【摘要】 目的 探讨妊娠期糖尿病孕妇(GDM)血中糖基化终产物(AGEs)指标和血管生长因子(VEGF)水平与常见母胎并发症的关系，测量胎盘中AGE与VEGF受体蛋白表达量，以探求GDM孕妇血中AGE、VEGF浓度与胎盘血管病变、母婴并发症的相关性及预测价值。 方法 在孕龄24～28周之间被诊断患有GDM的孕妇中收集产前检查提示存在母胎并发症的孕妇，为病例组，总数为264例，随机选择GDM无母胎并发症的孕妇作为对照组，30例。采用酶联免疫法检测孕母血清AGE、VEGF水平，分娩后立即收集胎盘低温保存，用于分析组织中RAGE及VEGFR蛋白的表达。 结果 病例组孕母血清AGE、VEGF水平均高于对照组。在病例组中：1.GDM合并胎儿生长受限(FGR)组孕母血清AGE、VEGF水平明显低于其他组，P<0.05;2.GDM合并妊娠期高血压疾病组孕母血清AGE、VEGF水平明显高于其他组，P<0.05;3. GDM合并胎儿FGR组胎盘组织中RAGE及VEGFR蛋白表达量明显低于其他组，P<0.05;4. GDM合并妊娠期高血压疾病组胎盘组织中RAGE及VEGFR蛋白表达量明显高于其他组，P<0.05;5. Logistic回归分析显示AGEs、VEGF浓度是GDM母胎并发症的危险因子;6. 病例组孕母血清AGE与VEGF水平呈正相关(r=0.625,P<0.01)。 结论 1. GDM孕母血清低AGE、VEGF水平可作为GDM产前预测合并FGR的筛查指标之一。2. GDM孕母血清高AGE、VEGF水平可作为GDM产前预测合并妊娠期高血压疾病的筛查指标之一。3.VEGF的表达水平与其上游因子AGE的表达水平正相关。

　　【关键词】 妊娠期糖尿病;糖基化终产物;血管内皮生长因子;胎儿生长受限;妊娠期高血压疾病;预测

　　AGEs and VEGF level in GDM maternal serum may be predictive indicators in placental vascular pathogenesis and maternal-fetal complications.

　　Tang Xu - wen，Lin Si，Xie Xiao-bing. GuangZhou Women and Children’s Medical Center， Guangzhou 510623.

　　【Abstract】 Objective The goal of this study was to measure the expressions of AGE and VEGF receptor protein in placenta to explore the relationship between AGEs and VEGF levels in GDM pregnant women blood and the common maternal-fetal complications; future for the predictive value in placental vascular pathogenesis and maternal-fetal complications. Methods The pregnant women diagnosed with GDM in 24-28 gestational weeks and indicated with maternal-fetal complications were case group (264 cases in total); GDM pregnant women without maternal-fetal complications were randomly selected as control group (30 cases in total). Detection of AGE and VEGF level in maternal serum by enzyme linked immunosorbent assay method (ELISA). The placenta tissues were collected freshly and been keeping in hypothermia for analysis of the expressions of RAGE and VEGFR protein. Results The case group maternal serum of AGE and VEGF were higher than the the control group. In case group, the AGE and VEGF level in maternal serum of GDM merger FGR group were significantly lower than other groups (P<0.05); the AGE and VEGF level in maternal serum of GDM merger hypertensive disorder complicating pregnancy was significantly higher than other groups (P<0.05). The expression of RAGE and VEGFR protein in GDM merger FGR group placenta tissue had a significantly lower compared to other groups (P<0.05); the expression of RAGE and VEGFR protein in GDM merger hypertensive disorder complicating pregnancy group placenta tissue had a significantly higher compared to other groups (P<0.05).Logistic regression analysis showed that AGEs and VEGF levels was a p redictor of adverse perinatal outcome in GDM. The AGE and VEGF level in case group maternal serum were positively correlated(r=0.625, P<0.01). Conclusions 1. Low AGE and VEGF levels in GDM maternal serum may be one screenng indicator to predict GDM merger FRG. 2. Similarly, high AGE and VEGF levels in GDM maternal serum may be one screening indicator to predict GDM merger hypertensive disorder complicating pregnancy. 3.VEGF expression level may reflect the activation or expression level of its upstream factor AGE.

　　【Key words】 Gestation diabetes mellitus; advanced glycation end-products; vascular endothelial growth factor; fetal growth restriction; hypertensive disorders complicating pregnancy; prediction