MacRury S M, Pinion S, Quin J D, O'Reilly D S, Lunan C B, Lowe G D, MacCuish A C
Diabetic Obstetric Clinic, Royal Maternity Hospital, Glasgow, UK.
Diabet Med. 1995 Jan;12(1):51-5. doi: 10.1111/j.1464-5491.1995.tb02062.x.
Blood rheology is altered in diabetes and also in non-diabetic pregnant women. The cumulative effect of hyperfiltration, abnormal rheology of pregnancy, and diabetes could be one mechanism contributing to increased intraglomerular pressure and albuminuria in diabetic pregnancy. We conducted a prospective study of 22 Type 1 (insulin-dependent) diabetic patients and 22 non-diabetic women to determine if there was an association of altered blood rheology on glomerular function in diabetic pregnancy. Albumin excretion showed no increment with increasing gestation and was similar in diabetic and non-diabetic women throughout pregnancy (first trimester: 5.0 (3.0-14.0) vs 5.8 (3.7-10.7) mg l-1, p = 0.89; second trimester: 6.0 (5.0-12.0) vs 5.1 (3.6-10.4) mg l-1, p = 0.25; third trimester: 7.5 (3.5-16.0) vs 4.9 (2.9-7.3) mg l-1, p = 0.18). Red cell aggregation index increased in both groups between the first and third trimesters (diabetic patients: mean difference 2.0; Cl: 1.0-2.9, p = 0.003, and control patients: mean difference 2.3, Cl: 1.0-3.5, p = 0.002). Fibrinogen levels were significantly higher between the third and first trimesters in diabetic patients (mean difference 0.7, Cl: 0.2-1.3 g l-1, p = 0.006). Pregnancy, therefore, was associated with increased red cell aggregation, related in part to increased fibrinogen levels but the extent of change was similar in diabetic and nondiabetic women and appeared to have no adverse effect on glomerular function in pregnant insulin-dependent diabetic women.
糖尿病患者以及非糖尿病孕妇的血液流变学都会发生改变。超滤、妊娠异常血液流变学和糖尿病的累积效应可能是导致糖尿病妊娠时肾小球内压力升高和蛋白尿增加的一种机制。我们对22例1型（胰岛素依赖型）糖尿病患者和22例非糖尿病女性进行了一项前瞻性研究，以确定糖尿病妊娠时血液流变学改变与肾小球功能之间是否存在关联。白蛋白排泄量并未随孕周增加而升高，且在整个孕期糖尿病女性和非糖尿病女性相似（孕早期：5.0（3.0 - 14.0）对5.8（3.7 - 10.7）mg l-1，p = 0.89；孕中期：6.0（5.0 - 12.0）对5.1（3.6 - 10.4）mg l-1，p = 0.25；孕晚期：7.5（3.5 - 16.0）对4.9（2.9 - 7.3）mg l-1，p = 0.18）。两组在孕早期和孕晚期之间红细胞聚集指数均升高（糖尿病患者：平均差值2.0；可信区间：1.0 - 2.9，p = 0.003，对照组患者：平均差值2.3，可信区间：1.0 - 3.5，p = 0.002）。糖尿病患者孕晚期与孕早期相比纤维蛋白原水平显著升高（平均差值0.7，可信区间：0.2 - 1.3 g l-1，p = 0.006）。因此，妊娠与红细胞聚集增加有关，部分与纤维蛋白原水平升高有关，但糖尿病女性和非糖尿病女性的变化程度相似，且似乎对妊娠胰岛素依赖型糖尿病女性的肾小球功能没有不良影响。
