妊娠期糖尿病与孕妇血清C-反应蛋白水平相关性研究

目的：探究妊娠期糖尿病与孕妇血清C-反应蛋白水平相关性。方法：选取2014年4月至2015年11月于我院接受孕检的孕妇190例,其中糖尿病孕妇97例,作为本研究实验组;另外93例健康状况良好,作为对照组。记录并比较两组孕妇年龄、平均孕周、孕前体重指数(BMI);检查并比较其血清C-反应蛋白(CRP)水平、胰岛素抵抗指数、空腹血糖水平、空腹胰岛素水平、孕期体重增长,并对CRP的相关影响因素进行Pearson相关分析以及多元线性回归分析。结果：对照组孕妇平均年龄为(29.13±2.18)岁,平均孕周为(25.36±3.23)周,孕前BMI为(20.27±1.72) kg/m2;实验组孕妇平均年龄为(28.24±1.97)岁,平均孕周(26.13±2.79)周,孕前BMI为(20.32±1.68) kg/m2,对比结果无统计学差异(P>0.05);对照组空腹血糖含量为(4.62±0.54) mmol/L,实验组为(5.21±0.81) mmol/L,对比结果无统计学意义(P>0.05);对照组空腹胰岛素水平为(8.93±1.76) mmol/L,实验组为(11.71±4.83) mmol/L,对比结果具有统计学意义(P<0.05);对照组孕妇血清CRP含量为(2.17±0.76) mg/L,胰岛素抵抗指数为1.76±0.69,孕期体重增长(13.47±2.01) kg,实验组为孕妇血清CRP含量为(4.12±0.73) mg/L,胰岛素抵抗指数为2.57±2.18,孕期体重增长(17.13±5.79) kg,对比结果具有统计学意义(P<0.05);Pearson分析显示血清CRP水平与胰岛素抵抗指数、孕期体重增长、孕前体重指数、空腹血糖呈正相关关系,其系数分别为0.369、0.319、0.289、0.268,均具有统计学意义(P<0.05),对CRP的多元线性回归分析,其方程为y(CRP)=0.319X1+0.09X2+0.239X3?3.879,r2=0.259(X1：胰岛素抵抗指数,X2：孕期体重增长,X3：孕前体重指数)。结论：对于妊娠期妇女,血清C-反应蛋白水平超标是引起糖尿病的重要因素之一,但独立影响尚不能被证实,建议临床上在孕期定期检查孕妇血清C-反应蛋白水平,有利于妊娠期糖尿病的有效防治。     

Platelets and endothelial dysfunction in gestational diabetes mellitus

The prevalence of gestational diabetes mellitus (GDM) has increased in recent years, along with the higher prevalence of obesity in women of reproductive age. GDM is a pathology associated with vascular dysfunction in the fetoplacental unit. GDM-associated endothelial dysfunction alters the transfer of nutrients to the foetus affecting newborns and pregnant women. Various mechanisms for this vascular dysfunction have been proposed, of which the most studied are metabolic alterations of the vascular endothelium. However, different cell types are involved in GDM-associated endothelial dysfunction, including platelets. Platelets are small, enucleated cell fragments that actively take part in blood haemostasis and thrombus formation. Thus, they play crucial roles in pathologies coursing with endothelial dysfunction, such as atherosclerosis, cardiovascular diseases, and diabetes mellitus. Nevertheless, platelet function in GDM is understudied. Several reports show a potential relationship between platelet volume and mass with GDM; however, platelet roles and signaling mechanisms in GDM-associated endothelial dysfunction are unclear. This review summarizes the reported findings and proposes a link among altered amount, volume, mass, reactivity, and function of platelets and placenta development, resulting in fetoplacental vascular dysfunction in GDM.     

The role of genetics and epigenetics in the pathogenesis of gestational diabetes mellitus

Diabetes mellitus (DM) is a heterogeneous group of disorders whose common trait is chronic hyperglycemia. Gestational diabetes mellitus (GDM) is one of the subtypes of DM that manifests during pregnancy. It is believed that 2%–5% of pregnancies worldwide are complicated with GDM, with the prevalence having significantly increased over the last decade. While the pathogenesis of the disease remains largely unknown, GDM is believed to be a result of interactions between genetic, epigenetic, and environmental factors. Linkage and association studies, including those that are genome-wide, have allowed us to identify complex genetic and epigenetic mechanisms that lead to the development of GDM. Multiple common variants in candidate genes such as potassium inwardly rectifying channel subfamily J, member 11 (KCNJ11), glucokinase (GCK), or hepatocyte nuclear factor 1α (HNF1A) have been found to increase the disease risk. In this review, we provide a detailed overview of the current knowledge concerning the influence of genetics and epigenetics on the development of GDM.     

Differentiation of gestational diabetes mellitus by nuclear magnetic resonance-based metabolic plasma analysis

This study aimed to investigate the metabolic pro?le of gestational diabetes mellitus (GDM) at both antepartum and postpartum periods. Seventy pregnant women were divided into three groups: the normal glucose-tolerant group (NGT, n=35), the abnormal glucose-tolerant groups without insulin therapy (A1GDM, n=24) or with insulin therapy (A2GDM, n=11). Metabolic pro?les of the plasma were acquired by proton nuclear magnetic resonance (¹H-NMR) spectroscopy and analyzed by multivariate statistical data analysis. The relationship between demographic parameters and the potential metabolite biomarkers was further explored. Group antepartum or postpartum showed similar metabolic trends. Compare with those of the NGT group, the levels of 2-hydroxybutyrate, lysine, acetate, glutamine, succinate, tyrosine, formate, and all three BCAAs (leucine, valine, isoleucine) in the A2GDM group were increased dramatically, and the levels of lysine, acetate, and formate in the A1GDM group were elevated significantly. The dramatically decreased levels of 3-methyl-2-oxovalerate and methanol were observed both in the A1GDM group and A2GDM group. Compare to the A1GDM group, the branched-chain amino acids (BCAAs) of leucine, valine, and isoleucine were increased dramatically in the A2GDM group. The levels of aromatic amino acids (AAAs), tyrosine and phenylalanine, were significantly increased in GDM women, consistent with the severity of GDM. Interference of amino acid metabolism and disturbance in energy metabolism occurred in women with different grades of GDM. Metabolic profiles could reflect the severity of GDM. Plasma BCAA concentrations showing strong positive correlations with weight and pre-delivery BMI. This study provides a new perspective to understand the pathogenesis and etiology of GDM, which may help the clinical management and treatment of GDM.     

孕中期超敏C反应蛋白与妊娠期糖尿病相关

目的探讨孕中期超敏C反应蛋白(hs CRP)水平与妊娠期糖尿病(GDM)发病及血糖有关指标的相关性。方法纳入GDM孕妇725人,糖耐量正常孕妇935人,详细记录受试者孕前体质量、身高、血压,于孕24~28周检测hs CRP、血糖、胰岛素水平。分析孕中期hs CRP水平与血糖和胰岛素水平及GDM发生的相关性。结果 GDM组的孕中期hs CRP水平明显高于糖耐量正常(NGT)组(P0.01)。hs CRP水平升高是GDM发病的独立危险因素(P0.05)。空腹血糖与hs CRP水平正相关(P0.05),50 g糖后1 h血糖与hs CRP水平正相关(P0.05),100 g OGTT后1、2和3 h血糖与hs CRP水平正相关(P0.05),糖化血红蛋白(Hb A1c)与hs CRP水平正相关(P0.05),空腹真胰岛素与hs CRP水平正相关(P0.05),100 g OGTT后1、2和3 h真胰岛素与hs CRP水平正相关(P0.05),HOMA-IR与hs CRP水平正相关(P0.05)。结论孕中期hs CRP水平升高能明显增加GDM的发病风险,可作为GDM诊断的指标之一。     

妊娠期糖尿病遗传易感性的研究进展

妊娠期糖尿病(GDM)是孕期发生的严重影响胎儿和母体的疾病。近年来其发病率有逐渐增高的趋势,但具体发病机制还未明确,研究显示遗传因素在GDM的发病中发挥重要作用。因此探讨GDM的遗传基础将有助于为GDM的早期诊治和个体化治疗提供依据。     

肠道菌群在妊娠期糖尿病发病中作用的研究进展

肠道菌群对引发妊娠期糖尿病(GDM)具有重要作用.肠道菌群通过对肠道黏膜屏障的破坏,释放代谢产物、引起脂肪因子和炎性因子的释放及影响肠道免疫功能等方式导致胰岛素抵抗及分泌水平下降,血糖稳态失衡,最终引发GDM.益生菌可以有效改善GDM患者的肠道菌群失调及血糖的紊乱,从而改善妊娠结局.     

血浆护骨素及有关因子水平在两组妊娠妇女间的比较

 摘要：目的 研究妊娠期糖尿病（GDM）和正常糖耐量(NGT)妊娠妇女在孕中晚期血浆护骨素及有关因子水平的比较。方法 收集NGT和GDM妊娠妇女各65例,于孕24-28周取静脉血5mL,置EDTA抗凝管中,3000r/min离心5min后留血浆,-20℃低温保存。用酶联免疫吸附测定法（ELISA）测定血浆护骨素(OPG)水平,同时测定空腹血糖(FPG),空腹胰岛素（FINS）,糖化血红蛋白（HbA1c）,血脂水平,超敏C反应蛋白（hs-CRP）,血细胞计数,计算胰岛细胞功能（HOMA-B）和胰岛素抵抗（HOMA-IR）的评估指数。结果 血浆OPG水平在NGT和GDM组中无明显差异,在NGT组中,OPG与FINS (r=0.335;P=0.012)、HOMA-IR (r=0.363;P=0.006)、血小板计数(r=0.333;P=0.009)和载脂蛋白B(r=-0.254;P=0.043)水平相关,在GDM组,未发现上述指标与OPG水平相关。结论 在糖耐量正常孕妇中OPG可能参与了妊娠期的胰岛素抵抗和炎症反应,而其在妊娠期糖尿病组中的作用不明显,可能原因是OPG为影响胰岛素抵抗和炎症反应的较弱因素,在妊娠期糖尿病时,影响力更强的因素掩盖了其作用。     

妊娠前体质指数和胎次对妊娠糖尿病发病的影响

目的：探讨妊娠前体质指数(body mass index,BMI)、胎次与妊娠糖尿病(gestational diabetes mellitus,GDM)发病的关系,并探讨其对妊娠糖尿病(GDM)发病的影响。方法：本研究选择我院2014年2月至2014年12月接受孕产期检查、临床资料完整的且患有妊娠糖尿病的孕妇262名,对其采取葡萄糖耐量实验(OGTT实验),按照WTO标准,对262例足月妊娠初产妇女在孕24~28周常规进行75 g口服糖耐量试验,并完整记录年龄、孕周、文化程度、妊娠前体质指数及胎次等临床资料。根据妊娠前体质指数(BMI)将孕妇分为BMI分为4组,BMI<18.5 kg/m2者为偏瘦组,BMI 18.5~23.0 kg/m2者为正常体质量组,BMI 23.1~25.0 kg/m2者为超重组,BMI>25.0 kg/m2为肥胖组,采用SPSS l8.0统计软件对资料进行描述性分析、两样本t检验、非条件Logistic回归分析两组孕妇妊娠前体质指数(BMI)、胎次与妊娠糖尿病的关系。结果：4组OGTT结果显示妊娠前超重或肥胖的孕妇发生妊娠糖尿病的风险高于正常和偏瘦体质量组;非条件logistic回归分析结果表明,影响GDM的因素依次为：胎次、体质指数、年龄、文化程度,各影响因素回归系数分别为：2.372、     

妊娠期糖尿病发病机制的研究进展

妊娠期糖尿病是指妊娠期间首次发生或发现的任何程度的糖耐量异常,是妊娠期常见并发症之一。该病在全球呈蔓延趋势,由此导致的母婴并发症危害极大,但发病机制尚不明确。目前研究发现的相关因素有遗传基因、炎性因子及脂肪因子。本综述主要简述上述因素与妊娠期糖尿病发生的相关性研究。     

妊娠糖尿病的治疗进展

妊娠糖尿病的治疗涉及到改善本次妊娠结局和预防将来成人胎源性疾病发生两个方面,要求为母亲和胎儿提供一个适合的孕期体内代谢环境。与普通糖尿病相比,妊娠糖尿病的治疗有着许多自身不同的特点。本综述从妊娠糖尿病治疗的获益、营养治疗、血糖及尿酮体的监测、运动治疗、药物治疗等几方面论述近年来在妊娠糖尿病治疗方面所取得的进展。     

人类白细胞Ⅱ类抗原DR、DQ基因型与妊娠期糖尿病的相关性研究

目的探讨人类白细胞II类抗原DR、DQ基因型与妊娠期糖尿病的相关性。方法对26例GDM孕妇及同期入院的42例正常健康孕妇,采用序列特异性引物聚合酶链反应技术(PCR-SSP)检测HLA-II类抗原DR和DQ的等位基因。结果研究中发现,DQA1*0101、DQA1*0201、DQB1*0609、DRB l*07-DQA1*0201-DQB1*0201基因频率在GDM中显著高于正常对照组,两组比较,统计学有差异(Ρ<0.05)。DQB1*0301基因频率在GDM中显著低于正常对照组,两组比较,有统计学差异(Ρ<0.05)。结论人类白细胞II类抗原DR、DQ基因型与GDM的易感性和保护性存在关联。DQA1*0101、DQA1*0201、DQB1*0609、DRB l*07-DQA1*0201-DQB1*0201基因是GDM的易感基因。DQB1*0301基因是GDM的保护基因。     

妊娠期糖尿病与CRP、IGF-1及IGFBP-1相关性研究

目的探讨C反应蛋白（CRP）、胰岛素样生长因子1（IGF-1）与胰岛素样生长因子结合蛋白l（IGFBP-1）在妊娠期糖尿病（GDM）发病中的作用。方法采用免疫透射比浊法和酶联免疫吸附法（ELISA）检测孕24～28周GDM孕妇18例（观察组）和29例正常孕妇（对照组）外周血CRP、IGF-1及IGFBP-1水平,并分析CPR与体重指数、IGF-1与IGFBP-1的相关性。结果（1）两组体重指数（BMI）比较：GDM组（26.01±3.54）kg,较正常组（23.31±2.13）kg高,差异有统计学意义（P〈0.01）;（2）血清CRP水平：GDM组（8.65±5.38）mg/dl,较正常组（5.83±3.26）mg/dl为高,但差异无统计学意义（P〉0.05）;（3）血清IGF-1水平：GDM组（89.16±41.32）ng/ml,正常组（148.95±53.90）ng/ml,两组比较差异有统计学意义（P〈0.01）;（4）血清IGFBP-1水平：GDM组（59.43±10.97）ng/ml较正常组（52.33±9.68）ng/ml高,两组比较差异有统计学意义（P〈0.01）;（5）相关性：血清CRP与体重指数成正相关（r=0.849,P〈0.01）;血清CRP水平与体重指数成正相关,IGF-1与IGFBP-1成负相关（r=-0.33755,P〈0.05）。结论CRP对GDM风险的独立影响不能被证实,但母体血清CRP水平与妊娠期的BMI显著相关,推论肥胖介导的炎症反应导致胰岛素抵抗和糖代谢失调;孕妇外周血IGF-1、IGFBP-1与GDM的发生相关。     

Increased serum insulin-like growth factor-1 levels in women with gestational diabetes

BackgroundInsulin-like growth factor-1 (IGF-1), which has effects similar to insulin, reduces blood glucose level, improves insulin sensitivity and may play an important role in the pathogenesis of gestational diabetes (GDM).ObjectiveThe aim of the study was to estimate the concentration of IGF-1 in pregnant women with GDM and 3 months after delivery and find relationships between IGF-1 and clinical and biochemical parameters.Materials and methods67 women between 24th - 28th week of pregnancy were enrolled in the study (46 with GDM and 21 as a control group). All women underwent clinical and biochemical examinations. Concentrations of IGF-1, adiponectin, fasting glucose, insulin, lipids, CRP, fibrinogen were measured during pregnancy, additionally IGF-1 concentration was determined 3 months after delivery.ResultsIGF-1, glucose, insulin, CRP, fibrinogen, lipids concentrations and HOMA-IR were significantly higher in women with GDM than in the control group (p<0.05). A significant decrease in IGF-1 concentration was observed in both groups after delivery. In the GDM group significant correlations between IGF-1 and BMI (r=0.370, p<0.05), insulin (r=0.469, p<0.01) and HOMA-IR (r=0.439, p<0.01) were observed. Regression analysis with IGF-1 as a dependent parameter showed that only BMI and insulin remained as predictors, explaining 32% of plasma IGF-1 variation. Re-evaluation after delivery revealed impaired glucose tolerance in 9% of the population studied.ConclusionsIncreased IGF-1 concentrations in pregnancy complicated with GDM may partly reflect metabolic disturbances, especially insulin resistance and hyperinsulinemia, and may be one of possible compensatory reactions of the organism in response to these disturbances.     

has-miR-27a和has-miR-124a基因单核苷酸多态性与妊娠期糖尿病的相关性

目的 探讨has-miR-27a基因rs895819位点和has-miR-124a基因rs531564位点单核苷酸多态性(SNP)与妊娠期糖尿病(GDM)发病的相关性.方法 共纳入1 719例孕妇,其中GDM 839例;糖耐量正常和50 g葡萄糖负荷试验阴性者880例,作为对照组.采用TaqMan探针法检测两组孕妇SNP位点基因型,比较两组孕妇各SNP位点等位基因和基因型频率差异,以及不同基因型间临床生化指标的差异.结果 1)rs895819位点CC、CT和TT基因型频率在GDM组分别为3.1％、39.3％和57.6％,对照组分别为7.1％、37.6％和55.3％,CC基因型频率显著低于对照组(P＜0.05);隐性模型(CC vs CT +TT)中两组差异仍具有显著性[P=0.001;OR0.435(0.270,0.702)];GDM组C等位基因频率(22.8％)低于对照组(25.9％)(P＜0.05).2)rs895819 CC基因型孕妇空腹血糖低于CT +TT基因型孕妇(P＜0.05).结论 has-miR-27a基因rs895819位点与GDM相关,C等位基因降低GDM的发病风险.     

不同阶段的运动疗法对妊娠期糖尿病患者的长期预后作用

目的:探讨不同阶段的运动疗法对妊娠期糖尿病(gestational diabetes mellitus,GDM)患者预后的作用.方法:选取2010年7月~2014年7月我们妇产科接诊的560例妊娠期糖尿病患者作为研究对象,根据运动疗法的不同阶段将患者分成三组:单纯的妊娠期运动疗法组200例(A组)、单纯的产后运动疗法组180例(B组)以及妊娠期和产后均运动的联合运动组180例(C组),进行队列研究,分析三组患者进展为2型糖尿病的风险差异.结果:三组患者的随访时间分别为2.7±1.1、2.9±0.8及2.8±1.7年,三组患者在平均随访时间上无显著差异(P>0.05).在随访期间,共发现2型糖尿病病例68例,其中A组38例,B组20例,C组10例.C组进展为2型糖尿病的风险明显低于A组和B组(P<0.05), B组疗法发展成2型糖尿病的风险低于A组疗法,但通过调整协变量体重指数后,这种差异仍显著(P<0.05).结论:强化运动治疗,特别是强化产后运动,能明显降低妊娠期糖尿病患者发展为2型糖尿病的风险,值得临床推广应用.     

Crystallization of oral fluid components in patients with type 1 diabetes mellitus

We systematized and described morphological criteria characterizing crystalline aggregates in mixed saliva from patients with type 1 diabetes mellitus.__________This revised version was published online in August 2005 with the addition of the issue titleTranslated from Byulleten’ Eksperimental’noi Biologii i Meditsiny, Vol. 139, No. 1, pp. 22–24, January, 2005     

ORIGINAL ARTICLE: Temporal and Spatial Expression of Tumor‐Associated Antigen RCAS1 in Pregnant Mouse Uterus

Citation Tskitishvili E, Nakamura H, Kinugasa‐Taniguchi Y, Kanagawa T, Kimura T, Tomimatsu T, Shimoya K. Temporal and spatial expression of tumor‐associated antigen RCAS1 in pregnant mouse uterus. Am J Reprod Immunol 2010; 63: 137–143 Problem The tumor‐associated antigen RCAS1 (receptor‐binding cancer antigen expressed on SiSo cells) is considered to play a role in the inhibition of maternal immune response during pregnancy, and participates in the initiation of labor and placental detachment. The aim of our study was to investigate the expression of RCAS1 protein in the uteri of normal pregnant mice. Method of study Uteri with fetuses were collected from pregnant ICR mice on days 1.5, 3.5, 5.5, 7.5, and 9.5 p.c., and uterine and placental tissues were obtained separately on days 11.5, 13.5, 15.5, and 17.5 p.c. Samples were examined using real‐time (RT)‐PCR, Western blotting, and immunohistochemical analyses. Results In normal pregnant mice, RCAS1 protein mRNA was significantly increased on day 7.5 p.c. Antigen localization was detected in the placenta, decidua, and fetus. Conclusion The results of this study suggest the importance of day 7.5 p.c. for RCAS1 protein expression in connection with placentation as a possible target for future in vivo studies.     

Missed opportunities for diabetes prevention: post-pregnancy follow-up of women with gestational diabetes mellitus in England

Background

Women with gestational diabetes mellitus (GDM) should be followed-up to exclude ongoing diabetes and for prevention of type 2 diabetes. The National Institute for Health and Clinical Excellence (NICE) diabetes in pregnancy guideline recommends checking fasting plasma glucose (FPG) at 6 weeks postpartum (short term), and annually thereafter (long term).

Aim

To examine the reported practice regarding GDM follow-up.

Design and setting

Nationwide postal survey in England 2008-2009.

Method

Questionnaires were distributed to a consultant diabetologist and obstetrician in all maternity units, and to a random sample of general practices (approximately 1 in 5).

Results

Response rates were: 60% (915/1532) GPs, 93% (342/368) specialists; 80% of GPs and 98% of specialists reported women with GDM had short-term follow-up. More GPs (55%) than specialists (13%) used a FPG test to exclude ongoing diabetes; 26% of GPs versus 89% of specialists thought the hospital was responsible for ordering the test. Twenty per cent of GPs had difficulty in discovering women had been diagnosed with GDM in secondary care. Seventy-three per cent of specialists recommended long-term follow-up; only 39% of GPs recalled women with GDM for this. A minority of GPs and specialists had joint follow-up protocols

Conclusion

Follow-up of GDM in England diverged from national guidance. Despite consensus that short-term follow-up occurred, primary and secondary care doctors disagreed about the tests and responsibility for follow-up. There was lack of long-term follow-up. Agreement about the NICE guideline, its promotion and effective implementation by primary and secondary care, and the systematic recall of women with GDM for long-term follow-up is required.