摘要目的 探讨妊娠期糖尿病(gestational diabetes mellitus,GDM)对新生儿氨基酸水平的影响. 方法 2016年6月至2017年5月于南京医科大学附属常州妇幼保健院被确诊为GDM的393例孕妇(GDM组)和同期3 924例健康孕妇(对照组)纳入研究.收集孕妇及其新生儿的一般临床资料,新生儿生后72～96 h采集足跟血.采用串联质谱技术非衍生化法检测新生儿足跟血丙氨酸、精氨酸、瓜氨酸、甘氨酸、亮氨酸/异亮氨酸/羟基脯氨酸、甲硫氨酸、鸟氨酸、苯丙氨酸、脯氨酸、酪氨酸和缬氨酸共1 1种氨基酸的水平.2组间氨基酸水平的比较采用t检验,并通过多因素线性回归分析GDM对新生儿氨基酸水平的影响. 结果 GDM组新生儿甲硫氨酸[(21.01±6.30)与(19.93±6.47)μmol/L,t=3.159,P=0.002]和苯丙氨酸水平[(47.19±9.19)与(45.78±8.58)μmol/L,t=3.076,P=0.002]较对照组升高,丙氨酸[(280.51±64.54)与(290.15±68.40)μmol/L,t=2.678,P=0.007]、脯氨酸[(147.64±30.64)与(152.36±33.57) μmol/L,t=2.680,P=0.007]、酪氨酸[(85.21±29.50)与(90.60±33.32)μmol/L,t=3.089,P=0.002]和鸟氨酸水平[(101.22±28.79)与(105.83±30.10)μmol/L,t=2.906,P=0.004]较对照组降低.多因素线性回归分析发现GDM能够导致新生儿甲硫氨酸(β=0.69,95％CI:0.02～1.37,P=0.044)和苯丙氨酸水平升高(β=1.60,95％CI:0.69～2.51,P=0.001),酪氨酸(β=-4.98,95％CI:-8.42～-1.54,P=0.005)和鸟氨酸水平下降(β=-3.16,95％CI:-6.30～-0.02,P=0.048). 结论 GDM孕母的新生儿生后甲硫氨酸和苯丙氨酸水平升高,酪氨酸和鸟氨酸水平下降.

abstractsObjective To investigate the influences of maternal gestational diabetes mellitus (GDM) on amino acid levels in neonates.Methods From June 2016 to May 2017,393 pregnancies diagnosed with GDM in Changzhou Maternity and Child Health Care Hospital Affiliated to Nanjing Medical University and 3 924 normal pregnancies were enrolled in this study.Clinical data of the gravidas and their newborns were collected.Heel blood samples were collected at 72 to 96 hours after birth.Tandem mass spectrometry was performed to detect the levels of 11 amino acids including alanine,arginine,citrulline,glycine,leucine/ isoleucine/hydroxyproline,methionine,ornithine,phenylalanine,proline,tyrosine and valine in neonatal heel blood.Differences in amino acid levels between the two groups were compared by t test.Influences of GDM on neonatal amino acid levels were analyzed by multivariate linear regression.Results Compared with the healthy pregnancy group,neonates in the GDM group had higher levels of methionine [(21.01 ±6.30) vs (19.93±6.47) μmol/L,t=3.159,P=0.002] and phenylalanine [(47.19±9.19) vs (45.78±8.58) μ mol/L,t=3.076,P=0.002],but lower levels of alanine [(280.51 ±64.54) vs (290.15±68.40) μ mol/L,t=2.678,P=0.007],proline [(147.64±30.64) vs (152.36±33.57) μ mol/L,t=2.680,P=0.007],tyrosine [(85.21 ±29.50) vs (90.60± 33.32) μ mol/L,t=3.089,P=0.002] and ornithine [(101.22±28.79) vs (105.83±30.10) μmol/L,t=2.906,P=0.004].Multivariate linear regression analysis showed that GDM was responsible for the increase of methionine (β=0.69,95％CI:0.02 to 1.37,P=0.044) and phenylalanine (β=1.60,95％CI:0.69 to 2.51,P=0.001),and the decrease of tyrosine (β=-4.98,95％CI:-8.42 to-1.54,P=0.005) and ornithine (β=-3.16,95％CI:-6.30 to-0.02,P=0.048) in neonates.Conclusions GDM neonates has increased of methionine and phenylalanine levels and decreased tyrosine and omithine levels.