文章摘要
张英,梁登辉,王德亮.血清载脂蛋白 C3、脂蛋白酯酶在妊娠期糖尿病中表达水平及临床意义[J].安徽医药,2024,28(11):2240-2245.
血清载脂蛋白 C3、脂蛋白酯酶在妊娠期糖尿病中表达水平及临床意义
Study on the expression levels and clinical significance of serum ApoC3 and LPL in gestational diabetes
  
DOI:10.3969/j.issn.1009-6469.2024.11.026
中文关键词: 糖尿病,妊娠  载脂蛋白 C3  脂蛋白酯酶  临床意义
英文关键词: Diabetes,gestational  Apolipoprotein C3  Lipoprotein lipase  Clinical significance
基金项目:
作者单位
张英 张家口市妇幼保健院妇产科河北张家口 075000 
梁登辉 河北北方学院附属第一医院生殖医学科河北张家口 075000 
王德亮 德州市人民医院产科山东德州 253000 
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中文摘要:
      目的探讨妊娠期糖尿病( GDM)病人血清载脂蛋白 C3(ApoC3)、脂蛋白酯酶( LPL)水平变化及其临床意义。方法选取 2020年 1月至 2021年 1月张家口市妇幼保健院收治的 GDM病人 100例为 GDM组,健康孕妇 104例为对照组,另根据是否发生新生儿不良结局,将 GDM病人分为结局不良组( 27例)和结局良好组( 73例)。收集两组血脂、血糖指标,采用酶联免疫吸附测定检测血清中 ApoC3、LPL水平。采用 Pearson法分析 GDM病人血清 ApoC3、LPL与血糖、血脂相关指标及 HOMA-IR的相关性;多因素 logistic回归分析影响 GDM病人新生儿不良结局的因素; ROC曲线分析血清 ApoC3、LPL水平对 GDM病人新生儿不良结局的预测价值。结果 GDM组血清 LPL[(38.03±15.80)μg/L比( 46.58±9.75)μg/L]、高密度脂蛋白胆固醇( HDL-C)[(1.16±0.31)mmol/L比( 1.53±0.37)mmol/L]水平均低于对照组( P<0.05),ApoC3[( 180.37±47.37)mg/L比( 144.62±35.83)mg/L]、总胆固醇( TC)[( 5.22±1.05)mmol/L比( 4.35±0.96)mmol/L]、三酰甘油( TG)[( 2.36±0.74)mmol/L比( 1.39±0.58)mmol/L]、低密度脂蛋白胆固醇( LDL-C)[( 3.18±0.97)mmol/L比( 2.51±0.72)mmol/L]、空腹血糖( FPG)[( 6.27±1.60)mmol/L比( 4.64±1.53)mmol/L]、空腹胰岛素( FINS)[( 1.84±0.69)mU/L比( 1.42±0.54)mU/L]及胰岛素抵抗指数( HOMA-IR)(6.12±1.48比 4.23±1.28)均高于对照组(P<0.05)。 GDM病人血清 ApoC3与 TG、TC、LDL-C、FPG、FINS及 HOMA-IR呈正相关( P<0.05),与 HDL-C呈负相关( P<0.05); GDM病人血清 LPL与 TG、TC、LDL-C、FPG、FINS及 HOMA-IR呈负相关( P<0.05),与 HDL-C呈正相关(P<0.05)。 GDM病人血清 ApoC3与 LPL水平呈负相关( r=?0.39,P<0.05)。结局不良组病人 FINS、HOMA-IR及血清 ApoC3水平高于结局良好组, LPL水平均低于结局良好组( P<0.05)。HOMA-IR、ApoC3是影响 GDM病人新生儿不良结局的独立危险因素, LPL是影响 GDM病人新生儿不良结局的保护因素( P<0.05)。血清 ApoC3、LPL水平联合预测 GDM病人新生儿不良结局的曲线下面积为 0.916,明显高于血清 ApoC3、LPL水平单独预测( P<0.05)。 ApoC3高表达病人新生儿总不良结局发生率高于低表达, LPL低表达病人新生儿总不良结局发生率高于高表达( P<0.05)。结论 GDM病人血清 ApoC3高表达, LPL低表达,且二者水平与血脂、血糖及胰岛素抵抗(IR)密切相关,并与新生儿不良结局有关。
英文摘要:
      Objective To investigate the changes of serum apolipoprotein C3 (ApoC3) and lipoprotein lipase (LPL) levels in patientswith gestational diabetes (GDM) and their clinical significance.Methods A total of 100 cases of GDM patients admitted to our hospital from January 2020 to January 2021 were selected as the GDM group, and 104 healthy pregnant women were selected as the controlgroup. In addition, according to whether adverse neonatal outcomes occurred, GDM patients were divided into the poor outcome group(27 cases) and the good outcome group (73 cases). The blood lipids and blood glucose indicators of the two group were collected, the levels of ApoC3 and LPL in serum were detected with enzyme-linked immunoassay. Pearson method was used to analyze the correlationbetween serum ApoC3, LPL, blood glucose, blood lipid and HOMA-IR in patients with GDM; Multivariate logistic regression was usedto analyze the influencing factors of adverse neonatal outcomes in GDM patients; ROC curve analysis of serum ApoC3 and LPL levels to predict the adverse outcome of newborns in GDM patients.Results The levels of serum LPL[(38.03±15.80)μg/L vs. (46.58±9.75)μg/ L] and high-density lipoprotein cholesterol (HDL-C) [(1.16±0.31)mmol/L vs. (1.53±0.37)mmol/L] in the GDM group were lower than those in the control group (P<0.05). ApoC3[(180.37±47.37)mg/L vs. (144.62±35.83)mg/L], total cholesterol (TC)[(5.22±1.05)mmol/L vs. (4.35±0.96)mmol/L], triglycerides (TG)[(2.36±0.74)mmol/L vs. (1.39±0.58)mmol/L], low-density lipoprotein cholesterol (LDL-C) levels [(3.18±0.97)mmol/L vs. (2.51±0.72)mmol/L], fasting blood glucose (FPG) [(6.27±1.60)mmol/L vs. (4.64±1.53)mmol/L], fasting insulin (FINS)[(1.84±0.69)mU/L vs. (1.42±0.54)mU/L] and insulin resistance index (HOMA-IR)(6.12±1.48 vs. 4.23±1.28) were all higher than those in the control group (P<0.05). Serum ApoC3 in patients with GDM was positively correlated with TG, TC, LDL-C, FPG, FINS and HOMA-IR (P<0.05), and negatively correlated with HDL-C(P<0.05); serum LPL in GDM patients was negatively correlated with TG, TC, LDL-C, FPG, FINS and HOMA-IR (P<0.05), and positively correlated with HDL-C(P<0.05). There was a negative correlation between serum ApoC3 and LPL levels in patients with GDM (r=?0.39, P<0.05). The FINS, HOMA-IR and serum ApoC3 level in the pooroutcome group was higher than that in the good outcome group, and the LPL level was lower than that in the good outcome group (P< 0.05). HOMA-IR and ApoC3 were independent risk factors affecting adverse neonatal outcomes in patients with GDM, while LPL was aprotective factor affecting adverse neonatal outcomes in patients with GDM (P<0.05). The area under the curve of serum ApoC3 andLPL levels combined to predict the adverse outcome of newborns in GDM patients was 0.916, which was significantly higher than thatpredicted by serum ApoC3 and LPL levels alone (P<0.05). ApoC3 high expression patients had a higher incidence of total adverse outcomes than low expression patients, and LPL low expression patients had a higher incidence of total adverse outcomes than high expression patients (P<0.05).Conclusion Serum ApoC3 is highly expressed in GDM patients, and LPL is lowly expressed, and the levels ofboth are closely related to blood lipids, blood glucose and insulin resistance (IR), and they are related to adverse neonatal outcomes.
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