妊娠期糖尿病患者血清miR-21，PPARγ和IGF-1R表达水平与凝血功能和妊娠结局的相关性研究

目的　研究微小RNA-21 (micro RNA21, miR-21)、过氧化物酶体增殖物激活受体γ（peroxisome proliferater-activated receptor γ，PPARγ）和胰岛素样生长因子1受体(insulin 1ike growth factor 1 Receptor, IGF-1R）在妊娠期糖尿病(gestational diabetes mellitus, GDM )中的表达情况及其与凝血功能、妊娠结局的相关性。方法　选取2017年1月~2020年1月在邢台市第三医院妇产科收治的164例GDM患者作为研究对象，同期健康妊娠产妇100例为对照组，收集临床资料、血清标本以及统计妊娠结局。检测受试者血清micro RNA21，PPARγ和IGF-1R水平以及凝血功能，比较两组各指标表达水平差异，采用Pearson相关性分析、多元线性回归分析GDM患者血清Micro RNA21，PPARγ和IGF-1R水平与凝血功能、不良妊娠结局的相关性。结果　GDM组血糖指标水平（空腹OGTT，1h OGTT，2h OGTT，HbAlc，HOMA-IR），FIB，D-D和IGF-1R均明显高于对照组（t=31.456，100.176，69.999，24.948，26.546；11.204，9.753，26.169），PT，APTT，Micro RNA21和PPARγ明显低于对照组（t=4.024，9.958，22.675，51.140），差异均有统计学意义（均P<0.05）。GDM组不良妊娠结局发生率明显高于对照组，差异有统计学意义（χ2=6.472，P<0.05）。Pearson分析显示，Micro RNA21， PPARγ与PT，APTT呈正相关（r=0.418, 0.526, 0.456, 0.603），与FIB，D-D呈负相关（r =-0.582, -0.512, -0.693, -0.587），差异有统计学意义（均P<0.05）。IGF-1R与PT，APTT呈负相关（r= -0.437, -0.571），与 FIB，D-D呈正相关（r=0.604, 0.562），差异均有统计学意义（均P<0.005）。不良妊娠结局产妇的Micro RNA21，PPARγ水平低于妊娠结局良好产妇，而IGF-1R水平高于妊娠结局良好产妇（t=14.575, 30.271, 13.684,均P<0.05）。多元线性回归分析显示Micro RNA21，PPARγ和IGF-1是妊娠结局的独立影响因素（P<0.05）。结论　Micro RNA21，PPARγ和IGF-1R在妊娠期糖尿病患者血清中表达异常，与凝血功能呈相关性，可有效预测GDM患者的妊娠结局。

Study on the Correlation between Serum miR-21, PPAR γ and IGF-1R Expression Levels in Patients with Gestational Diabetes and BloodCoagulation Function and Pregnancy Outcome

Objective　To study the expression of Micro RNA21, PPARγ and IGF-1R in gestational diabetes mellitus and theircorrelation with coagulation function and pregnancy outcome. Methods　164 GDM patients admitted to the Department ofObstetrics and Gynecology of the Third Hospital of Xingtai City were selected from February 2017 to April 2020, and 100healthy pregnant women in the same period were selected as the control group. Clinical data, serum samples and pregnancyoutcome were collected. Serum micro RNA21, PPAR, IGF-1R and coagulation function of the subjects were detected, and theexpression levels of each indicator were compared between the two groups. Pearson correlation analysis and multiple linearregression analysis were used to GDM the correlation between serum micro RNA21, PPARγ and IGF-1R level and coagulationfunction and adverse pregnancy outcome. Results　The blood glucose index level (fasting OGTT, 1h OGTT, 2h OGTT, HbAlcand HOMA-IR) of GDM group was significantly higher than that of the control group(t=31.456, 100.176, 69.999, 24.948,26.546), and the PT, APTT, micro RNA21 and PPARγ was significantly lower than that of the control group(t=4.024, 9.958,22.675, 51.140, all P<0.05), while the FIB, D-D and IGF-1R was significantly higher than that of the control group withstatistically significant differences(t=11.204, 9.753, 26.169). The adverse pregnancy outcome was mainly preterm birth,malformation and postpartum hemorrhage, and the incidence of adverse pregnancy outcome in GDM group was significantlyhigher than that in the control group, the difference was statistically significant(χ2=6.472，P<0.05). Pearson analysis showed thatmicro RNA21 and PPARγ were positively correlated with PT and APTT(r= 0.418, 0.526, 0.456, 0.603), and negativelycorrelated with FIB and DD（r = -0.582, -0.512, -0.693, -0.587）. IGF-1R were negatively correlated with PT and APTT（r =-0.437, -0.571）, and positively correlated with FIB and DD（r = 0.604, 0.562）, the differences were statistically significant (allP<0.005). The levels of micro RNA21 and PPARγ in the women with poor pregnancy outcome were lower than those in thewomen with good pregnancy outcome, while the levels of IGF-1R were higher than those in the women with good pregnancyoutcome (t=14.575, 30.271, 13.684, all P< 0.05). Multiple linear regression analysis showed that micro RNA21, PPAR and IGF-1R were the independent factors affecting pregnancy outcome (P<0.05). Conclusion　The expression of micro RNA21, PPARγand IGF-1R were abnormally expressed in serum of patients with gestational diabetes mellitus, which was correlated with bloodcoagulation function, and could effectively predict the pregnancy outcome of patients with GDM.