目的 探究益生菌联合饮食干预对妊娠期糖尿病(GDM)孕妇外周血糖脂代谢指标、胎盘组织胰岛素信号转导通路蛋白表达及妊娠结局的影响.方法 选取2021年12月至2022年12月在该院分娩的83例GDM患者为研究对象,采用随机数字表法分为益生菌组(益生菌联合饮食干预,43例)和对照组(单纯饮食干预,40例),比较两组干预前及干预8周后外周血血糖、血脂、胰岛素抵抗相关指标;采用苏木素-伊红(HE)染色观察胎盘组织学改变,并比较两组病理学指标;采用免疫组织化学法测定两组胎盘组织中胰岛素受体底物1(IRS-1)、葡萄糖转运蛋白4(GLUT4)、囊泡相关蛋白23(SNAP23)的表达;比较两组妊娠不良结局发生情况,评估益生菌的临床疗效.结果 与对照组比较,干预8周后益生菌组空腹血糖(FBG)、空腹胰岛素(FINS)及血清甘油三酯(TG)、低密度脂蛋白胆固醇(LDL-C)水平均明显降低(P＜0.05),血清高密度脂蛋白胆固醇(HDL-C)水平明显升高(P＜0.05).两组胎盘组织绒毛成熟不良、干绒毛小动脉增厚、绒毛间质毛细血管充盈发生率均无明显差异(P＞0.05);与对照组比较,益生菌组胎盘组织IRS-1、GLUT4、SNAP23表达水平均明显升高(P＜0.05).益生菌组新生儿低血糖、新生儿高胆红素血症发生率均明显低于对照组(P＜0.05).结论 与单纯饮食干预相比,益生菌联合饮食干预对GDM孕妇糖脂代谢的改善更具有优势,且减少了新生儿不良事件的发生.
Objective To investigate the effects of probiotics combined with dietary intervention on pe-ripheral blood glucose and lipid metabolism indicators,placental tissue insulin signaling pathway proteins ex-pression and pregnant outcome in the patients with gestational diabetes mellitus(GDM).Methods A total of 83 patients with GDM in this hospital from December 2021 to December 2022 were selected as the study sub-jects and divided into the probiotics group(probiotics combined with diet intervention,43 cases)and control group(simple diet intervention,40 cases)by the random number table method.The levels of peripheral blood glucose,lipid and insulin resistance related indicators before the intervention and in 8 weeks after the interven-tion were compared between the two groups.The histological changes of placenta were observed by HE stai-ning.The pathological indicators were compared between the two groups.The expression levels of insulin re-ceptor substrate-1(IRS-1),glucose transporter 4(GLUT4)and synaptosome-associated protein of 23 kDa(SNAP23)in placental tissue were detected by immunohistochemistry.The pregnant adverse outcomes were compared between the two groups,and the clinical efficacy of probiotics was evaluated.Results Compared with the control group,the levels of fasting blood glucose(FBG),fasting insulin(FINS),serum triglyceride(TG)and low density lipoprotein cholesterol(LDL-C)in 8 weeks after intervention in the probiotics group were significantly decreased(P＜0.05),and the level of serum high density lipoprotein cholesterol(HDL-C)was significantly increased(P＜0.05).There were no significant differences in the incidence rates of poor villi maturation,thickening of dry villi arterioles and capillary filling in villi interstitial between the two groups(P＞0.05).Compared with the control group,the expression levels of IRS-1,GLUT4 and SNAP23 in placen-tal tissue of the probiotics group were significantly increased(P＜0.05).The incidence rates of neonatal hy-poglycemia and neonatal hyperbilirubinemia in the probiotics group were significantly lower than those in the control group(P＜0.05).Conclusion Compared with simple dietary intervention,probiotics combined with dietary intervention has more advantages in improving glucose and lipid metabolism of GDM patients,moreo-ver reduces the adverse events occurrence in newborns.
秦智娟;马宗丽;邹美林;朱晓琴;刘姝;王晓梅
如皋市人民医院妇产科,江苏南通 226500如皋市人民医院病理科,江苏南通 226500
临床医学
妊娠期糖尿病;益生菌;糖脂代谢;胰岛素受体底物1;葡萄糖转运蛋白4;囊泡相关蛋白23
gestational diabetes mellitus;probiotics;glucolipid metabolism;insulin receptor substrate-1;glucose transporter 4;synaptosome-associated protein of 23 kDa
《重庆医学》 2024 (001)
102-107,113 / 7
江苏省南通市卫健委面上项目(MSZ2022079);江苏省南通市卫健委青年基金科研项目(QB2021033);江苏省如皋市科技攻关计划项目(RG2021SZD018).
10.3969/j.issn.1671-8348.2024.01.021
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