| Objective: Gestational diabetes mellitus (GDM) is a pregnancy-specificmetabolic diseases, it is one of the major causes of adverse outcomes ofmothers and infants. Its pathogenesis is not very clear thus far, currentlyconsidered insulin resistance and pancreatic β-cell dysfunction caused by avariety of factors are the main causes of disease, and endothelial damage iscaused by insulin resistance key link. Vascular cell adhesion molecule-1(VCAM-1) is a member of immunoglobulin superfamily, is a kind of mediatedcell-cell, cell-extracellular matrix interaction, played the adhesion of themembrane surface glycoprotein that mediates leukocyte adhesion toendothelial cell surface, damage vascular endothelial cells. Advancedoxidation protein products (AOPP) is a protein oxidation terminal products ofoxidative stress acting on the body formed by oxidation of a variety ofproteins, mediate lipid peroxidation, activation of monocytes and NADPHoxidase, release of intracellular reactive oxygen species, and induce theformation and release of inflammatory cytokines and adhesion molecules,causing systemic micro-inflammation, finally endothelial damage. Thepurpose of this study is to detect VCAM-1and AOPP concentrations andchanges in gestational diabetes mellitus women, to explore the correlationbetween VCAM-1, AOPP and gestational diabetes mellitus, and VCAM-1,AOPP change whether is related to the occurrence and severity of gestationaldiabetes mellitus, and then provides theoretical basis for the clinical diagnosis,prevention and treatment of gestational diabetes mellitus.Methods:1The study subject: According to the diagnostic criteria of gestationaldiabetes, randomly selected patients with diabetes from the second hospital of HeBei medical college from2012-2to2013-12. In the93cases,30pregnantwomen suffer from gestational diabetes mellitus,30pregnant women sufferfrom gestational diabetes, and33normal pregnant women were randomized toselect as the controls.2Sample collecting: After admission,6ml of fasting venous bloodsamples was collected before treatment, One of them (3ml, separated plasmaby2000rpm and10minutes) was stored at-70℃refrigerator for assaying theconcentrations of plasma VCAM-1and AOPP, the other one (3ml) was usedto detect the levels of FBG and other indicators. Immediately after delivery ofthe placenta should charge maternal surface of placental tissue and recent theumbilical cord root diameter within3cm range, about1cm3, after saline flushwith absorbed by filter paper, at room temperature for24h in4%formalin andconventional dehydrated paraffin embedded etc.3The experimem indicators: All of the subjects was measured VCAM-1,AOPP, high density lipoprotein (HDL), low density lipoprotein (LDL),apolipoprotein A (APOA), apolipoprotein B (APOB), hemoglobin A1c(HbA1c) and Fasting blood glucose (FBG) levels, and recorded age,gestational age at delivery, height, blood pressure, weight and other indicators.By enzyme-linked immunosorbent assay (ELISA) determine AOPP andVCAM-1concentration; and by immunohistochemical techniques(immunohistochemistry) observed placental VCAM-1, AOPP expression andimage analysis; lipids and Fasting blood glucose and other biochemicalmarkers of biochemical sent to the hospital laboratory was measured.4Statistical methods: The results were analyzed by the SPSS13.0software.Results：1①Patients with GDM and DM had significantly higher VCAM-1,AOPP levels than control group (P<0.05, separately), but no significantdifference between GDM and DM group (P>0.05).②GDM and DM grouphad significantly higher admission BMI, birth weight, FBG, HbA1c, LDL andAPOB levels than control group (P<0.05, separately), at the same time, HbA1c in DM group was higher than in GDM group (P<0.05), other indexbetween the two groups had no significant difference (P>0.05, separately).③GDM and DM group had significantly lower HDL and APOA levels thancontrol group (P<0.05, separately), but no significant difference betweenGDM and DM group (P>0.05).④Pre-pregnancy BMI was no significantdifferences among the three groups (P>0.05, separately).2Plasma VCAM-1, AOPP level in the control group were no significantcorrelation (P>0.05), and there were no significantly correlated withpre-pregnancy BMI, admission BMI, FBG, HbA1c, HDL, LDL, APOA,APOB, birth weight (P>0.05separately).3Plasma VCAM-1, AOPP concentrations in GDM group were positivelycorrelated (r=0.406, P<0.05).①VCAM-1level in GDM group was positivelycorrelated with the admission BMI, HbA1c, FBG, LDL, APOB (r=0.366,r=0.405, r=0.390, r=0.402, r=0.365, P<0.05), was negatively correlated withHDL and APOA (r=-0.366, r=-0.380, P<0.05), and no significant correlationwith pre-pregnancy BMI and birth weight (P>0.05, separately);②AOPP levelin GDM group was positively correlated with the admission BMI, HbA1c,FBG, LDL, APOB (r=0.400, r=0.412, r=0.449, r=0.387, r=0.394, P<0.05),was negatively correlated with HDL and APOA (r=-0.385, r=-0.368, P<0.05),and no significant correlation with pre-pregnancy BMI and birth weight(P>0.05, separately).Plasma VCAM-1, AOPP concentrations in DM group were positivelycorrelated (r=0.481, P<0.05).①VCAM-1level in DM group was positivelycorrelated with the admission BMI, HbA1c, FBG, LDL, APOB (r=0.363,r=0.494, r=0.426, r=0.363, r=0.364, P<0.05), was negatively correlated withHDL and APOA (r=-0.364, r=-0.380, P<0.05), and no significant correlationwith pre-pregnancy BMI and birth weight (P>0.05, separately);②AOPP levelin DM group was positively correlated with the admission BMI, HbA1c, FBG,LDL, APOB (r=0.389, r=0.566, r=0.436, r=0.433, r=0.416, P<0.05), wasnegatively correlated with HDL and APOA (r=-0.407, r=-0.393, P<0.05), andno significant correlation with pre-pregnancy BMI and birth weight (P>0.05, separately).4GDM and DM group with fetal macrosomia and obesity weresignificantly higher than the proportion of control group (P<0.05), and DMgroup with fetal macrosomia was significantly higher than the proportion ofGDM group (P<0.05), but the proportion of obesity was no significantdifference in GDM and DM group (P>0.05).5HE staining: Control group placental villous mature well, villous andvillous stroma of vascular morphology normal, and the nucleus ofsyncytiotrophoblasts are arranged orderly in the outermost surface of villous;GDM and DM group with mature undesirable placental villous, and villivessel wall thickening and villous stroma capillary filling, the nucleus ofsyncytiotrophoblasts was disordered.6Immunohistochemical staining results: Placenta of VCAM-1, AOPPwas expressed in the three groups. VCAM-1was mainly expressed inplacental syncytiotrophoblast and vascular endothelial cells, as plasm staining.Average optical density (OD) values of placenta VCAM-1in GDM and DMgroup were significantly higher than the control group (P<0.05, separately),GDM and DM group was no significant difference (P>0.05), placentalVCAM-1verage optical density (OD) values was positively correlated withplasma VCAM-1levels in the control, GDM, DM group (r=0.429, r=0.483,r=0.484, P<0.05). AOPP was mainly expressed in the placental trophoblastcells and vascular endothelial cells, as plasm staining. AOPP in GDM and DMgroup were significantly higher than the control group (P<0.05, separately),GDM and DM group was no significant difference (P>0.05), placental AOPPverage optical density (OD) values was positively correlated with plasmaAOPP levels in the control, GDM, DM group (r=0.749, r=0.840, r=0.824,P<0.05).Conclusion:1Plasma level of VCAM-1, AOPP were significantly higher withgestational diabetes mellitus than the control group, suggesting that both ofthem were involved in the pathological changes of gestational diabetes mellitus, and suggesting that vascular endothelial damage is the central link ofpathological changes in gestational diabetes mellitus.2Plasma VCAM-1, AOPP levels was correlated with FBG, HbA1c levels,and suggesting that VCAM-1, AOPP can be reacted to severity of gestationaldiabetes mellitus.3Plasma levels of VCAM-1, AOPP was correlated with HDL, LDL,APOA, APOB levels, and suggesting that endothelial damage in developmentof gestational diabetes mellitus plays a crucial role.4Immunohistochemistry showed that VCAM-1, AOPP in gestationaldiabetes mellitus was significantly higher expression than the control group inplacental trophoblast cells, AOPP level, and suggesting that high expression ofVCAM-1, AOPP can lead to damaged placental function in patients withgestational diabetes mellitus. |
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