姜海英 左金玲 桑雪梅 王茜 赵竞

[摘要] 目的 探討不同孕期摄食抑制因子（Nesfatin-1）、C-反应蛋白（CRP）及血清铁蛋白（SF）水平及其与妊娠期糖尿病（GDM）的关系。 方法 选取2015年6月～2017年1月在河北省唐山市妇幼保健院建档并行孕早期（11～13周）检查的103例孕妇作为研究对象，根据孕中期葡萄糖耐量试验糖代谢正常是否分为试验组（47例）和对照组（56例）。对两组患者孕中期一般情况（包括年龄、孕龄、体重指数、空腹血糖、空腹胰岛素）、孕早期和孕中期血清Nesfatin-1、CRP及SF水平进行比较，采用Logistic回归对GDM的相关因素进行分析。 结果 两组孕中期年龄、孕龄、体重指数比较，差异无统计学意义（P > 0.05），试验组空腹血糖及空腹胰岛素水平均高于对照组，差异有统计学意义（P < 0.05）。试验组孕早期及孕中期血清Nesfatin-1、CRP、SF水平均高于对照组，差异均有统计学意义（P < 0.05）。试验组孕中期血清上述指标水平均高于孕早期，差异有统计学意义（P < 0.05）；对照组孕中期上述指标水平与孕早期比较，差异无统计学意义（P > 0.05）。Logistic多因素回归分析显示，空腹血糖、空腹胰岛素及血清Nesfatin-1、CRP及SF是GDM发生的危险因素（P < 0.05）。 结论 血清Nesfatin-1、CRP及SF异常表达是GDM发生的危险因素，且在孕早期GDM患者血清Nesfatin-1、CRP及SF较正常孕妇已有升高，通过其水平检测有利于早期发现GDM，使患者血糖得到有效控制，对改善妊娠结局具有重要意义。

[关键词] 妊娠期糖尿病；Nesfatin-1；C-反应蛋白；血清铁蛋白

[中图分类号] R711.75 [文献标识码] A [文章编号] 1673-7210（2018）02（c）-0098-05

Difference on the levels of Nesfatin-1， C-reactive protein and serum ferritin in different gestational periods in patiens with gestational diabetes mellitus and their relationship

JIANG Haiying ZUO Jinling SANG Xuemei WANG Qian ZHAO Jing

Department of Gynaceology and Obstetrics， Maternal and Child Health Hospital of Tangshan， Heibei Province， TangShan 063000， China

[Abstract] Objective To investigate the levels of Nesfatin-1， C-reactive protein （CRP） and serum ferritin （SF） of different gestational periods in patients with gestational diabetes mellitus （GDM） and their relationship. Methods From June 2015 to January 2017， 103 patients in early pregnancy built profile and examined in Maternal and Child Health Hospital of Tangshan were selected as research objects and divided into the test group （47 cases） and the control group （56 cases） by the oral glucose tolerance test. The general conditions （includes age， gestational weeks， BMI， fasting blood glucose and fasting insulin） in middle pregnancy between the two groups were compared and the levels of Nesfatin-1， CRP and SF in the early and middle pregnancy between the two groups were compared. The logistic regression analysis was used to analyze the related factors of GDM. Results There were no statistically significant differences in the age， gestational weeks and BMI between the two groups in the middle pregnancy （P > 0.05）. The fasting blood glucose and fasting insulin in the test group were higher than those of control group， with statistically significant differences（P < 0.05）. In the early and middle pregnancy， the levels of Nesfatin-1， CRP and SF in the test group were higher than those of control group， with statistically significant differences （P < 0.05）. In the test group， the indicators above in the middle pregnany were higher than those of early pregnany， with statistically significant differences （P < 0.05）； in the control group， there were no statistically significant differences in the above indicators between the early and middle pregnany （P < 0.05）. The Logistic regressive analysis showed that the fasting blood glucose， fasting insulin， Nesfatin-1，CRP and SF were the risk factors of GDM （P < 0.05）. Conclusion Serum Nesfatin-1， CRP and SF are the risk factors of GDM. In early pregnancy of GDM patients， Nesfatin-1， CRP and SF are higher than those in normal pregnant women and it is helpful for early detection of GDM， so as to control the patients′ blood glucose effectively， which is of great significance to improve the pregnancy outcome.

[Key words] Gestational diabetes mellitus； Nesfatin-1； C-reactive protein； Serum ferritin

妊娠期糖尿病（gestational diabetes mellitus，GDM）是妇产科常见疾病，其临床经过复杂，妊娠过程中可出现流产、早产及产后出血等严重并发症，且可造成胎儿器官发育迟滞、畸形、胎死宫内、新生儿体重过大及高胆红素血症等，对孕产妇及围生儿具有较大危害，已引起临床广泛重视[1-2]。早期发现GDM，给予患者及时、有效干预，对降低妊娠期及围产期母婴并发症具有重要意义。葡萄糖耐量试验（oral glucose tolerance test，OGTT）是目前诊断糖尿病的金标准，但该检测手段操作繁琐，抽血次数较多，患者依从性相对较差，故寻找一种安全、有效、方便的检测手段诊断GDM成为临床亟待解决的热点问题[3]。近……