Research on maternal blood lipid,free fatty acid content and the neonatal lactic acid and myocardial enzyme levels in early-onset pre-eclampsia complicated gestational diabetes mellitus patients / 中国综合临床

Objective To study the changes of maternal serum lipid,free fatty acid levels and the neonatal arterial blood gas,lactic acid and myocardial enzyme levels in the patients with early-onset pre-eclampsia(EOPE) combine with gestational diabetes mellitus(GDM).Methods One hundred and fifty cases EOPE patients were divided into EOPE+GDM group(observation group,n=67) and normal glucose tolerance EOPE group(control group,n=83) according to international association of diabetic pregnancy study group standard.The maternal BMI,serum lipid(TC,TG,LDL-C,very low density lipoprotein cholesterol(VLDL-C)),free fatty acid(FFA),HbA1c levels and the blood routine and biochemical tests were compared between two groups.The neonatal peripheral arterial blood-gas,lactate(LAC) and myocardial enzymes(creatine kinase(CK),lactate dehydrogenase(LDH),creatine kinase isoenzyme(CK-MB)) levels within 1 h after birth were measured and compared between two groups.Pearson correlation analysis was used to explore the impact of maternal glucose/lipid metabolic index,the birth condition on the neonatal LAC and CK-MB levels in EOPE patients.Results (1)In observation group,the patients had significantly higher BMI((32.66±4.23) kg/m2 vs.(29.98±5.44) kg/m2,t=4.904),TC((7.28±1.34) mmol/L vs.(6.65±0.76) mmol/L,t=5.760),TG((4.10±1.26) mmol/L vs.(3.51±0.71) mmol/L,t=4.199),LDL-C((4.85±1.24) mmol/L vs.(3.77±0.82) mmol/L,t=5.292),VLDL-C((1.91±0.37) mmol/L vs.(1.26±0.48) mmol/L,t=4.498),HbA1c((5.95±0.41)% vs.(5.20±0.37)%,t=8.821) levels than control group(P<0.05),and the patients had significantly elevating levels of LAC((5.76±3.32) mmol/L vs.(3.89±1.53) mmol/L,t=5.348) and CK((419.03±198.29) U/L vs.(323.22±154.38) U/L,t=6.632),CK-MB((218.97±86.74) U/L vs.(142.18±60.12) U/L,t=5.562),LDH((723.22±180.16) U/L vs.(584.57±139.81) U/L,t=4.987)(P<0.05).(2)Stepwise multiple regression showed that in patients with early-onset preeclampsia,maternal HbA1c(β=70.821,t=5.461),FFA levels(β=88.590,t=4.990),the gestational age (β=-8.776,t=-4.901) and the neonatal LAC levels(β=5.948,t=4.047) were the independent factors of newborn's CK-MB level.Conclusion In patients with early-onset preeclampsia combine with GDM,the disorders in glucose and lipid metabolism are more severe.And the metabolic disturbance will further interfere with the perinatal material metabolism,resulting in the elevating levels of lactic acid and the potential myocardial injury in neonates.