晚期糖基化终产物水平及其受体的表达与妊娠期糖尿病围生儿结局关系的研究

目的:探讨妊娠期糖尿病(GDM)孕妇血清晚期糖基化终产物(AGEs)水平与围生儿结局间的关系,并观察晚期糖基化终产物受体(RAGE)蛋白在胎盘组织中的蛋白表达。方法:选择孕24～28周来我院产前检查被诊断患有GDM的孕妇100例为研究对象(GDM组),另选择同孕期、相应年龄的正常妊娠妇女50例作为正常对照组。检测GDM组孕妇治疗前、后和同孕期正常对照组孕妇的空腹血糖、糖化血红蛋白(HbA1c)和AGEs水平。分娩后立即收集两组胎盘低温保存,用于分析组织中RAGE蛋白的表达。并收集母婴临床信息,根据GDM组围生儿结局分为GDM围生儿正常组和GDM围生儿异常组。结果:①GDM组治疗前孕妇血清AGEs水平、HbA1c和空腹血糖值均明显高于同孕期正常对照组(P<0.05,P<0.01)。②GDM组经干预治疗后其空腹血糖和HbA1c水平与同孕期正常对照组比较,差异无统计学意义(P>0.05);但血清AGEs水平仍然高于正常对照组(P<0.01)。③GDM围生儿异常组孕妇血清AGEs水平高于GDM围生儿正常组(P<0.05)。④Logistic回归分析显示AGEs是GDM围生儿结局异常的危险因子(OR=6.197,P<0.01,95%CI2.514～15.453)。⑤Western印迹法测定胎盘组织中RAGE蛋白表达水平,GDM围生儿异常组高于GDM围生儿正常组和正常对照组(P<0.01)。结论:高AGEs血症是GDM围生儿结局的一个不利因素,高AGEs水平可作为GDM围生儿结局异常的预测指标。

Relationship between Advanced Glycation End Products and Perinatal Outcome of Gestational Diabetes Patients

Objective:To explore the relationship between serum advanced glycation end products(AGEs) level in gestation diabetic(GDM) patients and their perinatal outcomes,and to observe the RAGE protein expression in placenta.Methods:Recruit 100 cases pregnant women diagnosed with GDM between 24～28 weeks gestational age as the observation group,and another 50 cases of normal pregnant women of corresponding age as the study control.The blood samples of GDM patients was extracted,blood glucose、HbA1c、AGE was determined.The placentas were cryopreservated immediately after delivery for the analysis of tissue expression of RAGE protein.And the maternal and infant clinical information were collected,The patients were also divided into normal perinatal group and abnormal perinatal group according to their perinatal outcomes.Results:①GDM groups had higher serum AGEs levels and fasting blood glucose compared to the control group (P<0.05).②The same GDM in late pregnancy after intervention treatment,blood glucose was significantly lower HbA1c and the control group the difference was not statistically significant(P>0.05),but the level of serum AGEs remained higher.③Abnormal perinatal outcome in GDM had significantly higher maternal serum AGEs level than that in controls with normal perinatal outcome(P<0.05).④Logistic regression analysis showed that AGEs was a predictor of adverse perinatal outcome in GDM(OR=6.197,P<0.001,95% CI:2.514～15.453).⑤The RAGE protein expression in the placenta was also higher in the abnormal perinatal group than that in normal perinatal group and control group.Conclusions:High serum AGEs is a negative factor for the GDM perinatal outcome,High levels of AGEs can be used as a abnormal perinatal outcome predictor in GDM patients.