妊娠期糖尿病胎盘差异表达蛋白对胎盘生长发育的影响:系统评价和Meta分析  

Effect of differential placental protein expressions on placental growth and development in gestational diabetes:a systematic review and meta-analysis

作　　者：黄萍萍 葛莉[1] 缪海燕[3] 郑清香[1] 王冠东 赖玉婷 江心泳 庞书勤[1] 于红虹[1] 郑春松 Huang Pingping;Ge Li;Miao Haiyan(School of Nursing,Fujian University of Traditional Chinese Medicine,Fuzhou 350122;Department of Obstetrics and Gynecology,the Second People's Hospital Affiliated to Fujian University of Traditional Chinese Medicine,Fuzhou 350003)

机构地区：[1]福建中医药大学护理学院,福州350122 [2]福建中医药大学中西医结合研究院,福州350122 [3]福建中医药大学附属第二人民医院妇产科,福州350003

出　　处：《现代妇产科进展》2020年第5期368-374,共7页Progress in Obstetrics and Gynecology

基　　金：福建省自然科学基金资助项目(No:2018J01868)。

摘　　要：目的:系统评价妊娠期糖尿病(GDM)胎盘差异表达蛋白对胎盘生长发育的影响。方法:计算机检索PubMed、Web of Science、Cochrane Library、EMBase、Medline(Ovid)、Scopus、中国生物医学文献数据库、中国知网、万方数据知识服务平台和维普数据库中与GDM胎盘蛋白差异表达对胎盘生长发育影响的有关文献,检索时限为2009年6月至2019年6月。由两名研究者独立进行文献筛选、数据提取及质量评价。运用Review Manager 5.3软件对胎盘蛋白表达水平进行Meta分析;不适合Meta分析的数据进行描述性分析,包括蛋白表达水平改变、差异表达蛋白对胎盘的影响、蛋白定位、胎盘病理。结果:最终纳入20篇文献,共1210例研究对象。Meta分析结果示,GDM组胎盘VCAM-1表达水平和HIF-1α阳性率升高,PTEN表达水平降低。描述性分析发现(1)GDM胎盘差异表达蛋白通过影响滋养细胞融合、增殖、分化、侵袭及凋亡,干扰胎盘血管生成与损伤,加强胎盘局部氧化应激,引起胎盘生长发育异常,改变胎盘结构与功能;(2)胎盘差异蛋白主要免疫定位在滋养细胞、和(或)血管内皮细胞、和(或)绒毛间质细胞中;(3)GDM胎盘病理改变报道最多的是绒毛成熟不良和血管壁增厚、管腔狭窄。结论:胎盘蛋白表达失调可能介导胎盘结构和功能改变,从而促进GDM和其它妊娠期并发症的发生发展,其因果关系及调控机制尚不明确,有待进一步深入研究。Objective:To systematically evaluate the effect of differential placental protein expressions on placental growth and development in gestational diabetes mellitus.Methods:Relevant literature reporting placental protein expressions in gestational diabetes mellitus was identified by retrieving PubMed,Web of Science,Cochrane Library,EMBase,Medline(Ovid),Scopus,CBMdisc,CNKI,Wanfang Database and VIP from June 2009 to June 2019.Two researchers independently conducted literature screening,data extraction and quality evaluation.Review Manager 5.3 software was used for Meta-analysis among the placental protein expression levels,while descriptive analysis was conducted when data were not suitable for Meta-analysis including the changes of placental protein expression levels,effects of differential placental protein expressions on placenta growth and development,protein location,and placental pathology.Results:20 studies involving 1210 participants were included.Meta-analysis showed that the expression level of VCAM-1 and the positive rate of HIF-1αwere increased in the GDM group,and the expression level of PTEN was decreased.Descriptive analysis showed that:(1)The differentially placental protein expressions impacted the trophoblastic cells on fusion,proliferation,differentiation,invasion and apoptosis;interfered with placental angiogenesis and vascular injury;strengthened placental local oxidative stress.They thus caused the abnormal growth and development of the placenta and the changes in the structure and function of the placenta.(2)Placental differential proteins are mainly immunolocalized in trophoblast cells,and/or vascular endothelial cells,and/or villous mesenchymal cells.(3)The most common pathological changes in GDM placenta were poor villus maturation,thickening of the vessel wall,and stenosis of the vascular lumen.Conclusion:The dysregulation of placental protein expressions may mediate the changes of placental structural and functional,thus promote the occurrence and development of GDM and other pregnancy co

关 键 词：妊娠期糖尿病 胎盘 胎盘蛋白 系统评价 

分 类 号：R714[医药卫生—妇产科学]