妊娠期不同糖代谢状态血清脂联素、C反应蛋白的变化及其与胰岛素抵抗的关系

目的 研究妊娠期不同糖代谢状态血清脂联素（APN）和C反应蛋白（C-RP）变化与胰岛素抵抗（IR）的关系。方法测定48例妊娠期糖尿病（GDM）患者、30例妊娠期糖耐量减低（GIGT）患者和26名正常糖耐量（NGT）孕妇血清APN和C—RP水平，计算胰岛素抵抗指数（HOMA—IR）、胰岛8细胞功能指数（HOMA-β）和胰岛素敏感性指数（ISI）。结果GDM组和GIGT组HOMA—IR分别为0．53±0．47、0．50±0．49，APN分别为5．85±2．97mg／L、6．56±3．12mg／L，与NGT组HOMA—IR（0．15±0．04）、APN（10．13±5．89mg／L）比较差异有统计学意义；GDM组HOMAB（4．80±0．63）低于GIGT组（5．34±0．86）和NGT组（5．73±1．24），差异均有统计学意义；三组C-RP差异无统计学意义。多元回归分析显示，FPG、HOMA—IR为影响APN的显著因素，孕前BMI是影响C-RP的显著因素。结论随糖耐量异常进展，血清APN水平逐步下降；孕妇APN水平降低与FPG和IR密切相关；孕前BMI是影响孕期C—RP变化的主要因素。

The changes in serum levels of adiponectin and C-reactive protein and their relations with insulin resistance in pregnant women with various glycometabolism states

Objective To analyze the relationship of the levels of APN and C-RP with insulin resistance in pregnancy with various glucose tolerance states. Methods APN and C-RP were measured in 48 patients with GDM,30 GIGT and 26 NGT. HOMA-IR, HOMA-β and ISI were analyzed in three groups. Results HOMA IR and APN in GDM group（0.53±0. 47, 5.85 ± 2.97mg/L respectively） and GIGT group （0. 50±0.49, 6. 56 ± 3.12mg/L respectively） were significantly different from those in NGT group（0.15±0.04,10.13±5.89mg/L respectively）. HOMA-β was significantly decreased in GDM group （4.80±0. 63）versus GIGT（5.34±0. 86）and NGT group（5.73±1.24）. No significant difference in C-RP was found in three groups. Multiple regression analysis showed that FPG and HOMA-IR were significiantly independent determinants for serum APN. Pre-gestation BMI was significiantly independent determinants for C-RP. Conclusions With the deterioration of glucose metabolism from NGT to GDM, the level of APN is progressively decreased. APN in pregnancy is more significantly correlated with hyperglycemia and IR. C-RP is significantly associated with pre-pregnancy BMI.