血糖水平与妊娠期糖尿病孕妇肠道菌群的关系研究

目的 探讨血糖(FBG)水平与妊娠期糖尿病(GDM)孕妇肠道菌群的关系。方法 选取2020年在该院接受治疗的56例GDM孕妇作为GDM组,另选取同期该院体检健康的56例孕妇作为对照组,收集孕妇年龄、孕前体质量指数(BMI)、孕次、产次、分娩孕周、新生儿体质量、分娩方式及孕妇既往疾病史、用药史等一般资料,比较2组的FBG、血脂指标[三酰甘油(TG)、总胆固醇(TC)、高密度脂蛋白胆固醇(HDL-C)、低密度脂蛋白胆固醇(LDL-C)]、炎症因子[超敏C反应蛋白(hs-CRP)、白细胞介素IL-6(IL-6)]、肠道菌群及其Alpha多样性(Chao 1指数、Shannon指数)。结果 GDM组孕妇FBG、TG、TC、LDL-C、hs-CRP、IL-6水平高于对照组,HDL-C水平低于对照组,差异均有统计学意义(P<0.05)。GDM组孕妇双歧杆菌、乳酸杆菌水平低于对照组,差异均有统计学意义(P<0.05)。GDM组孕妇肠道菌群Alpha多样性Chao 1指数、Shannon指数低于对照组,差异均有统计学意义(P<0.05)。GDM组孕妇肠道乳酸杆菌和双歧杆菌水平,以及肠...     

妊娠期糖尿病与肠道菌群关系的研究进展

肠道菌群指定居于人体肠道的微生物群体,数量巨大,种类繁多,与人类许多疾病的发病相关,受到医学界广泛关注。已有研究证实,肠道菌群丰度及多样性改变引起的肠道菌群失调参与糖尿病的发生发展,而妊娠期糖尿病(GDM)属于糖尿病的四种类型之一,是妊娠期常见的合并症,肠道菌群的改变也对其发病有着不可忽视的影响。补充微生态调节剂可改善肠道菌群紊乱,这为探索GDM的防治提供新靶点和新思路。     

孕早期肠道菌群检测对妊娠期糖尿病的预测及评估价值

目的 研究孕早期肠道菌群检测对妊娠期糖尿病(GDM)的预测及评估价值。方法 选择2018年3月至2021年8月期间在河南省安阳市妇幼保健院建卡并规律产检的342例孕妇作为研究对象,根据孕中期口服葡萄糖耐量试验(OGTT)结果将其分为GDM组(n=32)和对照组(n=310)。孕早期检测肠道菌群多样性指标Ace指数、OTUs、Chao 1指数、Shannon指数、Simpson指数及厚壁菌门、拟杆菌门、变形菌门、放线菌门、瘤胃菌门的丰富度,孕中期计算胰岛素抵抗指数(HOMA-IR)和胰岛β细胞功能指数(HOMA-β)。结果 对照组比较,GDM组孕早期粪便中肠道菌群的Ace指数、OTUs、Chao 1指数及拟杆菌门、变形菌门的丰富度增加,差异有统计学意义(P<0.05),厚壁菌门、放线菌门的丰富度均明显降低,差异有统计学意义(P<0.05);经ROC曲线分析,孕早期粪便中肠道菌群多样性指标Ace指数、OTUs、Chao 1指数、拟杆菌门、变形菌门、厚壁菌门、放线菌门丰富度均对GDM具有预测价值(P<0.05);经Pearson检验,GDM组孕早期粪便中肠道菌群多样性指标A...     

肠道菌群移植治疗糖尿病的研究进展

糖尿病是全球常见的代谢性疾病之一,糖尿病病因复杂,越来越多的证据表明其受肠道菌群和微生物代谢产物的调节,菌群失调是糖尿病的危险因素。肠道菌群移植（faecal microbiota transplantation,FMT）作为一种新的治疗方法,可以调节菌群。在这篇综述中,我们重点概述了FMT在糖尿病人群和糖尿病动物模型中的应用,旨在评估FMT靶向治疗糖尿病的有效性及安全性,将FMT作为糖尿病的潜在治疗方法。     

糖皮质激素对过敏性紫癜患儿肠道菌群的影响

目的 探讨糖皮质激素(GC)对过敏性紫癜(HSP)患儿肠道菌群结构及多样性的影响.方法 收集2017年9月至2019年3月住院治疗的HSP患儿60例的粪便标本,根据是否使用GC治疗分为GC组30例和无GC组30例,以21例健康儿童粪便样本为对照,采用试剂盒提取法提取样本DNA并应用Illumina HiSeq平台进行高...     

肠道菌群与糖尿病大血管病变的研究进展

糖尿病大血管病变,是一种以大血管床内持续动脉粥样硬化为特点的糖尿病常见并发症.已有多个队列研究证实,肠道菌群及其代谢产物可通过多种代谢途径影响糖尿病和动脉粥样硬化发生发展.本文重点综述肠道菌群和糖尿病大血管病变之间的相互作用,分析肠道菌群、糖尿病和血管病变三者的联系,探索肠道菌群防治糖尿病大血管并发症的研究潜力,以期为...     

基于肠道菌群治疗糖尿病神经痛的研究进展

糖尿病神经痛（diabetic neuropathic pain, DNP）是糖尿病最常见、最复杂的并发症之一,近年来研究表明,肠道菌群可通过调节脂多糖、短链脂肪酸、胆汁酸以及支链氨基酸等相关因子,进而调控炎症反应、肠道通透性、葡萄糖代谢以及调节脂肪酸氧化、合成和能量消耗,达到治疗DNP的目的。该文就肠道菌群治疗DNP的相关机制进行总结,并对相关中西医干预措施进行整理,以期为临床治疗DNP提供新思路。     

肠道菌群失调与糖尿病肾病的关系

糖尿病肾病(diabetic nephropathy,DN)是糖尿病最严重的血管并发症,是导致终末期肾脏疾病的主要原因之一,目前认为其发病是糖脂代谢紊乱和血流动力学变化,细胞因子、炎性反应、氧化应激、遗传易感性等多种因素共同作用的结果。肠道菌群失调可通过影响炎性反应、肾素-血管紧张素系统等多种途径参与DN的发生、发展。本文就肠道菌群的结构、组成,肠道菌群失调与DN的关系,调整肠道菌群失调对DN潜在治疗作用的研究进展作一综述。     

Association of Maternal Folate and Vitamin B12 in Early Pregnancy With Gestational Diabetes Mellitus: A Prospective Cohort Study

OBJECTIVETo investigate the association of folate and vitamin B₁₂ in early pregnancy with gestational diabetes mellitus (GDM) risk.RESEARCH DESIGN AND METHODSThe data of this study were from a subcohort within the Shanghai Preconception Cohort Study. We included pregnancies with red blood cell (RBC) folate and vitamin B₁₂ measurements at recruitment (between 9 and 13 gestational weeks) and those with three samples available for glucose measurements under an oral glucose tolerance test. GDM was diagnosed between 24 and 28 weeks’ gestation. Odds ratio (OR) and 95% CI of having GDM was used to quantify the association.RESULTSA total of 1,058 pregnant women were included, and GDM occurred in 180 (17.01%). RBC folate and vitamin B₁₂ were significantly higher in pregnancies with GDM than those without GDM (P values were 0.045 and 0.002, respectively) and positively correlated with 1-h and 2-h serum glucose. Daily folic acid supplementation in early pregnancy increases the risk of GDM; OR (95% CI) was 1.73 (1.19–2.53) (P = 0.004). Compared with RBC folate <400 ng/mL, pregnancies with RBC folate ≥600 ng/mL were associated with ∼1.60-fold higher odds of GDM; the adjusted OR (95% CI) was 1.58 (1.03–2.41) (P = 0.033). A significant trend of risk effect on GDM risk across categories of RBC folate was observed (P_trend = 0.021). Vitamin B₁₂ was significantly associated with GDM risk (OR 1.14 per 100 pg/mL; P = 0.002). No significant association of serum folate and percentile ratio of RBC folate/vitamin B₁₂ with GDM was observed.CONCLUSIONSHigher maternal RBC folate and vitamin B₁₂ levels in early pregnancy are significantly associated with GDM risk, while the balance of folate/vitamin B₁₂ is not significantly associated with GDM.     

Exercise During the First Trimester of Pregnancy and the Risks of Abnormal Screening and Gestational Diabetes Mellitus

OBJECTIVETo estimate the effects of exercise during the first trimester on the risks of abnormal screening and gestational diabetes mellitus (GDM).RESEARCH DESIGN AND METHODSData come from PETALS, a prospectively followed pregnancy cohort (n = 2,246, 79% minorities) receiving care at Kaiser Permanente Northern California. A Pregnancy Physical Activity Questionnaire was used to assess exercise. Glucose testing results for screening and diagnostic tests were obtained from electronic health records. Inverse probability of treatment weighting and targeted maximum likelihood with data-adaptive estimation (machine learning) of propensity scores and outcome regressions were used to obtain causal risk differences adjusted for potential confounders, including prepregnancy BMI, exercise before pregnancy, and gestational weight gain. Exercise was dichotomized at 1) the cohort’s 75th percentile for moderate- to vigorous-intensity exercise (≥13.2 MET-h per week or ≥264 min per week of moderate exercise), 2) current recommendations (≥7.5 MET-h per week or ≥150 min per week of moderate exercise), and 3) any vigorous exercise.RESULTSOverall, 24.3% and 6.5% had abnormal screening and GDM, respectively. Exercise meeting or exceeding the 75th percentile decreased the risks of abnormal screening and GDM by 4.8 (95% CI 1.1, 8.5) and 2.1 (0.2, 4.1) fewer cases per 100, respectively, in adjusted analyses.CONCLUSIONSExercise reduces the risks of abnormal screening and GDM, but the amount needed to achieve these risk reductions is likely higher than current recommendations. Future interventions may consider promoting ≥38 min per day of moderate-intensity exercise to prevent GDM.     

妊娠期糖尿病的管理与妊娠结局相关性分析

目的分析妊娠期糖尿病(GDM)的管理与妊娠结局的相关性。方法回顾性分析87例GDM患者的临床资料,根据血糖控制程度分为满意组和不满意组,对比两组孕产妇并发症率、剖宫产率及新生儿病率。结果不满意组妊高征、酮症、羊水过多、早产、胎儿发育迟缓的发生率及剖宫产率明显高于满意组,新生儿巨大儿、低血糖、呼吸窘迫综合征、畸形、新生儿窒息的发生率明显高于满意组,差异均有显著性意义(P<0.05)。结论重视围产保健,争取GDM的早期诊断和治疗,加强管理,以饮食控制为基础,必要时加用胰岛素,适当放宽剖宫产指征,有利于获得良好妊娠结局。     

不同糖化血红蛋白控制水平对妊娠糖尿病妊娠结局的影响分析

目的 探讨不同糖化血红蛋白控制水平对妊娠糖尿病妊娠结局的影响.方法 选取深圳市人民医院2008～2009年住院分娩妊娠糖尿病患者136例,以糖化血红蛋白≥6.0%为A组,<6.0%为B组,比较两组的空腹血糖(FBG)、总胆固醇(TC)、三酰甘油(TG)、低密度脂蛋白胆固醇(LDL-C)、高密度脂蛋白胆固醇(HDL-C)、胰岛素(FINS)、稳态模式法的胰岛素抵抗指数(HOMA-IR)以及妊娠结局的差异.结果 A组的FBG,TC,TG,LDL-C,FINS,HOMA-IR均高于B组,差异有统计学意义.除胎膜早破和巨大儿两者差异不明显外,A组的妊高征、羊水过多、剖宫产、新生儿窒息、高胆红素血症均显著高于B组.HbA1c与FPG显著正相关,相关系数为0.912 (P<0.05).结论 GDM患者的HbA1c水平与妊娠结局相关.     

自然受孕与辅助生殖受孕妊娠期糖尿病患者围生期结局的回顾性队列研究

目的 比较不同受孕方式的妊娠期糖尿病患者围生期结局。方法 选取2015年2月—2018年2月在本院分娩的的1 839例妊娠期糖尿病患者资料进行回顾性队列研究,其中辅助生殖组298例,自然受孕组1 541例,比较2组间母婴围生期结局。结果 与自然受孕组相比,辅助生殖组孕妇年龄偏高,超重率偏低,差异有统计学差异（P<0.05）。辅助生殖组孕妇妊娠期高血压、严重子〗前期、剖宫产以及早产发生率高于自然妊娠组,差异有统计学意义（P<0.05）。结论 通过辅助生殖受孕的妊娠期糖尿病患者妊娠期高血压、严重子〗前期、剖宫产以及早产等不良分娩结局风险增加。     

Gestational Diabetes Mellitus: Simplifying the International Association of Diabetes and Pregnancy diagnostic algorithm using fasting plasma glucose

OBJECTIVE

To determine the impact of the International Association of Diabetes and Pregnancy Study Group (IADPSG) criteria on 1) gestational diabetes mellitus (GDM) diagnosis compared with the American Diabetes Association (ADA) criteria and 2) the fasting plasma glucose (FPG) to predict GDM.

RESEARCH DESIGN AND METHODS

In 10,283 pregnant women undergoing a 75-g oral glucose tolerance test (OGTT) for universal screening of GDM, two FPG thresholds (of the OGTT) were used to rule in and to rule out GDM.

RESULTS

The IADPSG and ADA criteria identified GDM in 3,875 (37.7%) women and 1,328 (12.9%) women, respectively (P < 0.0005). FPG thresholds of ≥5.1 mmol/l ruled in GDM in 2,975 (28.9%) women with 100% specificity, while <4.4 mmol/l ruled out GDM in 2,228 (21.7%) women with 95.4% sensitivity. FPG independently could have avoided the OGTT in 5,203 (50.6%) women.

CONCLUSIONS

The IADPSG criteria increased GDM prevalence nearly threefold. By circumventing a significant number of OGTTs, an initial FPG can greatly simplify the IADPSG diagnostic algorithm.The scourge of gestational diabetes mellitus (GDM) is the lack of an international agreement on the screening and diagnosis among the pre-eminent diabetes, obstetric, and health care organizations (1). Therefore, without a globally accepted guideline, the diagnosis of GDM causes a great deal of clinical confusion (2). In March 2010, the International Association of Diabetes and Pregnancy Study Group (IADPSG) issued consensus guidelines to potentially attain a single approach for GDM diagnosis worldwide (3).The inconsistency in GDM diagnosis is evident in the United Arab Emirates (UAE), which has the second highest prevalence of type 2 diabetes (18.7%) in the world (4). GDM in the UAE varies from 7.9 to 24.9%, depending on which of the six well-accepted criteria are used for diagnosis (2). The popular American Diabetes Association (ADA) criteria (5) demonstrates a prevalence of 10.6–14.7% (2,6–8). In this population, multiple studies have confirmed that the initial fasting plasma glucose (FPG) result of the oral glucose tolerance test (OGTT) is excellent in determining the need to continue with the OGTT (6,9–10); however, its efficiency depends on the criteria used for GDM diagnosis (6). The aim of this study was to determine, in this high-risk population, the impact of the new IADPSG criteria on 1) the diagnosis of GDM compared with the ADA criteria and 2) the FPG to predict GDM in order to decide whether to proceed with the OGTT.     

妊娠早期和中期孕妇发生抑郁状况的调查及分析

目的调查妊娠早期和中期孕妇发生抑郁的状况,并分析其原因,以期为制定有针对性的护理措施提供依据。方法采用方便抽样法从省部级、市级、区级医院中各抽取一所医院,再从中整群抽取妊娠早期作产前检查的孕妇1051例为研究对象。于妊娠早期和妊娠中期,采用爱丁堡产后抑郁量表(Edinburgh postnatal depression scale,EPDS)分别对其进行调查。结果妊娠早期发生抑郁者348例,占33.11%;妊娠中期发生抑郁者209例,占19.86%;妊娠早、中期都有抑郁者134例(12.75%)。妊娠早期研究对象EPDS各条目得分均为高于妊娠中期,差异均有统计学意义(均P0.05)。两次调查中,均以事情出错时我毫无必要责备自己、因心情不好而影响睡眠、因心情不好而哭泣等3个条目得分最高。结论妊娠早期是妊娠期抑郁的高发期,部分妊娠早期抑郁孕妇会延续至妊娠中期。因此,应早期发现妊娠期抑郁孕妇,极早干预,以免抑郁延续至妊娠中期、晚期,甚至产后。     

Lower Adiponectin Levels at First Trimester of Pregnancy Are Associated With Increased Insulin Resistance and Higher Risk of Developing Gestational Diabetes Mellitus

OBJECTIVE

To evaluate the associations between adiponectin levels and 1) the risk of developing gestational diabetes mellitus (GDM), and 2) insulin resistance/sensitivity, β-cell function, and compensation indices in a prospective cohort representative of the general population of pregnant women.

RESEARCH DESIGN AND METHODS

We performed anthropometric measurements and collected blood samples at 1st (6–13 weeks) and 2nd (24–28 weeks) trimesters. Diagnosis of GDM was made at 2nd trimester based on a 75-g oral glucose tolerance test (International Association of the Diabetes and Pregnancy Study Groups criteria). Insulin was measured (ELISA; Luminex) to estimate homeostasis model assessment of insulin resistance (HOMA-IR), β-cell function (HOMA-B), insulin sensitivity (Matsuda index), insulin secretion (AUC_{insulin/glucose}), and β-cell compensation (insulin secretion sensitivity index-2). Adiponectin was measured by radioimmunoassay.

RESULTS

Among the 445 participants included in this study, 38 women developed GDM. Women who developed GDM had lower 1st-trimester adiponectin levels (9.67 ± 3.84 vs. 11.92 ± 4.59 µg/mL in women with normal glucose tolerance). Lower adiponectin levels were associated with higher risk of developing GDM (OR, 1.12 per 1 µg/mL decrease of adiponectin levels; P = 0.02, adjusted for BMI and HbA_1c at 1st trimester). Adiponectin levels at 1st and 2nd trimesters were associated with HOMA-IR (both: r = −0.22, P < 0.0001) and Matsuda index (r = 0.28, P < 0.0001, and r = 0.29, P < 0.0001). After adjustment for confounding factors, we found no significant association with HOMA-B and AUC_{insulin/glucose}.

CONCLUSIONS

Pregnant women with lower adiponectin levels at 1st trimester have higher levels of insulin resistance and are more likely to develop GDM independently of adiposity or glycemic measurements.Gestational diabetes mellitus (GDM) is defined as any degree of glucose intolerance with onset or first recognition determined during pregnancy (1). In normal pregnancy, there is a progressive physiologic increase of insulin resistance, compensated by an increase of insulin secretion by pancreatic β-cells (2). Among GDM women, there is an imbalance between insulin resistance and insulin secretion capacity, resulting in increased circulating glucose levels (3). Over the past decades, GDM has drawn scientific attention because of its growing incidence and deleterious consequences for mothers and offspring (4,5). Nevertheless, the exact mechanisms implicated in its pathophysiology remain poorly understood.Adiponectin is an adipokine suspected to have insulin-sensitizing properties (6). Furthermore, lower adiponectin levels have been repeatedly and consistently associated with increased risk of type 2 diabetes incidence (7–9), but reports on GDM are inconsistent. Few studies investigated the association between adiponectin levels measured early in pregnancy and GDM incidence: some showed that low adiponectin levels are associated with increased risk of GDM (10–13), while others showed no association (14,15). Contradictory findings between studies can be partly explained by limited power and different study designs. Also, these studies inconsistently accounted for potential confounding factors like adiposity and baseline impaired glucose regulation in pregnant women. Therefore, larger prospective studies are needed, designed to take into account potential confounding factors to adequately assess whether there is an independent association between adiponectin levels and the risk of developing GDM.Thus, in the current study, we evaluated whether 1st-trimester adiponectin levels are associated with higher risk of developing GDM during pregnancy. Also, we assessed whether there is an association between adiponectin at both 1st and 2nd trimesters (or the change [Δ] over 1st to 2nd trimester) and insulin resistance/sensitivity or pancreatic β-cell function/compensation indices at 2nd trimester of pregnancy.     

视黄醇结合蛋白4在妊娠期糖尿病患者中的表达及其临床意义

目的：分析视黄醇结合蛋白4（retinol-binding protein4,RBP4）在妊娠期糖尿病患者和健康孕妇血清中的浓度差异及其与临床、病理特征的关系。方法：检测18例妊娠期糖尿病（GDM）和212例健康孕妇血清中RBP4的表达,分别于孕18周、孕20周、孕28周及产后8周空腹收集血清。利用酶联免疫吸附实验（ELISA）检测血清RBP4的表达。用HOMA-IR（homeosta-sis model assessment）模型评价胰岛素抵抗程度。结果：所有孕妇血清RBP4水平在产前各时间点呈时间依赖性升高。产后8周（中位数,15.35μg/mL;四分位数,11.32～27.85μg/mL）孕妇血清RBP4水平均下降。孕20周（中位数,45.72μg/mL;四分位数,33.34～58.69μg/mL）、孕28周（中位数,52.34μg/mL;四分位数,42.65～73.54μg/mL）时,GDM患者血清RBP4水平高于健康孕妇（孕20周：中位数,19.13μg/mL;四分位数,15.23～22.65μg/mL;孕28周：中位数,42.54μg/mL;四分位数,24.56～55.21μg/mL）。孕18周（中位数,16.80μg/mL;四分位数,14.58～28.67μg/mL）和产后8周（中位数,15.35μg/mL;四分位数,11.32～27.85μg/mL）,GDM患者血清RBP4水平和健康孕妇无显著差异（孕18周：中位数,15.78μg/mL;四分位数,10.23～19.35μg/mL;产后8周：中位数,13.54μg/mL;四分位数,9.21～18.35μg/mL）。孕20周时血清RBP4水平和HOMA-IR（相关系数r=0.872;P=0.002）、体质量指数、血清三酰甘油和低密度脂蛋白呈正相关,和高密度脂蛋白呈负相关。结论：孕20周血清RBP4水平可能成为GDM的早期诊断指标。     

Prospective Study of Pre-Gravid Sugar-Sweetened Beverage Consumption and the Risk of Gestational Diabetes Mellitus

OBJECTIVE

Consumption of sugar-sweetened beverages (SSBs) was related to an elevated risk of type 2 diabetes and insulin resistance in several recent studies among middle- or older-aged populations. Studies on SSB consumption and glucose intolerance among pregnant women, however, are lacking. We therefore examined the association between regular SSB consumption before pregnancy and the risk of gestational diabetes mellitus (GDM).

RESEARCH DESIGN AND METHODS

This was a prospective study among 13,475 U.S. women who reported at least one singleton pregnancy between 1992 and 2001 in the Nurses'' Health Study II. GDM was self-reported and validated by medical record review in a subsample. Cox proportional hazards models with multivariate adjustments were applied to examine the association of SSB consumption with GDM risk.

RESULTS

During 10 years of follow-up, 860 incident GDM case subjects were identified. After adjustment for age, parity, race, physical activity, smoking, alcohol intake, prepregnancy BMI, and Western dietary pattern, intake of sugar-sweetened cola was positively associated with the risk of GDM, whereas no significant association was found for other SSBs and diet beverages. Compared with women who consumed <1 serving/month, those who consumed ≥5 servings/week of sugar-sweetened cola had a 22% greater GDM risk (relative risk 1.22 [95% CI 1.01–1.47]).

CONCLUSIONS

Findings from this study suggest that prepregnancy higher consumption of sugar-sweetened cola (≥5 servings/week) is associated with an elevated GDM risk, whereas no significant association with GDM risk was observed for other SSBs and diet beverages.Gestational diabetes mellitus (GDM), defined as glucose intolerance with onset or first recognition during pregnancy, is one of the most common pregnancy complications (1). Women with GDM are at increased risk of pregnancy complications, perinatal morbidity, and type 2 diabetes in the years after pregnancy. Offspring of women with GDM have increased risk of obesity, glucose intolerance, and diabetes in childhood and early adulthood (1). Despite the maternal and infant morbidity associated with GDM, limited attention has been paid to the identification of dietary risk factors for GDM.Sugar-sweetened beverages (SSBs) are the leading source of added sugars in Americans'' diets (2). In animal models and human studies, a high-sugar diet reduces insulin sensitivity (3,4) and insulin secretion (5). Higher consumption of SSBs was associated with an elevated risk of type 2 diabetes (6–8) and insulin resistance (9) among middle- or older-aged adults in several recent epidemiological studies. Studies regarding the impact of habitual SSB consumption on glucose intolerance among pregnant women, however, are lacking. We therefore examined the association of pregravid SSB consumption with GDM risk in a large prospective cohort of U.S. women.