significant(P＞0.05). The results of Pearson correlation analysis showed that adiponectin in fetal cord blood was positively correlated with neonatal gestational age, neonatal birth weight, neonatal birth mass index, cord blood HOMA-IR, but negatively correlated with cord blood HbA1c and cord blood insulin(P＜0.05). The results of multiple linear regression analysis showed that neonatal birth weight index, cord blood adiponectin, cord blood HbA1c, and cord blood insulin were the influencing factors of fetal growth and development(P＜0.05).Conclusion Umbilical blood adiponectin has a positive correlation with fetal glucose and lipid metabolism and growth and development, which can reflect fetal glucose and lipid metabolism and growth and development, thereby providing guidance for promoting normal fetal growth and development and reducing fetal insulin resistance.