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红细胞叶酸代谢对妊娠期糖尿病患者胎儿发育的影响研究
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Abstract:
近年来,妊娠期糖尿病(Gestational Diabetes Mellitus, GDM)作为一种典型的妊娠并发症,受到广泛关注。GDM不仅影响孕妇健康,更会对胎儿发育造成潜在风险。本研究探讨了红细胞叶酸代谢在GDM患者中的活性变化及其对胎儿发育的影响,以期为GDM患者的临床治疗提供新的干预策略。通过采集200例GDM孕妇和200例正常对照孕妇的血样,运用高效液相色谱(High Performance Liquid Chromatography, HPLC)技术和放射免疫分析(Radioimmunoassay, RIA)对红细胞中的叶酸水平及相关代谢酶活性进行了严格测定。研究显示,GDM患者群体中红细胞叶酸浓度显著低于正常对照组(P < 0.05),相应的代谢酶活性也有所下降。进一步的胎儿生长发育评估发现,GDM组孕妇胎儿的体重、身长及头围等生长指标均低于正常组(P < 0.05)。通过对研究数据进行多元线性回归分析,确立了红细胞叶酸代谢与胎儿生长指标之间的正相关性(R2 = 0.624)。此外,运用逻辑回归发现叶酸代谢异常可作为预测GDM妊娠结局的独立风险因素(OR = 2.64, 95%CI: 1.57~4.42)。本研究强调了红细胞叶酸代谢在GDM患者胎儿生长发育中的关键作用,并且提示,通过叶酸的补充和代谢调控可能成为改善GDM孕妇妊娠结局的有效途径。针对这一发现,本文提出了若干实际可行的临床应用意见,希望为未来GDM患者的治疗与管理提供科学依据。
In recent years, Gestational Diabetes Mellitus (GDM) has garnered widespread attention as a typical pregnancy complication. Not only does GDM affect maternal health, but it also poses potential risks to fetal development. This study explored the changes in erythrocyte folate metabolism in patients with GDM and its impact on fetal development, aiming to provide new intervention strategies for the clinical treatment of patients with GDM. Blood samples from 200 pregnant women with GDM and 200 healthy control pregnant women were collected, and the levels of folate in erythrocytes and the activity of related metabolic enzymes were rigorously measured using High Performance Liquid Chromatography (HPLC) techniques and radioimmunoassay (RIA). The study revealed that the concentration of erythrocyte folate in the GDM patient group was significantly lower than that of the normal control group (P < 0.05), and the activity of the metabolic enzymes also decreased. Further evaluation of fetal growth and development indicated that the weight, length, and head circumference growth indicators of fetuses from the GDM group were all lower than those of the normal group (P < 0.05). Multivariate linear regression analysis of the research data established a positive correlation between erythrocyte folate metabolism and fetal growth indicators (R2 = 0.624). In addition, logistic regression identified folate metabolism abnormalities as an independent risk factor for predicting GDM pregnancy outcomes (OR = 2.64, 95%CI: 1.57~4.42). This study highlights the crucial role of erythrocyte folate metabolism in the fetal growth and development of GDM patients and suggests that folate supplementation and metabolic regulation may become effective ways to improve pregnancy outcomes for pregnant women with GDM. Based on these findings, this paper proposes a number of practical clinical application opinions, in the hope of
[1] | Sedaghat, F., Akhoondan, M., Ehteshami, M., Aghamohammadi, V., Ghanei, N., Mirmiran, P. and Rashidkhani, B. (2017) Maternal Dietary Patterns and Gestational Diabetes Risk: A Case-Control Study. Journal of Diabetes Research, 2017, Article 5173926. https://doi.org/10.1155/2017/5173926 |
[2] | 刘阳. 妊娠期糖尿病患者产后早期糖代谢转归的研究[D]: [硕士学位论文]. 泸州: 西南医科大学, 2020 |
[3] | 刘晓敏, 崔妙平, 姚琼, 等. CRP、叶酸代谢能力基因检测与妊娠期糖尿病的相关性研究[J]. 药品评价, 2019, 16(20): 57-59. |
[4] | Laurino, L.F., Viroel, F.J.M., Caetano, E., et al. (2019) Lentinus edodes Exposure before and after Fetus Implantation: Materno-Fetal Development in Rats with Gestational Diabetes Mellitus. Nutrients, 11, Article 2720. https://doi.org/10.3390/nu11112720 |
[5] | 张晨霞, 晋聪聪, 尉小芳, 等. 采用综合营养管理的干预模式对妊娠期糖尿病患者糖脂代谢及妊娠结局的影响研究[J]. 中华临床营养杂志, 2024, 32(1): 8-14. |
[6] | Cai, Q.Y., Yang, Y., Ruan, L.L., et al. (2023) Effects of COVID-19 Home Quarantine on Pregnancy Outcomes of Patients with Gestational Diabetes Mellitus: A Retrospective Cohort Study. The Journal of Maternal-Fetal & Neonatal Medicine, 36, Article 2193284. https://doi.org/10.1080/14767058.2023.2193284 |
[7] | 强金萍, 王彦芳, 魏新亭. 叶酸对妊娠期糖尿病患者血清同型半胱氨酸, 游离脂肪酸的影响及其相关性研究[J].母婴世界, 2020(23): 23. |
[8] | 郑淑莺. 基于LC-Q-TOF MS技术分析妊娠期糖尿病患者血浆代谢组学的研究[D]: [硕士学位论文]. 杭州: 浙江大学, 2019. |
[9] | 李芒, 吴晓莹, 吴文芳, 等. 妊娠期糖尿病患者不同血糖控制水平对胎儿心脏结构的影响研究[J]. 医药界, 2020(20): 152-153. |
[10] | 邓虎重, 王晓荣, 田斌, 等. 探讨妊娠期糖尿病患者孕期血脂水平对产后糖脂代谢的影响[J]. 长寿, 2020(10): 133. |
[11] | 毛训. 基于代谢组学分析的妊娠期糖尿病纵向队列相关血浆代谢标志物研究[D]: [硕士学位论文]. 重庆: 重庆医科大学, 2019 |
[12] | 郭华鑫. 综合营养干预对妊娠期糖尿病患者血清脂肪因子及血糖代谢指标的影响研究[J]. 实用妇科内分泌电子杂志, 2019, 6(19): 74-75. |
[13] | 龚丹丹. 营养治疗对妊娠期糖尿病患者剖宫产术后机体糖代谢的影响分析[J]. 糖尿病天地, 2019, 16(1): 172-173. |
[14] | 汪洋. 胰岛素, 格列苯脲和二甲双胍对妊娠期糖尿病小鼠分别干预改善子代糖脂代谢[D]: [硕士学位论文]. 合肥: 安徽医科大学, 2019 |
[15] | 闫贞蓉, 邢子洋, 薛婷匀, 等. 糖尿病心肌病治疗的潜在靶点——IGF-1 [J]. 承德医学院学报, 2024, 41(2): 153-157. |
[16] | Ndrepepa, G., Kastrati, A., Braun, S., Koch, W., Ko?lling, K., Mehilli, J., et al. (2008) Circulating Homocysteine Levels in Patients with Type 2 Diabetes Mellitus. Nutrition, Metabolism and Cardiovascular Diseases, 18, 66-73. https://doi.org/10.1016/j.numecd.2006.03.007 |
[17] | Vijayakumar, A., Kim, E., Kim, H., Choi, Y.J., Huh, K.B. and Chang, N. (2017) Effects of Folic Acid Supplementation on Serum Homocysteine Levels, Lipid Profiles, and Vascular Parameters in Post-Menopausal Korean Women with Type 2 Diabetes Mellitus. Nutrition Research and Practice, 11, 327-333. https://doi.org/10.4162/nrp.2017.11.4.327 |
[18] | 倪菲菲, 张红萍, 彭继文, 等. 血清同型半胱氨酸和亚甲基四氢叶酸还原酶基因C677T多态性与妊娠期糖尿病的相关性[J]. 中国妇幼保健, 2021, 36(16): 3831-3834. |
[19] | Yan, Q., Qiu, D., Liu, X., et al. (2022) The Incidence of Gestational Diabetes Mellitus among Women with Polycystic Ovary Syndrome: A Meta-Analysis of Longitudinal Studies. BMC Pregnancy Childbirth, 22, Article No. 370. https://doi.org/10.1186/s12884-022-04690-3 |
[20] | Serapinas, D., Boreikaite, E., Bartkeviciute, A., et al. (2017) The Importance of Folate, Vitamins B6 and B12 for the Lowering of Homocysteine Concentrations for Patients with Recurrent Pregnancy Loss and MTHFR Mutations. Reproductive Toxicology, 72, 159-163. https://doi.org/10.1016/j.reprotox.2017.07.001 |
[21] | Ponziani, F.R., Cazzato, I.A., Danese, S., Fagiuoli, S., Gionchetti, P., Annicchiarico, B.E., et al. (2012) Folate in Gastrointestinal Health and Disease. European Review for Medical and Pharmacological Sciences, 16, 376-385. |
[22] | Sahin, M., Tutuncu, N.B., Ertugrul, D., Tanaci, N. and Guvener, N.D. (2007) Effects of Metformin or Rosiglitazone on Serum Concentrations of Homocysteine, Folate, and Vitamin B12 in Patients with Type 2 Diabetes Mellitus. Journal of Diabetes and its Complications, 21, 118-123. https://doi.org/10.1016/j.jdiacomp.2005.10.005 |
[23] | Aghamohammadi, V., Gargari, B.P. and Aliasgharzadeh, A. (2011) Effect of Folic Acid Supplementation on Homocysteine, Serum Total Antioxidant Capacity, and Malondialdehyde in Patients with Type 2 Diabetes Mellitus. Journal of the American College of Nutrition, 30, 210-215. https://doi.org/10.1080/07315724.2011.10719962 |
[24] | 杨旭, 郭丽魁, 齐俊巧, 等. 妊娠期糖尿病孕妇血脂特点及对分娩结局的影响[J]. 河北医药, 2020, 42(12): 1828-1831. |
[25] | Bianco, M.E. and Josefson, J.L. (2019) Hyperglycemia during Pregnancy and Long-Term Offspring Outcomes. Current Diabetes Reports, 19, Article No. 143. https://doi.org/10.1007/s11892-019-1267-6 |
[26] | Xiao, Y. and Zhang, X. (2020) Association between Maternal Glucose/Lipid Metabolism Parameters and Abnormal Newborn Birth Weight in Gestational Diabetes Complicated by Preeclampsia: A Retrospective Analysis of 248 Cases. Diabetes Therapy, 11, 905-914. https://doi.org/10.1007/s13300-020-00792-3 |
[27] | International Diabetes Federation (2019) IDF Diabetes Atlas. https://www.diabetesatlas.org/en/ |
[28] | Kouiti, M., Hernández-Mu?iz, C., Youlyouz-Marfak, I., Salcedo-Bellido, I., Mozas-Moreno, J. and Jiménez-Moleón, J.J. (2022) Preventing Gestational Diabetes Mellitus by Improving Healthy Diet and/or Physical Activity during Pregnancy: An Umbrella Review. Nutrients, 14, Article 2066. https://doi.org/10.3390/nu14102066 |
[29] | Najib, S. and Sanchez-Margalet, V. (2001) Homocysteine Thiolactone Inhibits Insulin Signaling, and Glutathione Has a Protective Effect. Journal of Molecular Endocrinology, 27, 85-91. https://doi.org/10.1677/jme.0.0270085 |
[30] | Gargari, B.P., Aghamohammadi, V. and Aliasgharzadeh, A. (2011) Effect of Folic Acid Supplementation on Biochemical Indices in Overweight and Obese Men with Type 2 Diabetes. Diabetes Research and Clinical Practice, 94, 33-38. https://doi.org/10.1016/j.diabres.2011.07.003 |
[31] | Song, Y., Cook, N.R., Albert, C.M., Van Denburgh, M. and Manson, J.E. (2009) Effect of Homocysteine-Lowering Treatment with Folic Acid and B Vitamins on Risk of Type 2 Diabetes in Women. Diabetes, 58, 1921-1928. https://doi.org/10.2337/db09-0087 |
[32] | Gao, C., Sun, X., Lu, L., Liu, F. and Yuan, J. (2018) Prevalence of Gestational Diabetes Mellitus in Mainland China: A Systematic Review and Meta-Analysis. Journal of Diabetes Investigation, 10, 154-162. https://doi.org/10.1111/jdi.12854 |
[33] | Lee, S., Badoux, G.O., Wu, B. and Chong, T.H. (2021) Enhancing Performance of Biocarriers Facilitated Gravity-Driven Membrane (GDM) Reactor for Decentralized Wastewater Treatment: Effect of Internal Recirculation and Membrane Packing Density. Science of the Total Environment, 762, Article 144104. https://doi.org/10.1016/j.scitotenv.2020.144104 |
[34] | Lee, J., Ouh, Y., Ahn, K.H., Hong, S.C., Oh, M., Kim, H., et al. (2017) Preeclampsia: A Risk Factor for Gestational Diabetes Mellitus in Subsequent Pregnancy. PLOS ONE, 12, e0178150. https://doi.org/10.1371/journal.pone.0178150 |
[35] | Jeyabalan, A. (2013) Epidemiology of Preeclampsia: Impact of Obesity. Nutrition Reviews, 71, S18-S25. https://doi.org/10.1111/nure.12055 |
[36] | Larrabure-Torrealva, G.T., Martinez, S., Luque-Fernandez, M.A., Sanchez, S.E., Mascaro, P.A., Ingar, H., et al. (2018) Prevalence and Risk Factors of Gestational Diabetes Mellitus: Findings from a Universal Screening Feasibility Program in Lima, Peru. BMC Pregnancy and Childbirth, 18, Article No. 303. https://doi.org/10.1186/s12884-018-1904-0 |
[37] | Abu-Heija, A.T., Al-Bash, M.R. and Al-Kalbani, M.A. (2017) Effects of Maternal Age, Parity and Pre-Pregnancy Body Mass Index on the Glucose Challenge Test and Gestational Diabetes Mellitus. Journal of Taibah University Medical Sciences, 12, 338-342. https://doi.org/10.1016/j.jtumed.2017.01.005 |
[38] | Bianchi, C., de Gennaro, G., Romano, M., Aragona, M., Battini, L., Del Prato, S., et al. (2018) Pre-Pregnancy Obesity, Gestational Diabetes or Gestational Weight Gain: Which Is the Strongest Predictor of Pregnancy Outcomes? Diabetes Research and Clinical Practice, 144, 286-293. https://doi.org/10.1016/j.diabres.2018.08.019 |