妊娠期糖尿病对新生儿心脏发育和功能的影响

The impact of gestational diabetes mellitus on neonatal cardiac development and function

摘要

目的 探讨母亲妊娠期糖尿病(GDM)对新生儿心脏功能的影响,并分析其超声心动图特征.方法 在2019年1月至2022年1月潍坊市益都中心医院新生儿科病房收治的无高危分娩疾病的足月新生儿中,选取GDM孕母的足月新生儿95例为GDM组,非GDM孕母的新生儿90例为对照组.检测并比较两组新生儿的出生血糖、出生体重、出生身长、心肌损伤标志物[肌酸激酶(CK)、肌酸激酶同工酶(CK-MB)、超敏心肌肌钙蛋白T(hs-cTnT)]水平,以及对新生儿心脏的测量数据,包括升主动脉径、左心房前后径、右心室前后径、左室前后径、肺动脉径、室间隔厚度、射血分数和先天性心脏病的发生率,并对GDM组新生儿室间隔肥厚的影响因素进行多元线性回归分析.结果 GDM组新生儿的出生体重、出生身长、出生血糖与对照组比较差异均有统计学意义(t值分别为-6.627、-8.378、15.561,P<0.01).GDM组新生儿的CK、CK-MB、hs-cTnT与对照组比较差异均有统计学意义(t值分别为-5.028、-10.510、-8.804,P<0.01).GDM组新生儿的升主动脉径、左心房前后径、右心室前后径、肺动脉径、左室前后径和室间隔厚度与对照组比较差异均有统计学意义(t值分别为-3.729、-5.612、-2.703、-3.516、-7.647、-6.028,P<0.01),而两组的射血分数比较差异无统计学意义(P>0.05).GDM组新生儿先天性心脏病发生率与对照组比较差异有统计学意义(χ²=5.746,P<0.05).相关性分析表明,室间隔厚度与新生儿出生血糖水平呈负相关(r=-0.305,P<0.01),与新生儿出生体重和血清hs-cTnT均呈正相关(r值分别为0.546、0.566,P<0.01),与孕母血清C肽水平和糖化血红蛋白均呈正相关(r值分别为0.222、0.634,P<0.01).多元线性回归分析显示,新生儿出生体重、血清hs-cTnT水平、孕母糖化血红蛋白均是室间隔厚度的影响因素(t值分别为3.628、5.777、2.538,P<0.05).结论 母亲GDM对出生新生儿的心脏功能有不良影响;监测血清心肌损伤标志物及超声心动图可作为诊断孕母GDM的新生儿心脏损伤的早期指标.

Abstract

Objective To investigate the impact of maternal gestational diabetes mellitus (GDM) on neonatal cardiac function and analyze its echocardiographic characteristics. Methods Among the full-term newborns without high-risk delivery diseases admitted to the neonatal ward of Yidu Central Hospital of Weifang from January 2019 to January 2022, 95 full-term newborns of GDM mothers were selected as the GDM group, and 90 newborns of non-GDM mothers were selected as the control group. The birth blood glucose, birth weight, birth length, myocardial injury markers [creatine kinase (CK), creatine kinase isoenzyme (CK-MB), high-sensitive cardiac troponin T (hs-cTnT)] levels and neonatal heart measurement data, including ascending aorta diameter, left atrial anteroposterior diameter, right ventricular anteroposterior diameter, left ventricular anteroposterior diameter, pulmonary artery diameter, interventricular septal thickness, ejection fraction and the incidence of congenital heart disease, were detected and compared between the two groups of newborns. Multivariate linear regression analysis was conducted to identify factors influencing interventricular septal hypertrophy in neonates of the GDM group. Results The differences in birth weight, birth length, and birth blood glucose levels between the GDM group and the control group were statistically significant (t=-6.627, -8.378, 15.561, respectively, P<0.01). There were significant differences in CK, CK-MB and hs-cTnT between the GDM group and the control group (t=-5.028, -10.510, -8.804, respectively, P<0.01). Significant differences were observed in the ascending aorta diameter, left atrial anteroposterior diameter, right ventricular anteroposterior diameter, pulmonary artery diameter, left ventricular anteroposterior diameter and interventricular septal thickness between the GDM group and the control group (t=-3.729, -5.612, -2.703, -3.516, -7.647, -6.028, respectively, P<0.01). However, there was no significant difference in ejection fraction between the two groups (P>0.05). The incidence of congenital heart disease was significantly different in the GDM group compared to the control group (χ ²=5.746, P<0.05). Correlation analysis indicated that interventricular septal thickness was negatively correlated with neonatal birth blood glucose levels (r=-0.305, P<0.01), and positively correlated with birth weight, serum hs-cTnT (r=0.546, 0.566, respectively, P<0.01), and positively correlated with maternal serum C-peptide levels and glycosylated hemoglobin (r=0.222, 0.634, respectively, P<0.01). Multivariate linear regression analysis showed that neonatal birth weight, serum hs-cTnT level, and maternal glycosylated hemoglobin were influencing factors of interventricular septal thickness (t=3.628, 5.777, 2.538, respectively, P<0.05). Conclusion Maternal GDM has adverse effects on the cardiac function of neonates. Monitoring serum myocardial injury markers and performing echocardiography can serve as early indicators for diagnosing cardiac injury in neonates born to mothers with GDM.

关键词

妊娠期糖尿病 / 心脏 / 心肌病 / 肥厚性 / 先天性心脏病 / 新生儿

Key words

gestational diabetes mellitus / heart / cardiomyopathy / hypertrophic / congenital heart disease / neonates

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基金资助

潍坊市卫生健康委科研项目(WFWSJKG2021G232)