妊娠期糖尿病孕妇血脂变化与胎盘脂质转运

正常妊娠时，为了满足胎儿生长发育需要，妊娠期脂代谢将发生巨大变化。这些变化包括早、中孕期脂肪生成增加，晚孕期脂肪分解增加，主要表现为甘油三酯(TG)升高，磷脂和胆固醇也轻度升高。妊娠期糖尿病(GDM)孕妇因胰岛素抵抗(IR)，抑制脂肪氧化和分解作用减弱，血脂较正常妊娠更高，并且TG水平与新生儿体重呈正相关。胎盘不能直接转运脂蛋白，TG需水解成脂肪酸才能通过胎盘。胎盘中脂肪酸转运蛋白(FATPs)、胎盘膜脂肪酸结合蛋白(pFABPpm)、脂蛋白脂酶(LPL)和内皮脂肪酶(EL)在脂肪酸转运中起重要作用，GDM孕妇通过增强其表达而影响胎儿生长发育。

Lipid Metabolism and Transfer Across Placenta in Women With Gestational Diabetes Mellitus

In order to meet the needs of fetal growth and development, dramatic change happened in lipid metabolism in normal pregnancy. The lipogenesis increased in the early as well as second trimester and the lipolysis increased in the last trimester. Compared with that in the early trimester, triglycerides (TG) elevated markedly, phospholipids and cholesterol also increased slightly. Due to insulin resistance (IR), the role of inhibiting fat oxidation and lipolysis decreased in women with gestational diabetes mellitus (GDM), and the level of lipoids was higher. TG of women with GDM were positively correlated with newborn weight. The lipoprotein can not be directly transported across the placenta, but TG can be hydrolyzed into fatty acids and cross through the placenta. Fatty acid transport proteins, placenta specific membrane bound fatty acid binding protein, lipoprotein lipase (LPL) and endothelial lipase (EL) played an important role in fatty acid transfer, and their roles were enhanced in women with GDM.