多囊卵巢综合征合并妊娠期糖尿病患者铁代谢与胰岛素抵抗的关系

目的分析多囊卵巢综合征(polycystic ovary syndrome,PCOS)合并妊娠期糖尿病(gestational diabetes mellitus,GDM)患者铁代谢改变及与胰岛素抵抗(insulin resistance,IR)的关系。方法选择2017年1月至2018年2月在烟台毓璜顶医院常规产检,妊娠24~28周的孕妇为筛查对象。确诊为GDM的孕妇60例为GDM组,既往诊断为PCOS且合并GDM的孕妇60例为多囊卵巢合并妊娠期糖尿病(polycystic ovary syndrome with gestational diabetes mellitus,PGDM)组,同时按年龄段进行1∶1∶1匹配,选择正常孕妇60例为正常对照(NC)组。检测3组患者血糖、胰岛素、血红蛋白(Hb)、铁代谢(血清铁、铁蛋白、转铁蛋白饱和度)水平,并评估患者氧化应激损伤及炎症水平的改变,利用多元线性回归法分析铁代谢指标与炎症指标及IR的关系。结果与NC组相比,PGDM组Hb水平降低,铁蛋白(SF)、转铁蛋白饱和度(TS)升高(F=3.55、8.24、5.10,均P<0.05);丙二醛(MDA)水平升高,超氧化物歧化酶(SOD)水平降低(F=11.11、7.24,均P<0.01);肿瘤坏死因子-α(TNF-α)、白介素-6(IL-6)水平升高(F=4.02、19.06,均P<0.05);与GDM组相比,PGDM组Hb水平降低,SF、TS升高,HOMA-IR、MDA、TNF-α、IL-6水平均升高(均P<0.05)。MDA、TNF-α、IL-6与SF呈正相关(r=0.42、0.43、0.56,均P<0.05),与TS呈正相关(r=0.61、0.42、0.52,均P<0.01);SF、TS与胰岛素抵抗指数呈正相关(r=0.39、0.41,均P<0.01)。结论PGDM患者铁沉积状况导致机体氧化应激损伤程度升高,炎症反应增加,从而加重了IR程度。铁代谢紊乱可能与PGDM患者血糖升高机制有关。

Relationship between iron metabolism and insulin resistance in patients with polycystic ovary syndrome complicated with gestational diabetes mellitus

Objective To analyze the relationship between iron metabolism and insulin resistance in patients with polycystic ovary syndrome(PCOS)complicated with gestational diabetes mellitus(GDM).Methods The pregnant women who were routinely tested in Yantai Yuhuangding Hospital from Jan.2017 to Feb.2018 were selected for screening.60 pregnant women with GDM were diagnosed as gestational diabetes group(GDM),60 cases of GDM pregnant women previously diagnosed as polycystic ovary syndrome(PCOS)as polycystic ovarian diabetes group(PGDM),and 60 normal pregnant women were as the normal control group(NC).The levels of blood glucose,insulin,hemoglobin and iron indexes(serum iron,ferritin and transferrin saturation)were measured in three groups,and the changes of oxidative stress injury and inflammation level were evaluated.The relationship between iron and inflammation with insulin resistance was analyzed by multiple linear regression.Results Compared with NC,the hemoglobin decreased,the saturation of ferritin and transferrin increased in PGDM groupF=3.55,8.24,5.10,all P<0.05],Malondialdehyde increased and superoxide dismutase decreasedF=11.11,7.24,all P<0.01],the level of tumor necrosis factor-alpha and interleukin-6 increasedF=4.02,19.06,all P<0.05].Compared with GDM group,Hb was decreased,SF,TS were increased and HOMA-IR,MDA,TNF-α,IL-6 were increased in PGDM group(all P<0.05).MDA,TNF-alpha and interleukin-6 were positively correlated with ferritin(r=0.42,0.43,0.56,P<0.05),and were positively correlated with the saturation of ferritin(r=0.61,0.42.0.52,all P<0.01),and the superoxide dismutase was negatively correlated with the saturation of ferritin and transferrin(r=-0.61,-0.42,P<0.05),and the saturation of ferritin and transferrin was positively correlated with the insulin resistance index(r=0.39,0.41,P<0.01).Conclusions Iron deposition in patients with PGDM leads to increased oxidative stress injury and inflammatory response,which aggravates insulin resistance.The disorder of iron metabolism may be related to the mechanism of hyperglycemia in patients with PGDM.