二甲双胍对妊娠期糖尿病孕妇母血和脐血长链脂肪酸的影响
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常州市卫健委重大项目(ZD201922);江苏省“第五期333工程”科研项目(BRA2019160)


Effects of metformin on long⁃chain fatty acids in maternal blood and umbilical cord blood of pregnant women with gestational diabetes
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    摘要:

    目的:探讨二甲双胍对妊娠期糖尿病(gestational diabetes mellitus,GDM)孕妇和新生儿体内长链脂肪酸(long-chain fatty acid,LCFA)含量和成分的影响。方法:选取2018年8月—2020年8月南京医科大学附属常州妇幼保健院分娩的孕妇127例,糖耐量正常孕妇(N组,32例)和仅需饮食控制的GDM孕妇(G1组,32例)作为对照,将需药物治疗的GDM孕妇按随机并自愿原则分别纳入二甲双胍治疗组(G2组,33例)和胰岛素治疗组(G3组,30例)。比较各组分娩前血糖、血脂、胰岛素抵抗指数(homeostasis model assessment- insulin resistance index,HOMA-IR),对比各组孕前及分娩前体重指数(body mass index,BMI)、妊娠结局,分析各组母血和脐血中LCFA构成和含量。结果:G2组孕妇孕期增重低于N组、G1组和G3组,G2、G3组空腹血糖高于N组,G1、G2、G3组餐后2 h血糖高于N组,G2组HOMA-IR高于N组、G1组和G3组(P<0.05);4组母血总胆固醇、甘油三酯、游离脂肪酸、新生儿体重比较,差异无统计学意义(P>0.05),对母血和脐血中11种主要LCFA进行液相色谱分析,分别为二十碳一烯酸(eicosenoic acid,EA)、二十二碳五烯酸(docosapentaenoic acid,DPA)、亚油酸(linolenic acid,LA)、α-亚麻酸(α-linolenic acid,ALA)、花生四烯酸(arochidonic acid,AA)、二十二碳六烯酸(docosahexaenoic acid,DHA)、磷脂酸(phosphatidic acid,PA)、油酸(oleic acid,OA)、二十碳五烯酸(eicosapentenoic acid,EPA)、w-6-二十二碳五烯酸(w-6-docosapentaenoic acid,DPA6)、γ-亚麻酸(gamma linolenic acid,GLA)。G2、G3组EA高于G1组,G2组DPA含量高于N组、G1和G3组(P<0.05),4组脐血EA、DPA、LA、ALA、PA、OA、EPA、DPA6、GLA含量均低于母血中含量(P<0.05)。母血EA、LA、ALA、AA、DHA、PA、OA、EPA、GLA均与空腹血糖呈明显负相关(P<0.05)。结论:二甲双胍与胰岛素用于GDM治疗,新生儿体重、血糖、血脂控制效果相同,二甲双胍孕期体重控制优于胰岛素,其对母血和脐血中LA和ALA等重要脂肪酸含量无明显影响,且对脐血中AA和DHA无明显影响,从对必需脂肪酸影响的角度看,二甲双胍在GDM的使用是安全的。

    Abstract:

    Objective:This study aims to investigate the effects of metformin on the content and composition of long-chain fatty acids(LCFA) in pregnant women with gestational diabetes mellitus(GDM) and their newborns. Methods:A total of 127 pregnant women who delivered in Changzhou Maternal and Child Health Hospital Affiliated to Nanjing Medical University from August 2018 to August 2020 were selected,32 pregnant women with normal glucose tolerance(N Group)and 32 pregnant women with GDM who only needed diet control (G1 Group)were selected as control. According to the principle of randomization and voluntariness,the pregnant women with GDM who needed drug treatment were randomly divided into metformin treatment group(G2 group,33 cases) and insulin treatment group(G3 group,30 cases). Blood glucose,blood lipids and insulin resistance index(HOMA-IR) were compared before delivery in each group. Body mass index(BMI)before pregnancy and delivery,and pregnancy outcome were compared. The composition and content of long LCFA in maternal blood and umbilical cord blood were analyzed. Results:The weight gain during pregnancy in G2 group was lower than that in N group,G1 group and G3 group. Fasting blood glucose(FBG)in G2 and G3 group was higher than that in N group. The 2-hour postprandial glucose(2hPG)in G1,G2 and G3 group was higher than that in N group. HOMA-IR in G2 group was higher than that in N group,G1 group and G3 group(P<0.05). There were no statistically significant differences in total cholesterol,triglyceride,free fatty acid in maternal blood and neonatal weight among the four groups(P > 0.05). The main 11 kinds of LCFA in maternal blood and cord blood were analyzed by liquid chromatography,which were eicosenoic acid(EA),docosapentaenoic acid(DPA),linolenic acid(LA),α-linolenic acid(ALA),arochidonic acid(AA),docosahexaenoic acid(DHA),phosphatidic acid(PA),oleic acid(OA),eicosapentenoic acid(EPA),w-6-docosapentaenoic acid(DPA6),gamma linolenic acid(GLA). EA in G2 and G3 groups was higher than that in G1 group,while DPA in G2 group was higher than that in N group,G1 and G3 groups(P < 0.05). The contents of EA,DPA,LA,ALA,PA,OA,EPA,DPA6 and GLA in umbilical cord blood were lower than those in maternal blood(P < 0.05). The levels of EA,LA,ALA,AA,DHA,PA,OA,EPA and GLA in maternal blood were significantly negatively correlated with FBG(P < 0.05). Conclusion:Metformin and insulin have the same effect in the control of neonatal weight,blood glucose and blood lipid in the treatment of GDM,and metformin is better than insulin in the control of pregnancy weight. It has no significant effect on the contents of important fatty acids such as LA and ALA in maternal blood and umbilical cord blood,and has no significant effect on the contents of AA and DHA in umbilical cord blood. From the perspective of effect on essential fatty acids,the use of metformin in GDM is safe.

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潘兆萍,佘广彤,王慧艳,王文丽,周文柏,张 铭,虞 斌,孙彩凤,杨丽萍.二甲双胍对妊娠期糖尿病孕妇母血和脐血长链脂肪酸的影响[J].南京医科大学学报(自然科学版),2021,(11):1592-1599

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  • 收稿日期:2021-05-03
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  • 在线发布日期: 2021-12-13
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