Serum inflammatory markers and preeclampsia in type 1 diabetes: a prospective study.
Serum inflammatory markers and preeclampsia in type 1 diabetes: a prospective study.
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DOI：
10.2337/dc12-1934
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发表时间：
2013-07
期刊：
影响因子：
16.2
通讯作者：
Lyons TJ
中科院分区：
文献类型：
--
作者：
Du M;Basu A;Fu D;Wu M;Centola M;Jenkins AJ;Hanssen KF;Garg SK;Hammad SM;Scardo JA;Aston CE;Lyons TJ
炎症和内皮功能障碍与子痫前期（PE）的免疫生物学相关，这是不良妊娠结局的重要原因。在母体存在1型糖尿病（T1 DM）的情况下，PE的患病率升高数倍。虽然对非糖尿病女性妊娠的横断面研究表明，PE存在时炎症标志物发生改变，但缺乏对糖尿病女性的纵向研究。在母体血清样本中，我们研究了T1 DM女性患者炎症标志物与随后发生PE的时间相关性。我们对妊娠早期（平均值± SD，12.2 ± 1.9周）、中期（21.6 ± 1.5周）和晚期（31.5 ± 1.7周）（分别为访视1-3）的血清C反应蛋白（CRP）、粘附分子和细胞因子进行了纵向分析。所有研究访视均在PE发作前进行。协变量为BMI、HbA 1c、发病年龄、糖尿病病程和平均动脉压。在发生PE的T1 DM女性患者中，与血压保持正常的患者相比，CRP在访视1时往往较高（P = 0.07）和2（P = 0.06），访视3时显著更高可溶性E-选择素和干扰素-γ-诱导蛋白-10（IP-10）在访视3时显著升高（P < 0.05）;白细胞介素1受体拮抗剂（IL-1 ra）和嗜酸性粒细胞趋化因子（eotaxin）在第2次访视时分别升高和降低（均P < 0.05）。这些结论在调整协变量后仍然存在。在T1 DM孕妇中，CRP、可溶性E-选择素、IL-1 ra和IP-10升高以及嗜酸性粒细胞趋化因子降低与随后的PE相关。炎症因子作为T1 DM患者PE高患病率的标志物和潜在机制的作用值得进一步研究。
Inflammation and endothelial dysfunction have been associated with the immunobiology of preeclampsia (PE), a significant cause of adverse pregnancy outcomes. The prevalence of PE is elevated several fold in the presence of maternal type 1 diabetes mellitus (T1DM). Although cross-sectional studies of pregnancies among women without diabetes have shown altered inflammatory markers in the presence of PE, longitudinal studies of diabetic women are lacking. In maternal serum samples, we examined the temporal associations of markers of inflammation with the subsequent development of PE in women with T1DM. We conducted longitudinal analyses of serum C-reactive protein (CRP), adhesion molecules, and cytokines during the first (mean ± SD, 12.2 ± 1.9 weeks), second (21.6 ± 1.5 weeks), and third (31.5 ± 1.7 weeks) trimesters of pregnancy (visits 1–3, respectively). All study visits took place before the onset of PE. Covariates were BMI, HbA1c, age of onset, duration of diabetes, and mean arterial pressure. In women with T1DM who developed PE versus those who remained normotensive, CRP tended to be higher at visits 1 (P = 0.07) and 2 (P = 0.06) and was significantly higher at visit 3 (P < 0.05); soluble E-selectin and interferon-γ–inducible protein-10 (IP-10) were significantly higher at visit 3; interleukin-1 receptor antagonist (IL-1ra) and eotaxin were higher and lower, respectively, at visit 2 (all P < 0.05). These conclusions persisted following adjustment for covariates. In pregnant women with T1DM, elevated CRP, soluble E-selectin, IL-1ra, and IP-10 and lower eotaxin were associated with subsequent PE. The role of inflammatory factors as markers and potential mechanisms of the high prevalence of PE in T1DM merits further investigation.
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