妊娠期糖尿病病人血清胱抑素...蛋白水平与胎儿心功能的关系_连立芬.pdf

安 徽 医 药 Anhui Medical and Pharmaceutical Journal 2023 Aug，27（8）gous CLCNKB gene mutations（c.1755AG/c.848_850delTCT）cause classic Bartter syndromeJ.Am J Physiol Renal Physiol，2018，315（4）：F844-F851.9 ZHU B，JIANG H，CAO M，et al.A novel CLCNKB mutation in a Chinese girl with classic Bartter syndrome：a case reportJ.BMC Med Genet，2019，20（1）：137.10SHIBLI AA，NARCHI H.Bartter and Gitelman syndromes：spectrum of clinical manifestations caused by different mutationsJ.World Journal of Methodology，2015，5（2）：55-61.11刘永林，刘瑞，SHAMSI BH.CLCNKB基因突变致巴特综合征1例报告及文献复习 J.中国实用儿科杂志，2021，36（8）：637-640.12MRAD FCC，SOARES SBM，DE MENEZES SILVA LAW，et al.Bartters syndrome：clinical findings，genetic causes and therapeutic approach J.World J Pediatr，2021，17（1）：31-39.13GASONGO G，GREENBAUM LA，NIEL O，et al.Effect of nonsteroidal anti-inflammatory drugs in children with Bartter syndromeJ.Pediatr Nephrol，2019，34（4）：679-684.14刘舒蕾，李志辉，张良，等.巴特综合征25例临床特点分析 J.中国中西医结合儿科学，2013，5（6）：553-554.15李传义，周瑞海，张德奎，等.枸橼酸钾粒剂对低钾血症患者电解质的影响 J.中国临床药理学与治疗学杂志，1997，18（2）：117-119.（收稿日期：2022-02-11，修回日期：2022-04-08）妊娠期糖尿病病人血清胱抑素C、糖化血红蛋白水平与胎儿心功能的关系连立芬，刘晓娟作者单位：秦皇岛市妇幼保健院妇产科，河北 秦皇岛066000摘要：目的 探讨妊娠期糖尿病（GDM）病人血清胱抑素C（Cys-C）、糖化血红蛋白（HbA1c）水平与胎儿心功能的关系，以期为临床及早判断GDM病人胎儿心功能异常提供参考。方法 选取2018年12月至2020年1月河北省秦皇岛市妇幼保健院诊治的GDM孕妇75例为GDM组，并纳入同期体检健康孕妇75例为对照组。比较两组一般资料及血清Cys-C、HbA1c水平；测定胎儿（孕2428周）心功能参数等容舒张时间（IRT）、射血时间（ET）、等容收缩时间（ICT），计算心肌做功指数（MPI）；Pearson法分析GDM病人血清Cys-C、HbA1c水平与ICT、ET、IRT、MPI，及血清Cys-C水平与HbA1c的相关性。结果 GDM组病人血清Cys-C （1.710.57）mg/L 比（0.530.18）mg/L、HbA1c 水平 （9.733.24）%比（5.471.82）%及胎儿 ICT （43.149.53）ms 比（39.728.75）ms、IRT （44.826.62）ms比（41.136.09）ms、MPI水平（0.550.11比0.500.10）均高于对照组，差异有统计学意义（P0.05）；GDM病人血清Cys-C、HbA1c水平与MPI均呈正相关（r=0.49、0.54，P0.05），血清Cys-C水平与HbA1c呈正相关（r=0.58，P0.05）。结论 CysC、HbA1c在GDM病人血清中呈高水平，二者均与MPI呈正相关，临床及时监测GDM病人血清Cys-C、HbA1c水平，有助于预防GDM病人胎儿的心功能异常。关键词：糖尿病，妊娠；糖化血红蛋白；胎儿；胱抑素C；心功能Relationship between serum CysC and HbA1c levels and fetal cardiac function in patients with gestational diabetes mellitusLIAN Lifen,LIU XiaojuanAuthor Affiliation:Department of Obstetrics and Gynecology,Qinhuangdao Maternal and Child Health Hospital,Qinhuangdao,Hebei 066000,ChinaAbstract：Objective To investigate the relationship between serum cystatin C(Cys-C),glycosylated hemoglobin(HbA1c)level and fetal cardiac function in patients with gestational diabetes mellitus(GDM),in order to provide reference for early clinical judgment of fetal cardiac function abnormalities in GDM patients.Methods Seventy-five pregnant women with GDM diagnosed and treated in Qinhuangdao Maternal and Child Health Hospital of Hebei Province from December 2018 to January 2020 were randomly selected as the GDM group,and 75 healthy pregnant women were included as the control group.The general data and serum Cys-C and HbA1c levels of GDM group and control group were compared;the fetal(24-28 weeks of pregnancy)cardiac function parameters such as isovolumic diastolic time(IRT),ejection time(ET)and isovolumic systolic time(ICT)were measured,and the myocardial work index(MPI)was calculated;Pearson method was used to analyze the correlation between serum Cys-C and HbA1c levels and ICT,ET,IRT,MPI,and se引用本文：连立芬，刘晓娟.妊娠期糖尿病病人血清胱抑素C、糖化血红蛋白水平与胎儿心功能的关系 J.安徽医药，2023，27（8）：1668-1671.DOI：10.3969/j.issn.1009-6469.2023.08.039.临床医学1668网络首发时间：2023-07-06 12:56:43网络首发地址：https:/ 徽 医 药 Anhui Medical and Pharmaceutical Journal 2023 Aug，27（8）rum Cys-C level and HbA1c in patients with GDM.Results The levels of serum Cys-C(1.710.57)mg/L vs.(0.530.18)mg/L and HbA1c(9.733.24)%vs.(5.471.82)%and fetal ICT(43.149.53)ms vs.(39.728.75)ms,IRT(44.826.62)ms vs.(41.136.09)ms and MPI(0.550.11 vs.0.500.10)in GDM group were higher than those in control group,and the differences were statistically significant(P0.05);the levels of serum Cys-C and HbA1c were positively correlated with MPI(r=0.49,0.54,P0.05),and the levels of serum Cys-C were positively correlated with HbA1c(r=0.58,P0.05).Conclusion CysC and HbA1c are at high levels in the serum of GDM patients,and both of them are positively correlated with MPI.Timely clinical monitoring of serum Cys-C and HbA1c levels in GDM patients is helpful to prevent fetal cardiac dysfunction in GDM patients.Key words：Diabetes,gestational;Glycosylated hemoglobin;Fetus;Cystatin C;Cardiac function妊 娠 期 糖 尿 病（gestational diabetes mellitus，GDM）不仅能影响母体健康，也可损伤胎儿心功能1-2。目前，临床多利用超声心动图检查胎儿心脏结构，经超声心动图获得的Tei指数可有效评估胎儿心功能。有关研究3-4发现，胱抑素C（Serum cystatin C，Cys-C）在GDM病人中水平较高，与胎儿妊娠结局显著有关；另外，糖化血红蛋白（glycosylated hemoglobin A1c，HbA1c）与GDM胎儿相关心脏功能相关。基于上述研究，本文通过检测GDM病人血清Cys-C、HbA1c水平，探究两者与胎儿心功能的关系，以期为临床及早判断GDM病人胎儿心功能异常提供参考。1资料与方法1.1一般资料随机选取2018年12月至2020年1月河北省秦皇岛市妇幼保健院诊治的75例GDM孕妇设为 GDM 组，其中年龄范围为 2237 岁，年龄（29.785.32）岁，孕周范围为2428周，孕周（25.820.93）周，孕前身体质量指数（body mass index，BMI）范围为 17.0424.65 kg/m2，BMI（20.612.43）kg/m2。纳入同期75例体检健康孕妇设为对照组，其中年龄范围为2237岁，年龄（30.145.46）岁，孕周范围为2428 周，孕周（25.950.97）周，孕前 BMI 范围为17.0124.86 kg/m2，BMI（20.722.54）kg/m2。另外，收集两组孕妇餐后 2 h 血糖（2 hour postprandial blood glucose，2 h PG）、空腹胰岛素（fasting insulin，FINS）、餐后 1 h 血糖（2 hour postprandial blood glucose，1 h P