肥胖孕妇血清同型半胱氨酸超敏C-反应蛋白及叶酸水平与妊娠期糖尿病的相关性  

Correlation between serum homocysteine,hypersensitive CRP and folate levels and gestational diabetes mellitus in obese pregnant women

作　　者：于宁[1] 张雅楠[1] 崔洪艳[1] 冯卿卿[1] YU Ning;ZHANG Ya-nan;CUI Hong-Yan;FENG Qing-qing(Tianjin Central Hospital of Obstetrics and Gynecology,Nankai University Affiliated Maternity,Tianjin Key Laboratory of Human Development and Reproductive Regulation,Tianjin 300100,China)

机构地区：[1]天津市中心妇产科医院,南开大学附属妇产医院,天津市人类发育与生殖调控重点实验室,天津300100

出　　处：《中国妇幼保健》2025年第2期201-205,共5页Maternal and Child Health Care of China

基　　金：天津市卫生健康科研项目(ZC20142);天津市医学重点学科(专科)建设项目(TJYXZDXK-043A)。

摘　　要：目的探讨肥胖孕妇中血清同型半胱氨酸(Hcy)、超敏C-反应蛋白(hs-CRP)、叶酸(FA)水平、胰岛素抵抗指数(IR)及妊娠期糖尿病(GDM)的相关性。方法随机选取2022年1月—2022年11月于天津市中心妇产科医院住院分娩的足月单胎初产妇,孕前BMI≥28 kg/m2,根据孕中期75 g口服葡萄糖耐量试验(OGTT)结果,诊断为GDM的肥胖孕妇作为GDM组(88例),并选取同期匹配的正常糖耐量肥胖孕妇作为对照组(92例)。记录一般临床资料,检测各组血清Hcy、hs-CRP、FA水平及空腹血糖(FPG)、胰岛素、血脂等相关生化指标。结果与对照组相比,GDM组血清Hcy、hs-CRP水平显著升高(12.34±4.85μmol/L vs.9.58±4.07μmol/L;26.02±18.90 mg/L vs.9.35±7.66 mg/L),血清FA水平显著降低(4.64±2.23 ng/ml vs.6.07±2.86 ng/ml),差异均有统计学意义(均P<0.05),并且血清Hcy水平与hs-CRP、HOMA-IR、孕前及孕期BMI呈正相关(r=0.294,P<0.05;r=0.481,P<0.05;r=0.247,P<0.05;r=0.198,P<0.05),与FA呈负相关(r=-0.368,P<0.05),但与血脂水平无明显相关性(r=0.081,P>0.05;r=0.102,P>0.05)。结论肥胖孕妇中血清Hcy水平的升高和炎症反应可能是IR的重要原因,并进而导致GDM的发生。Hcy与FA呈负相关,表明合理补充FA可改善肥胖孕妇高同型半胱氨酸血症(HHcy)。监测血清Hcy、hs-CRP水平可能对肥胖孕妇患GDM及远期心血管疾病风险具有一定预测价值。Objective To investigate the relationship between serum homocysteine(Hcy),high sensitivity CRP(hs-CRP)and folic acid(FA)levels and insulin resistance(IR)in obese pregnant women and the association of gestational diabetes mellitus(GDM).Methods A random selection of full-term single pregnant women with pre-pregnancy BMI≥28 kg/m2 who were hospitalized in Tianjin Central Hospital of Gynecology and Obstetrics during from January 2022 to November were selected.According to the results of OGTT in the second trimester,obese pregnant women diagnosed as GDM were selected as the case group(88 cases),and matched obese pregnant women with normal glucose tolerance were selected as the control group(92 cases).General clinical data were recorded,and serum Hcy,hs-CRP,FA levels,fastingplasmaglucose(FPG),insulin,blood lipid and other related biochemical indexes were detected in each group.Results Compared with obese pregnant women with normal glucose tolerance,serum Hcy and hs-CRP levels were significantly increased in obese pregnant women with GDM(12.34±4.85μmol/L vs.9.58±4.07μmol/L,P<0.05;26.02±18.90 mg/L vs.9.35±7.66 mg/L,P<0.05),while serum FA levels were significantly decreased(4.64±2.23 ng/ml vs.6.07±2.86 ng/ml,P<0.05).Serum Hcy levels were positively correlated with hs-CRP,HOMAIR,pre-pregnancy and pregnancy BMI(r=0.294,P<0.05;r=0.481,P<0.05;r=0.247,P<0.05;r=0.198,P<0.05),Hcy and FA were negatively correlated(r=-0.368,P<0.05),but there was no significant correlation with lipid levels(r=0.081,P>0.05;r=0.102,P>0.05).Conclusion The increase of serum Hcy level and inflammatory reaction in obese pregnant women may be the important causes of IR,and then lead to the occurrence of GDM.There was a negative correlation between Hcy and FA,indicating that rational supplementation of FA can improve Hyperhomocysteinemia(HHcy)in obese pregnant women.Monitoring serum Hcy and hs-CRP levels may have a certain value in predicting GDM and long-term cardiovascular disease risk in obese pregnant women.

关 键 词：同型半胱氨酸 超敏C-反应蛋白 叶酸 妊娠期糖尿病 肥胖 

分 类 号：R714.2[医药卫生—妇产科学]