妊娠20周内母血mTOR表达和血脂水平与妊娠期糖尿病的关系  

Association between mTOR and maternal serum lipids levels within 20 weeks’gestation and gestational diabetes mellitus

作　　者：程彬伟 金铭敏 王杉杉 黄慧君 俞秋嫣 杨新军[1] CHENG Binwei;JIN Mingmin;WANG Shanshan;HUANG Huijun;YU Qiuyan;YANG Xinjun(School of Public Health,Wenzhou Medical University,Wenzhou 325035,China)

机构地区：[1]温州医科大学公共卫生学院,浙江温州325035

出　　处：《温州医科大学学报》2025年第2期96-104,111,共10页Journal of Wenzhou Medical University

基　　金：浙江省公益技术研究计划/社会发展项目(GF20H260039)。

摘　　要：目的:探讨妊娠20周内母血哺乳动物雷帕霉素靶蛋白(mTOR)表达和血脂水平与妊娠期糖尿病(GDM)发生风险的关系。方法:采用前瞻性巢式病例对照研究设计,选取2020年7月20日至2021年4月30日间在温州市4家医院首次产检并登记建卡的妊娠20周内孕妇为研究对象。以确诊为GDM的88例孕妇为GDM组,以与GDM组采血孕周相同且孕妇年龄相差≤2岁进行1:1匹配,得到88例正常孕妇作为对照组。采用限制性立方样条和条件Logistic回归分析母血mTOR表达和血脂水平与GDM发生风险的关系。结果:妊娠20周内GDM组母血mTOR表达水平低于对照组(P<0.05),甘油三酯(TG)和甘油三酯-葡萄糖指数(Ty G指数)均高于对照组(P<0.05);mTOR表达和TyG指数水平与GDM的发生风险相关联,且呈线性剂量反应关系(非线性P>0.05,总效应P<0.05)。条件Logistic回归分析显示妊娠20周内高水平的TG、TyG指数是发生GDM的危险因素(P<0.05),而mTOR高表达会降低GDM的发生风险(P<0.05)。但未发现mTOR表达水平与血脂异常存在相乘交互作用(P>0.05)。结论:妊娠20周内母血mTOR低表达和高水平的TG和TyG指数均会增加GDM发生风险,提示在孕20周内监测mTOR表达水平和血脂的变化可能有利于早期发现GDM高危人群。Objective:To investigate the association of mammalian target of rapamycin(mTOR)expression,maternal blood lipids with the risk of gestational diabetes mellitus(GDM)during 20 weeks of pregnancy.Methods:Using a prospective nested case-control study design,pregnant women within 20 weeks’gestation who received their first prenatal examination and made their registration cards in 4 Wenzhou hospitals from July 20,2020 to April 30,2021 were selected as the study population.Eighty-eight pregnant women diagnosed with GDM were assigned as GDM group,and eighty-eight pregnant women with normal blood glucose as control group at 1:1 with the same gestational weeks and maternal age difference≤2 years compared with GDM group.Restricted cubic spline function and conditional logistic regression were used to analyze the relationship between maternal blood mTOR expression,blood lipid level and the risk of GDM.Results:Within 20 weeks of pregnancy,GDM group had lower level of serum mTOR expression but higher triglyceride(TG)and triglyceride-glucose index(TyG index)than control group(all P<0.05).The expression of serum mTOR and TyG index with 20 weeks’gestation were associated with the risk of GDM,which showed a linear dose-response relationship(P-non-linear>0.05,P-overall<0.05).Conditional logistic regression analysis showed that high TG and TyG index within 20 weeks of gestation were risk factors for GDM(P<0.05),and high mTOR expression reduced the risk of GDM(P<0.05).However,there was no multiplicative interaction between mTOR expression level and dyslipidemia(P>0.05).Conclusion:Low expression of mTOR and high levels of TG and TyG index in maternal blood within 20 weeks of pregnancy increased the risk of GDM,suggesting that monitoring the mTOR expression level and the blood lipid changes within 20 weeks of pregnancy may be beneficial to the early detection of GDM high-risk population.

关 键 词：哺乳动物雷帕霉素靶蛋白 母血血脂 妊娠期糖尿病 前瞻性巢式病例对照研究 

分 类 号：R714.25[医药卫生—妇产科学]