妊娠期糖尿病孕妇胎盘和大网膜脂肪组织TNF-α及IL-1β的表达及其与胰岛素抵抗的关系

目的:探讨妊娠期糖尿病(GDM)孕妇胎盘和大网膜脂肪组织中肿瘤坏死因子-α(TNF-α)、白细胞介素-1β(IL-1β)的表达及其与胰岛素抵抗的相关性.方法:采用荧光实时定量PCR检测20例GDM孕妇(GDM组)和20例正常孕妇(对照组)胎盘和大网膜脂肪组织中TNF-α、IL-1β mRNA的相对表达量,测定两组孕妇空腹血浆葡萄糖(FPG)、胰岛素(FIN)水平,计算出胰岛素抵抗指数(HOMA-IR),并进行相关性分析.结果:①与对照组相比,GDM组孕妇胎盘和脂肪组织中TNF-α mRNA的表达量升高,差异有统计学意义(P=0.01;P=0.01).②两组孕妇胎盘和脂肪组织中IL-1β mRNA的表达比较,差异无统计学意义(P＞0.05).③GDM组孕妇胎盘和大网膜脂肪组织TNF-α mRNA表达水平与HOMA-IR呈明显正相关(r=0.54,P=0.01;r=0.61,P=0.01);对照组大网膜脂肪组织TNF-α mRNA表达水平与HOMA-IR呈明显正相关(r =0.52,P=0.02).④两组孕妇胎盘和大网膜脂肪组织IL-1β mRNA表达水平与HO-MA-IR均无明显相关性(P＞0.05).结论:胎盘和脂肪组织TNF-α的过度表达可能是GDM孕妇胰岛素抵抗的重要原因,IL-1β在胰岛素抵抗过程中发挥的作用并不明显.     

脂肪和胎盘组织肿瘤坏死因子-α表达与妊娠期糖尿病胰岛素抵抗的相关性研究

目的探讨脂肪和胎盘组织中肿瘤坏死因子-α(tumornecrosisfactor-α,TNF-α)表达与妊娠期糖尿病(gestationaldiabetesmellitus,GDM)及胰岛素抵抗之间的关系。方法采用免疫组化法和反转录聚合酶链反应(RT-PCR)半定量法检测了50例非GDM孕妇(对照组)及48例GDM孕妇(30例BMI<30kg/m2为Ⅰ组,18例BMI≥30kg/m2为Ⅱ组)脂肪及胎盘组织中TNF-α蛋白和TNF-αmRNA的表达。采用放射免疫法测定各组血清TNF-α水平,并测定空腹血糖、胰岛素水平,计算胰岛素敏感指数(HOMA-ISI)和胰岛素抵抗指数(HOMA-IR)。结果(1)Ⅰ、Ⅱ组脂肪组织TNF-αmRNA表达水平分别为0.99±0.23、1.29±0.27,均显著高于对照组(0.86±0.13)(P<0·05,0.01),并且Ⅱ组高于Ⅰ组(P<0.01);Ⅰ、Ⅱ组脂肪组织TNF-α蛋白表达水平分别为163·032±16·240、179.331±23.039,均显著高于对照组(152.175±22.218)(P<0.05,0.01),Ⅱ组高于Ⅰ组(P<0·01)。(2)各组胎盘TNF-αmRNA及TNF-α蛋白表达水平差异无统计学意义(P>0.05)。(3)脂肪组织TNF-αmRNA表达水平与血清TNF-α水平、HOMA-ISI及HOMA-IR均有明显相关性(P<0·05)。结论脂肪组织TNF-α过度表达可能是GDM患者胰岛素抵抗的重要原因。胎盘TNF-α的表达与GDM及其胰岛素抵抗的关系不明显。     

血清瘦素及瘦素受体基因Gln223Arg多态性与妊娠期糖尿病的相关性研究

目的:探讨血清瘦素水平及瘦素受体基因Gln223Arg多态性与妊娠期糖尿病的相关性。方法:应用放射免疫分析法(RIA)及聚合酶链反应-限制性内切酶片段长度多态性(PCR-RFLP)技术,检测62例妊娠期糖尿病(GDM)患者及60例正常孕妇(NGT)血清瘦素及瘦素受体基因Gln223Arg多态性。结果:(1)GDM组血清瘦素水平为14.2±4.3μg/L,NGT组为10.1±2.6μg/L,二者差异有统计学意义(P<0.05)。(2)GDM组孕妇瘦素受体基因Gln223Arg基因型GG、(GA+AA)频率分别为61.29%、38.71%,正常孕妇组分别为81.67%、18.33%,两组比较差异有统计学意义(P<0.05);GDM组孕妇瘦素受体基因Gln223Arg等位基因频率G、A分别为77.42%、22.58%,正常孕妇组孕妇分别为89.17%、10.83%,两组比较差异有统计学意义(P<0.05);(3)GDM组中基因型为GA+AA的孕妇瘦素水平为15.3±4.1μg/L,GG基因型为13.5±3.7μg/L,二者差异有统计学意义(P<0.05)。结论:瘦素,瘦素受体基因Gln223Arg多态性与GDM相关,GDM患者瘦素受体基因Gln223Arg变异可能影响血清瘦素水平。     

妊娠期糖尿病孕妇血清肿瘤坏死因子α水平变化与胰岛素抵抗关系的研究

目的　探讨妊娠期糖尿病孕妇血清肿瘤坏死因子α(TNF α)水平变化与胰岛素抵抗的关系。方法　采用酶联免疫吸附试验测定 4 2例妊娠期糖尿病孕妇 (GDM组 )、4 0例正常妊娠晚期孕妇 (正常妊娠组 )空腹血清TNF α水平 ;同时测定两组孕妇空腹血糖、C肽、胰岛素、糖化血红蛋白(HbA1c)水平。并且根据公式计算两组孕妇的胰岛素敏感指数 (ISI) ,以评价胰岛素抵抗程度。结果(1)GDM组孕妇空腹血清TNF α水平为 (5 2± 1 6 )ng/L ,正常妊娠组孕妇为 (4 5± 0 5 )ng/L ,两组比较 ,差异有极显著性 (P <0 0 1) ;GDM组孕妇ISI为 - 4 3± 0 4 ,正常妊娠组为 - 3 8± 0 3,两组比较 ,差异有极显著性 (P <0 0 1)。 (2 )GDM组孕妇空腹血糖、胰岛素、C肽水平分别为 (5 5± 0 7)mmol/L、(13 4± 3 8)mU/L、(1 6± 0 4 )nmol/L ,正常妊娠组孕妇空腹血糖、胰岛素、C肽水平分别为(4 9± 0 4 )mmol/L、(9 3± 2 5 )mU/L、(1 2± 0 3)nmol,两组比较 ,差异有极显著性 (P <0 0 1) ;GDM组孕妇HbA1c为 (5 6± 0 5 ) % ,正常妊娠组孕妇为 (5 3± 0 5 ) % ,两组比较 ,差异有显著性(P <0 0 5 )。 (3)GDM组孕妇空腹血清TNF α水平与ISI呈显著负相关 (r=- 0 70 3,P <0 0 1) ,分别与空腹血糖、C肽、HbA1c呈显著正相关 (r     

膳食脂肪对妊娠期糖尿病孕妇发病的影响

目的探讨膳食脂肪对妊娠期糖尿病(GDM)发病的影响。方法选择GDM孕妇85例(GDM组),及正常孕妇159例(正常妊娠组)为调查对象。饮食治疗前对GDM组孕妇和正常妊娠组孕妇进行膳食调查。比较两组孕妇膳食结构中三大营养素供能百分比,特别是膳食脂肪、脂肪酸类型等。结果(1)GDM组孕妇每日摄入总热卡为(8970±2115)kJ,正常妊娠组为(8799±1785)kJ,两组比较,差异无统计学意义(P>0·05)。(2)GDM组孕妇碳水化合物、蛋白质和脂肪供能百分比分别为(51·9±7·2)%、(17·5±0·9)%和(30·6±1·3)%,正常妊娠组分别为(53·6±8·1)%、(18·3±1·1)%和(28·1±2·3)%。GDM组脂肪供能百分比高于正常妊娠组,两组比较,差异有统计学意义(P<0·05);两组碳水化合物和蛋白质供能百分比比较,差异无统计学意义(P>0·05)。(3)GDM组孕妇饱和脂肪酸、多不饱和脂肪酸和单不饱和脂肪酸供能百分比分别为(15·2±0·4)%、(8·3±0·5)%和(7·1±0·5)%,正常妊娠组饱和脂肪酸、多不饱和脂肪酸和单不饱和脂肪酸供能百分比分别为(11·7±0·6)%、(10·1±0·4)%和(6·3±0·3)%。GDM组饱和脂肪酸供能百分比高于正常妊娠组,两组比较,差异有统计学意义(P<0·05);GDM组多不饱和脂肪酸供能百分比低于正常妊娠组,两组比较,差异有统计学意义(P<0·05);两组单不饱和脂肪酸供能百分比比较,差异无统计学意义(P>0·05)。结论孕妇高脂肪、高饱和脂肪酸和低多不饱和脂肪酸饮食可能是GDM发病的外部原因之一。     

妊娠不同时期脂肪细胞因子的动态变化与胰岛素抵抗的关系

目的探讨妊娠不同时期脂肪细胞因子的动态变化及其与孕妇胰岛素抵抗的关系。方法选择2004年10月—2005年10月在我院门诊行产前检查的正常孕妇67例,其中妊娠早期18例(妊娠早期组),妊娠中期19例(妊娠中期组),妊娠晚期30例(妊娠晚期组);另选同期正常非孕妇女46例为对照组。采用酶联免疫吸附试验检测各组妇女血清中可溶性肿瘤坏死因子α受体(sTNFR)-Ⅰ、Ⅱ水平;采用放射免疫法测定各组妇女血清中瘦素、脂联素水平;采用免疫组化链霉菌抗生物素蛋白-过氧化物酶连接(SP)法检测妊娠晚期组妇女胎盘及脂肪组织中sTNFR定位与阳性表达。结果(1)妊娠早、中、晚期组及对照组妇女血清中sTNFR-Ⅰ水平分别为(799±173)、(1003±241)、(1278±306)及(729±167)ng/L,妊娠中、晚期组明显高于对照组,分别比较,差异有统计学意义(P<0·001)。(2)妊娠早、中、晚期组及对照组妇女血清中sTNFR-Ⅱ水平分别为(1383±305)、(1772±293)、(1933±498)及(1002±221)ng/L,妊娠早、中、晚期组明显高于对照组,分别比较,差异均有统计学意义(P<0·001)。并随孕期的增加,sTNFR-Ⅱ水平不断升高。(3)妊娠早、中、晚期组及对照组妇女血清中瘦素水平分别为(65±37)、(70±40)、(89±57)及(61±37)μg/L,妊娠晚期组明显高于对照组,两组比较,差异有统计学意义(P<0·05)。(4)妊娠早、中、晚期组及对照组妇女血清中脂联素水平分别为(13±6)、(9±5)、(10±4)及(14±7)mg/L,妊娠中、晚期组明显低于对照组,分别比较,差异有统计学意义(P<0·05)。(5)妊娠晚期组妇女胎盘及脂肪组织中sTNFR-Ⅰ、Ⅱ均呈阳性表达,无阴性表达;sTNFR-Ⅰ阳性染色颗粒主要定位于胎盘绒毛组织中的合体滋养细胞以及细胞滋养细胞中的胞质和胞膜,sTNFR-Ⅱ阳性染色颗粒主要定位于胎盘血管内皮细胞中的胞质和胞膜。结论孕妇血清中sTNFR-Ⅰ、Ⅱ及瘦素水平随孕期的增加不断升高;而脂联素水平则随孕期的增加有所下降,上述变化可能与孕妇的胰岛素抵抗有关。     

妊娠期糖尿病的饮食管理与围生期结局

目的探讨对妊娠期糖尿病(GDM)孕妇给予合理饮食的管理方案,以降低围生期并发症。方法选择中国福利会国际和平妇幼保健院1998-01-2002-12170例GDM孕妇,随机分为制定食谱组(观察组)和口头指导组(对照组),两组孕妇均由产科医生定期随访,观察组同时有营养科医生定期随访。结果观察组81例(95·3%)孕妇孕期血糖控制满意,4例(4·7%)孕妇需加用胰岛素;对照组则有12例(14·1%)孕期需加用胰岛素,两组比较差异有显著性意义(P<0·05)。GDM的并发症依次为:妊娠期高血压疾病共24例(为14·1%),两组比较差异无显著意义(P>0·05);巨大儿21例(12·4%),其中观察组4例,对照组17例,两组比较差异有非常显著性意义(P<0·01);小于胎龄儿两组各2例,其中各有1例为双胎;两组孕妇均无羊水过多发生。观察组新生儿平均体重(3309·0±396·4)g,对照组(3565·1±640·4)g,其中新生儿体重>4200g者,观察组为0,对照组11例,两组比较差异有显著性意义(P<0·05)。结论对GDM孕妇进行合理的饮食管理,因人而宜制定食谱能够减少巨大儿的发生率,从而降低剖宫产率。     

脂联素基因多态性与妊娠期糖尿病的相关性研究

目的:探讨脂联素基因启动子区单核苷酸多态性与妊娠期糖尿病(GDM)的相关性。方法:采用基质辅助激光解吸电离飞行时间质谱(MALDI-TOFMS)技术,检测103例GDM孕妇和97例正常孕妇脂联素基因启动子区-11426A>G及-11377C>G多态位点,并测定40例未经任何治疗的GDM孕妇FINS、FPG、TC、TG、HDL-C、LDL-C、脂联素水平,同时计算稳态模型的胰岛素抵抗指数。结果:(1)GDM孕妇脂联素基因-11426A>G位点的AG、GG基因型频率显著高于对照组(χ2=8.822,P=0.012),G等位基因频率明显高于对照组(χ2=10.283,P=0.001)。-11377C>G位点基因型频率及等位基因频率在二组孕妇中分布无显著差异(P>0.05)。(2)GDM孕妇脂联素-11426A>G多态性位点AG+GG基因型组甘油三酯水平高于AA基因型组(P=0.023),血清脂联素水平低于AA基因型组(P=0.024)。结论:脂联素基因-11426A>G位点多态性可能与GDM的发生有关,G等位基因在GDM孕妇中分布频率增加,A→G突变可能通过降低血清脂联素水平参与GDM的发生。     

妊娠期糖尿病PAI-1 4G/5G基因多态性与胰岛素抵抗的相关性

目的:探讨纤溶酶原激活物抑制剂-1(PAI-1)4G/5G基因多态性与天津及河北地区汉族人群中妊娠期糖尿病(GDM)发病及胰岛素抵抗(IR)的相关性。方法:用PCR方法检测GDM组和正常妊娠对照组(每组75例)PAI-1 4G/5G基因型,并分析相关临床资料。结果:GDM组4G/4G基因型频率及4G等位基因频率均高于正常对照组(P<0.05)。GDM组4G/4G基因型孕妇空腹胰岛素、胰岛素抵抗指数均高于5G/5G组(P<0.05)。结论:PAI-1 4G/5G基因多态性与GDM发病相关,4G/4G基因型可能是GDM的易感基因;PAI-1 4G/4G基因型与GDM患者IR的发生有关。     

妊娠期糖尿病与胰岛素抵抗综合征的关系探讨

目的探讨妊娠期糖尿病(GDM)是否为胰岛素抵抗综合征。方法选择1999-01-2001-12在上海市第一妇婴保健院住院的218例孕妇(均为单胎),分成两组GDM孕妇106例(研究组)、正常孕妇112例(对照组),比较两组孕妇血糖、胰岛素、血脂以及胰岛素敏感指数。结果GDM孕妇100g葡萄糖耐量试验(OGTT)各个时点血糖值高于正常孕妇[空腹(5.13±0.88)mmol/L、(4.37±0.37)mmol/L,1h(11.38±1.48)mmol/L、1h(8.86±1.09)mmol/L,2h(9.98±0.75)mmol/L、2h(7.55±1.07)mmol/L,3h(7.96±1.10)mmol/L、3h(5.83±1.24)mmol/L],差异均有统计学意义(P<0.01);同样GDM孕妇空腹血胰岛素[(15.29±6.48)mU/L、(10.83±9.74)mU/L]、甘油三酯[(4.11±1.42)mmol/L、(2.64±0.76)mmol/L]以及胰岛素敏感指数(4.22±0.48、3.52±0.52)高于正常孕妇(P<0.01)。结论GDM可能是一种胰岛素抵抗综合征。     

妊娠期糖尿病患者磺脲类药物受体1基因多态性的研究

目的　探讨与妊娠期糖尿病(GDM)遗传易感性相关的磺脲类药物受体 1(SUR1)基因型以及SUR1不同基因型与体重指数 (BMI)、胰岛素分泌水平之间的关系。方法　采用聚合酶链反应-限制性片段长度多态性(PCR-RFLP)分析方法,检测GDM患者 35例(GDM组)、2型糖尿病的女性住院患者 35例(T2DM组)、正常健康孕妇 35例 (正常对照组 )的SUR1基因型,包括 24内含子 (c和t等位基因,cc、ct和tt基因型)与 31外显子(A和G等位基因,AA、AG和GG基因型);用放射免疫法和葡萄糖氧化酶法测定GDM组患者空腹血糖、空腹胰岛素(INS0 )水平和口服 75g葡萄糖后 2h胰岛素(INS120 )水平。结果　(1)GDM组、T2DM组c等位基因频率 (分别为 70.0%、71.4% )均明显高于正常对照组的(52.9% ), 2组分别与正常对照组比较,差异均有统计学意义 (P<0.05)。(2)GDM组、T2DM组A等位基因频率(分别为 41.4%、44.3% )均明显高于正常对照组的 (24.3% ), 2组分别与正常对照组比较,差异均有统计学意义 (P<0.05 )。 ( 3 )GDM组 24内含子cc基因型患者BMI[ (29.2±5.6)kg/m2 ]、INS0 [ (14.9±8.7)mU/L]、INS120 [ (40.2±12.1)mU/L]均显著高于ct基因型患者[BMI(25.2±4.6)kg/m2、INS0 (10.1±6.2)mU/L、INS120 (32.7±10.5)mU/L]及tt基因型患者[BMI(24.2±1.7)kg/m2、     

Perinatal complications in women with gestational diabetes mellitus

BACKGROUND: The aim of the study was to examine the outcome of the pregnancy and neonatal period in 1) women with gestational diabetes mellitus and non-diabetic pregnant women, and 2) in women with early and late diagnosis of gestational diabetes mellitus. METHODS: Included were 327 women with gestational diabetes mellitus and 295 non-diabetic women, who were screened with a 75 g oral glucose tolerance test because of risk factors for gestational diabetes. Women with gestational diabetes mellitus were treated with low-caloric diet and insulin when appropriate, while women in the control group received routine antenatal care. RESULTS: Gestational age at delivery was significantly lower in the group with gestational diabetes mellitus, both when considering all deliveries (39.1+/-1.7 weeks versus 39.8+/-2.0 weeks, p<0.05) and only those with spontaneous onset of labor (38.8+/-2.0 weeks versus 40.0+/-1.6 weeks, p<0.05). The frequency of macrosomia was increased, although not statistically significant (8% vs. 2%, p=0.07), and the rate of admission to the neonatal ward was significantly increased (18% vs. 9%, p<0.05) in the group with gestational diabetes. Women with early diagnosis of gestational diabetes mellitus had a significantly increased need for insulin treatment during pregnancy (36% vs. 9% p<0.05) and a significantly higher occurrence of diabetes mellitus at follow-up from two months until three years postpartum. CONCLUSIONS: This study of women with gestational diabetes mellitus and non-diabetic pregnant women showed that gestational diabetes mellitus was associated with a significantly lower gestational age at delivery and an increased rate of admission to the neonatal ward. Women diagnosed with GDM before 20 weeks of gestation had an increased need for insulin treatment during pregnancy and a high risk of subsequent overt DM, compared with women diagnosed with GDM later in pregnancy.     

Total plasma homocysteine correlates in women with gestational diabetes

AIM: We aim to assess serum total homocysteine (tHcy) associations with metabolic syndrome components and B-vitamins in women with gestational diabetes mellitus (GDM). METHODS: We studied 61 consecutive pregnant women, 44 with GDM and 17 with normal glucose tolerance (CG). Serum homocysteine levels were analyzed by ELISA, using Bio-Rad reagents. Serum folates and vitamin B(12) concentrations were determined by chemiluminescent immunoassay, free fatty acids (FFA) and lipids enzymatically. RESULTS: Serum homocysteine levels were similar in both the GDM and the CG groups (8 +/- 2.0 vs 7.4 +/- 1.1 mumol/l, respectively). Women with GDM in comparison to CG women were characterized by higher values of homeostasis model of insulin resistance (HOMA-IR) (2.8 +/- 1.7 vs 1.6 +/- 0.9, P < 0.01), serum triglycerides (2.7 +/- 0.9 vs 1.9 +/- 0.5 mmol/l, P < 0.01) and FFA (0.6 +/- 0.2 vs 0.46 +/- 0.2 mmol/l, P < 0.05). In GDM women serum tHcy correlated with vitamin B(12) (r = -0.47, P < 0.01) and folates (r = -0.51, P < 0.001); in CG women with HOMA-IR, a marker of insulin resistance (r = -0.49, P < 0.05). In multiple regression analysis with serum tHcy as a dependent variable, folate and vitamin B(12) entered the analysis in GDM women (beta = -0.42 and -0.34, respectively, P < 0.05), whereas in CG cystatin C and HOMA-IR entered the analysis (P < 0.05). CONCLUSIONS: In women with GDM, serum homocysteine is significantly associated with vitamin B(12) and folate levels, while in healthy pregnant women with HOMA-IR and with kidney function. The results suggest the importance of the B-group vitamins in regulation of serum tHcy levels in women with insulin resistance/gestational diabetes, what might be relevant in protection against pregnancy complications associated with elevated tHcy in GDM women.     

尾加压素Ⅱ基因多态性与妊娠期糖尿病遗传易感性的关系

目的探讨尾加压素Ⅱ基因rs228648位点单核苷酸多态性与妊娠期糖尿病（GDM）发病的关系。方法应用聚合酶链反应-限制性内切酶片段长度多态性（PCR—RFLP）技术;采用病例一对照研究的方法,对中国北方地区无血缘关系的70例GDM孕妇（GDM组）和70例正常妊娠妇女（对照组）的尾加压素Ⅱ基因rs228648位点（G—A）进行单核苷酸多态性分析。结果（1）两组孕妇尾加压素Ⅱ基因rs228648位点各基因型频率分布均符合Hardy-Weinberg平衡榆验,具有群体代表性。（2）GDM组孕妇尾加压素Ⅱ基因rs228648位点G等位基因频率为70．7％,对照组为57．9％,两组比较,差异有统计学意义（P〈0．05）;GDM组孕妇尾加压素Ⅱ基因rs228648位点A等位基因频率为29．3％,对照组为42．1％,两组比较,差异也有统计学意义（P〈0.05）。而两组孕妇的G／G基因型频率比较（分别为52．9％和41．4％）,差异无统计学意义（P〉0．05）。（3）尾加压素Ⅱ基因rs228648位点的A／A基因型频率与GDM组呈负相关关系,经多因素logistie同归分析显示,其OR值为0．312,OR值的95％可信区间为0．108～0．900（P=0．031）。结论尾加压素Ⅱ基因rs228648位点单核苷酸多态性可能在GDM遗传易感性中起重要作用。G等位基因可能与GDM发生有关,而尾加压素Ⅱ基因rs228648位点的A型纯合子可能是GDM的重要保护因素。     

Circulating concentrations of adiponectin and tumor necrosis factor-alpha in gestational diabetes mellitus.

Adiponectin and tumor necrosis factor-alpha (TNF-alpha) have been implicated in insulin resistance and diabetes mellitus (DM). In the present study we investigated levels of adiponectin and TNF-alpha and their relationships with each other and metabolic factors in women with gestational DM (GDM). Thirty-four pregnant women with GDM and 31 pregnant women with normal glucose tolerance (NGT) were included in the study. Plasma adiponectin levels were lower in GDM than in NGT (36.9 +/- 6.7 vs. 61.3 +/- 13.0 ng/ml, p = 0.028). Serum TNF-alpha levels were increased in GDM compared with NGT (20.5 +/- 2.4 vs. 14.0 +/- 1.5 pg/ml, p = 0.042). After adjustment for pre-pregnancy and current body mass index (BMI), adiponectin levels correlated negatively with insulin resistance by homeostasis model assessment-insulin resistance (HOMA-IR) and 0-h and 1-h glucose both at glucose challenge test and oral glucose tolerance test in GDM. Adiponectin levels were correlated only with very low-density lipoprotein cholesterol and triglyceride levels in NGT. TNF-alpha levels were correlated with glycated hemoglobin in GDM. There was a significant positive correlation between TNF-alpha levels and pre-pregnancy and current BMI in GDM as well as NGT. HOMA-IR for adiponectin and pre-pregnancy BMI for TNF-alpha remained as significant determinants in multiple regression analyses. In conclusion, these data suggest that reduced adiponectin and increased TNF-alpha may be involved in the pathogenesis of GDM.     

Vitamin C and the risk of gestational diabetes mellitus: a case-control study

OBJECTIVE: To examine whether low maternal dietary intake of vitamin C and low maternal plasma ascorbic acid (AA) concentrations are associated with an increased risk of gestational diabetes mellitus (GDM). METHODS: Cases were 67 women with GDM meeting National Diabetes Data Group criteria. Controls were 260 women without such a diagnosis. Maternal dietary vitamin C consumption during the periconceptional period and during pregnancy was assessed using a 121-item, semiquantitative food frequency questionnaire. Maternal plasma AA concentrations were determined using automated enzymatic procedures on specimens collected during the intrapartum period. RESULTS: Mean maternal daily consumption of vitamin C and plasma AA concentrations were 10% and 31% lower, respectively, among GDM cases as compared with controls (130.7 +/- 10.2 vs. 145 +/- 4.9 mg/d, P = .190; 36 +/- 2.0 vs. 53 +/- 1.0 micromol/L, P <.001). After controlling for maternal age, race, prepregnancy adiposity, family history of type 2 diabetes, energy intake and income, women reporting low daily vitamin C intake (< 70 mg/d), as compared with the other women, experienced a 3.7-fold increased risk of GDM (odds ratio [OR] = 3.7, 95% confidence interval [CI] 1.7-8.2). There was a linear relation in risk of GDM with decreasing concentrations of plasma AA (P for linear trend <.001). After adjusting for confounders, women in the lowest quartile (< 42.6 micromol/L), as compared with women in the highest quartile (> 63.3 micromol/L), experienced > 12-fold increased risk of GDM (OR = 12.8, 95% CI 3.5-46.2). CONCLUSION: Low maternal dietary vitamin C intake and low plasma AA concentrations are associated with an increased risk of GDM. Large, prospective, cohort studies are needed to further evaluate the potential beneficial role of vitamin C and other antioxidants in the prevention of impaired glucose tolerance in pregnancy.     

葡萄糖激酶基因与妊娠糖尿病的关系

目的 探讨葡萄糖激酶（ＧＣＫ）基因与妊娠糖尿病（ＧＤＭ）易感性的关系。方法 采用群体关联研究的方法,应用聚合酶链反应－变性聚丙烯酰胺凝胶电泳技术,对４０例ＧＤＭ患者（ＧＤＭ组）及４３例正常对照（对照组）ＧＣＫ基因３＇和５＇端的微卫星ＤＮＡ多态标记（ＧＣＫ１、ＧＣＫ２）,进行基因分型,并比较其等位基因、基因型和单倍型在两组中的频率分布。结果 （１）ＧＣＫ１的等位基因频率及基因型频率在两组间无差异。（