妊娠糖尿病孕妇血清HO-1、HIF-1α水平与胎儿大脑中动脉血流的关系及对产前胎儿宫内缺氧诊断  

Relationship between serum HO-1,HIF-1αlevels and fetal middle cerebral artery blood flow in pregnant women with gestational diabetes mellitus and diagnosis of prenatal fetal intrauterine hypoxia

作　　者：蒋志敏[1] 吴林军[1] 雷建东[1] 季沙 李丹[2] JIANG Zhimin;WU Linjun;LEI Jiandong;JI Sha;LI Dan(Department of Clinical Laboratory,Leshan Hospital of Traditional Chinese Medicine,Leshan,Sichuan 614000,China;Department of Ultrasound,Leshan Hospital of Traditional Chinese Medicine,Leshan,Sichuan 614000,China)

机构地区：[1]乐山市中医医院检验科,四川乐山614000 [2]乐山市中医医院超声科,四川乐山614000

出　　处：《中国优生与遗传杂志》2023年第7期1476-1482,共7页Chinese Journal of Birth Health & Heredity

摘　　要：目的探讨妊娠糖尿病(GDM)孕妇血清HO-1,HIF-1α水平与胎儿大脑中动脉血流的关系以及对胎儿宫内缺氧的预测价值。方法选取2020年2月至2022年6月乐山市中医医院收治的163例GDM孕妇作为研究对象,根据胎儿是否宫内缺氧诊断标准将其分为无宫内缺氧组(118例)和宫内缺氧组(45例)。对比两组研究对象的临床资料,单因素以及多因素COX回归分析可能造成胎儿宫内缺氧的危险因素;采用ROC曲线预测胎儿宫内缺氧发生的效能,并构建列线图模型并对其进行验证。结果无宫内缺氧组在羊水过少、母孕期感染、妊高征、胎动异常、全血高切黏度(HWBV)、血沉(ESR)、全血低切黏度(LWBV)、孕妇血清HO-1、HIF-1α水平方面均显著低于宫内缺氧组(P<0.05),而在胎儿大脑中动脉血流参数方面则显著高于宫内缺氧组(P<0.05);以上具有显著性差异的指标均是导致胎儿宫内缺氧发生的危险因素(OR值>1,P<0.05);孕妇血清HO-1、HIF-1α水平与胎儿大脑中动脉血流参数呈明显负相关(P<0.05),且二者联合预测胎儿宫内缺氧具有更优的预测效能;列线图模型危险因素总分726分,对应发生宫内缺氧概率为78.33%,经验证模型具有良好的区分度、准确度和有效性。结论通过GDM孕妇血清HO-1,HIF-1α水平检测和胎儿大脑中动脉血流的超声监测,对产前胎儿宫内缺氧诊断具有十分重要的预测价值,并且联合检测比单一指标评估更准确、可靠。Objective To explore the relationship between serum HO-1,HIF-1αlevels in pregnant women with gestational diabetes mellitus(GDM)and the blood flow of the foetal middle cerebral artery blood flow and the predictive value of foetal intrauterine hypoxia.Methods A total of 163 pregnant women with GDM admitted to Leshan Hospital of Traditional Chinese Medicine from February 2020 to June 2022 were selected as research objects.According to the diagnostic criteria of fetal intrauterine hypoxia,they were divided into a group without intrauterine hypoxia(118 cases)and a group with intrauterine hypoxia(45 cases).By comparing the clinical data of the two groups,univariate and multivariate COX regression analysis was conducted to analyze the risk factors that may cause fetal hypoxia in utero.The ROC curve was used to predict the efficiency of the occurrence of fetal hypoxia in utero,and the line graph model was constructed and verified.Results The levels of hydramniotic fluid,maternal pregnancy infection,pregnancy-induced hypertension,fetal motility,whole blood high shear viscosity(HWBV),erythrocyte sedimentation rate(ESR),whole blood low shear viscosity(LWBV),serum HO-1 and HIF-1αof pregnant women in the no-intrauterine hypoxia group were significantly lower than those in the intrauterine hypoxia group(P<0.05).The blood flow parameters of fetal middle cerebral artery were significantly higher than those of intrauterine hypoxia group(P<0.05).All the above indexes with significant differences were risk factors leading to the occurrence of fetal intrauterine hypoxia(OR value>1,P<0.05).Serum HO-1 and HIF-1αlevels of pregnant women were negatively correlated with fetal middle cerebral artery blood flow parameters(P<0.05),and the combination of the two levels had better predictive efficacy for fetal intrauterine hypoxia.The total score of risk factors in the line graph model was 726 points,corresponding to the probability of intrauterine hypoxia was 78.33%.The verified model had good differentiation,accuracy and effectiveness.Co

关 键 词：妊娠糖尿病 血红素氧合酶 缺氧诱导因子 大脑中动脉 宫内缺氧 

分 类 号：R714.256[医药卫生—妇产科学]