妊娠糖尿病患者胎盘LPL基因Hind片段多态性与新生儿发生胰岛素抵抗风险的相关性研究

目的　研究妊娠糖尿病（gestational diabetes mellitus, GDM）患者胎盘脂蛋白酯酶（lipoprotein lipase, LPL）基因Hind片段多态性与新生儿发生胰岛素抵抗（insulin resistance, IR）的关系。方法　收集2018年4月～2020年4月84例GDM患者作为观察组，另纳入同期84例健康孕妇作为对照组。比较两组孕妇LPL多态性分布，比较两组新生儿血糖（FPG，HbA1c及2h PG）和血脂（TC，TG，HDL-C及LDL-C）指标水平，计算胰岛素抵抗指数（homeostasis model assessment of insulin resistance, HOMA-IR）值。分析胎盘LPL多态性与子代胰岛素抵抗的关系。结果　观察组H+H+基因型48例，H+H-基因型24例，H-H-基因型12例。对照组H+H+基因型32例，H+H-基因型38例，H-H-基因型14例，两组孕妇胎盘LPL基因型分布比较，差异有统计学意义（χ2=6.52，P<0.05）。GDM不同基因型患者所生新生儿TC，TG，HDL-C，LDL-C及HOMA-IR水平差异均有统计学意义（F=5.29~16.33，均P<0.05）。多元逐步回归分析结果显示胎盘LPL多态性是新生儿HOMA-IR的重要影响因素（t=2.86，P<0.05）。结论　胎盘LPL多态性与GDM发病有关，H+H+基因型产妇子代发生胰岛素抵抗的风险更高。

Relevance between Hind Fragment Polymorphism of Placental LPL Gene and the Risk of Neonatal Insulin Resistance in Patients with Gestational Diabetes Mellitus

Objective　To study the relevance between Hind fragment polymorphism of placental lipoprotein lipase (LPL) gene and the risk of neonatal insulin resistance (IR) in patients with gestational diabetes mellitus (GDM). Methods　84 GDM patients from April 2018 to April 2020 were collected as observation group,84 healthy pregnant women were selected as control group in addition.The distribution of LPL polymorphism was compared between the two groups,the levels of blood glucose (FPG, HbA1c and 2h PG) and blood lipids (TC, TG, HDL-C and LDL-C) were compared between the two groups,the homeostasis model assessment of insulin resistance (HOMA-IR) were calculated.The relationship between placental LPL polymorphism and insulin resistance in offspring were analyzed. Results　There were 48 cases of H+H+ genotype, 24 cases of H+H-genotype and 12 cases of H-H- genotype in the observation group. There were 32 cases of H+H+ genotype, 38 cases of H+H-genotype and 14 cases of H-H- genotype in the control group. There was significant difference in the distribution of LPL genotype between the two group (χ2=6.52, P<0.05).There were significant differences in TC, TG, HDL-C, LDL-C and HOMA-IR levels in newborns with different GDM genotypes (F=5.29~16.33, all P<0.05).The multiple stepwise regression analysis showed that placental LPL polymorphism was an important influencing factor of neonatal HOMA-IR (t=2.86, P<0.05). Conclusion　The placental LPL polymorphism was associated with GDM, and the risk of insulin resistance in the offspring of H + H + genotype was higher.