妊娠期糖尿病患者血清脂联素水平测定及意义

目的:探讨妊娠期糖尿病孕妇体内血清脂联素水平与胰岛素抵抗的关系,为脂联素治疗妊娠期糖尿病提供临床依据。方法:随机抽取孕24~32周的孕妇385名,进行糖筛查(GCT)试验,异常者再行OGTT试验。按结果进行分组:正常糖代谢组(NGT)、糖耐量损害组(GIGT)、妊娠期糖尿病组(GDM),利用Elisa方法测空腹脂联素,并测空腹血糖、空腹胰岛素。根据HOMA稳态模型提出的公式,计算胰岛素抵抗指数,分析各指标间的相关性。结果:血清脂联素水平在NGT、GIGT、GDM3组的浓度是逐渐下降的,在GDM组下降最明显。相关分析发现,血清脂联素浓度与胰岛素抵抗指数、体质指数、空腹血糖和空腹胰岛素呈负相关(r=-0.765 0、P<0.000 1,r=-0.390 9、P=0.003 5,r=-0.585 1、P<0.000 1,r=-0.765 0、P<0.000 1)。结论:脂联素是妊娠期糖尿病的保护因子之一,是胰岛素的一个增敏剂;脂联素水平可作为预测妊娠期糖尿病胰岛素敏感性的一个指标,将来可能是治疗妊娠期糖尿病的新靶点。

Valule of serum concentration of adiponectin and its correlation with insulin resistance in pregnant women with gestational diabetes mellitus

Objective:To investigate serum concentration of adiponectin and its correlation with insulin resistance in pregnant women with gestational diabetes mellitus(GDM) to provid the clinical evidence that adiponectin is one of the medicine of GDM.Methods:50-g glucose screening test was conducted for 385 cases pregnant women at 24~32 weeks of pregnancy.If the blood sugar value was abnormal to examine with oral glucose tolerance test(OGTT).According to the result of OGTT,three groups were divided.The first group was normal glucose tolerance(NGT),the second group was impaired glucose tolerance(GIGT),the third group was gestational diabetes mellitus(GDM).ELISA technique was employed to determine the plasma adiponectin concentration,at the same time the fasting blood glucose,insulin concentration were detected.Insulin resistance index was calculated by HOMA.Results:(1)In the NGT,GIGT and GDM groups the serum adiponectin level tended to dicline gradually in turn(P<0.001),especially in the GDM.(2) Plasma adiponectin correlated negatively with insulin resistance index,fasting blood glucose BMI(respectively:r=-0.765 0,P=<0.000 1;r=-0.585 1,P=<0.000 1;r=-0.390 9,P=<0.003 5).Conclusion:Adiponectin is one of the protection factors of GDM,and is a sensitizer of insulin.It could be used as a new sensitive indicator to evaluate the degree of insulin resistance in GDM and it can be a new target of treatment of GDM.