TSP-1和TGF-β1在妊娠期糖尿病胎盤組織中的意義及與胎兒缺氧的關系

李小敏 李娜

【摘要】 目的：探討血小板反應蛋白1（TSP-1）和轉化生長因子β1（TGF-β1）在妊娠期糖尿病（gestational diabetes mellitus，GDM）胎盤組織中的意義及與胎兒缺氧的關系。方法：選取本院2019年1-8月的40例GDM孕婦作為觀察組，并選取同期40例正常孕婦作為對照組。所有孕婦分娩時留取胎盤組織。比較兩組TSP-1和TGF-β1表達陽性率;比較觀察組TSP-1、TGF-β1表達陽性與陰性者的血糖指標;分析TSP-1和TGF-β1表達與GDM孕婦血糖指標的相關性，比較觀察組TSP-1和TGF-β1表達陽性與陰性者的胎兒缺氧發生率。結果：觀察組TSP-1與TGF-β1表達陽性率均高于對照組（P<0.05）。觀察組TSP-1與TGF-β1陽性者的空腹血糖、糖化血紅蛋白及胰島素抵抗指數（HOMA-IR）均高于陰性者（P<0.05）。TSP-1與TGF-β1表達與空腹血糖、糖化血紅蛋白、HOMA-IR均呈正相關（P<0.05）。觀察組TSP-1與TGF-β1表達陽性者的胎兒缺氧發生率均高于陰性者（P<0.05）。結論：GDM孕婦胎盤組織中TSP-1和TGF-β1表達陽性率較高，TSP-1和TGF-β1表達與空腹血糖、糖化血紅蛋白及HOMA-IR均呈正相關，TSP-1和TGF-β1表達陽性會增加胎兒缺氧風險。

【關鍵詞】 妊娠期糖尿病 血小板反應蛋白1 轉化生長因子β1

[Abstract] Objective： To investigate the significance of thrombospondins-1 （TSP-1） and transforming growth factor β1 （TGF-β1） in the placental tissues of gestational diabetes mellitus （GDM） and their relationship with fetal hypoxia. Method： A total of 40 pregnant women with GDM in our hospital from January to August 2019 were selected as the observation group， and 40 normal pregnant women in the same period were selected as the control group. Placental tissue was collected from all pregnant women at the time of delivery. The positive expression rates of TSP-1 and TGF-β1 in the two groups were compared. The blood glucose indexes of the patients with positive and negative expression of TSP-1 and TGF-β1 in the observation group were compared. To analyze the correlation between the expression of TSP-1 and TGF-β1 and the blood glucose index in pregnant women with GDM， and the incidence of fetal hypoxia in the patients with positive and negative expression of TSP-1 and TGF-β1 in the observation group were compared. Result： The positive rate of expression of TSP-1 and TGF-β1 in the observation group were higher than those in the control group （P<0.05）. Fasting glucose， glycosylated hemoglobin and insulin resistance index （HOMA-IR） of patients with positive expression of TSP-1 and TGF-β1 in the observation group were higher than those with negative （P<0.05）. The expression of TSP-1 and TGF-β1 was positively correlated with fasting blood glucose， glycosylated hemoglobin and HOMA-IR （P<0.05）. The incidence of fetal hypoxia in the patients with positive expression of TSP-1 and TGF-β1 in the observation group was higher than negative （P<0.05）. Conclusion： The positive rate of expression of TSP-1 and TGF-β1 in the placental tissues of pregnant women with GDM was higher， the expression of TSP-1 and TGF-β1 was positively correlated with fasting blood glucose， glycosylated hemoglobin and HOMA-IR， and positive expression of TSP-1 and TGF-β1 increased the risk of fetal hypoxia.[Key words] Gestational diabetes mellitus TSP-1 TGF-β1

妊娠期糖尿病（gestational diabetes mellitus，GDM）為孕期常見并發癥，發病率7%～10%，此病不僅增加孕婦產后糖尿病風險，還會影響妊娠結局。GDM發病機制雖仍不明確，但有研究發現，多功能糖蛋白血小板反應蛋白1（TSP-1）參與機體免疫、炎癥反應等，可通過對炎癥因子水平的影響增加糖尿病風險[1]。轉化生長因子β1（TGF-β1）為多功能細胞因子，參與糖尿病、代謝綜合征等疾病的發生。由于GDM與糖尿病發病機制存在相似性，故有專家推測TSP-1和TGF-β1表達與GDM之間也存在相關性，但相關研究目前較為缺乏。本研究以40例GDM孕婦為例，分析GDM產婦胎盤組織中TSP-1和TGF-β1表達及與胎兒缺氧的關系，現報道如下。

1 資料與方法

1.1 一般資料 選取本院2019年1-8月GDM孕婦40例作為觀察組，并選取同期本院40例正常孕婦作為對照組。納入標準：符合GDM診斷標準;年齡>18歲;孕周24～28周;單胎妊娠;臨床資料完善。排除標準：有煙酒嗜好者;伴妊娠期高血壓等其他妊娠期并發癥者;伴全身急慢性感染、多囊卵巢綜合征者;伴心血管、腎臟、免疫與血液系統疾病者;不明原因的陰道流血者;前置胎盤、胎盤早剝及先兆早產者;妊娠期服用過除維生素與鈣劑外的其他治療藥物者。所……