妊娠期高血压胰岛素抵抗及胎盘生乳素、雌二醇、NO、NOS水平的检测意义

目的探讨正常妊娠和妊娠期高血压产妇胰岛素抵抗及其相关因子的水平改变情况,为明确妊娠期高血压病因和临床早期诊断治疗提供依据。方法分别采用己糖激酶法、放射免疫法、硝酸盐还原酶法等方法对30例妊娠期高血压产妇和30例正常产妇不同孕周的血糖血脂、血胰岛素、胎盘生乳素（human placental lactogen,HPL）、雌二醇（estradiol,E2）、一氧化氮（nitric oxide,NO）和一氧化氮合酶（nitric oxide synthase,NOS）的水平进行检测。结果随着孕周的增加,两组产妇的空腹血糖和胰岛素水平并无明显改变（P〉0.05）,而血清甘油三酯（triglycerides,TG）、总胆固醇（total cholesterol,TC）、高密度脂蛋白胆固醇（high density lipoprotein cholesterol,HDL-C）和低密度脂蛋白胆固醇（low density lipoprotein cholesterol,LDL-C）、HPL和E2的含量测定值则逐渐升高,且妊娠晚期的各指标水平明显高于妊娠早期（P〈0.05）。与正常组相比,妊高组的空腹血糖值亦无显著性改变,但妊高组胰岛素、HDL-C、NO和NOS水平均显著低于正常组,LDL-C则显著增加,差异均具有统计学意义（P〈0.05）。值得注意的是,妊娠期高血压组妊娠16周、28周时的E2水平显著高于正常组（P〈0.05）,而妊娠期高血压组HPL水平则在妊娠28周和分娩时显著低于正常组（P〈0.05）。结论胰岛素抵抗及其相关因子的异常是导致妊娠期高血压的主要因素,可作为诊断和治疗妊娠期高血压潜在的生物学标志。

Values of Insulin Resistance,Placental Lactogen,Estradiol,NO and NOS in the Gestational Hypertension

Objective To investigate the changes of insulin resistance and its associated factors in normal and gestational hypertension pregnant women,determine the cause of disease and provide the basis for early clinical diagnosis and treatment. Methods The levels of blood lipid,glucose,insulin,human placental lactogen（HPL）,estradiol（E2）,nitric oxide（NO） and nitric oxide synthase（NOS） were detected by shexokinase method,radioimmunoassay and nitrate reductase etc respectively in 30 normal pregnant and 30 gestational hypertension cases. Results Fasting glucose and insulin levels did not change significantly in both groups with increasing gestational age（P〉 0. 05）. Total cholesterol（TC）,triglycerides（TG）,high density lipoprotein cholesterol（HDL-C）,low density lipoprotein cholesterol（LDL-C）,HPL and E2 were significantly increased. The trimester of pregnancy were significantly higher than the indicators in early pregnancy（P〈0. 05）. Compared with normal group,there was no significant change in fasting blood glucose,but lower insulin,HDL-C,NO and NOS,and higher LDL-C in the pregnancy-induced hypertension cases（P〈0. 05）. In the gestational hypertension cases,at 16 weeks and 28 weeks of pregnancy,the levels of E2 were significantly higher than the normal group（P〈0. 05）,while the HPL levels in 28 weeks of pregnancy and childbirth was significantly lower than those in the normal group（P〈0. 05）. Conclusion Insulin resistance and the disruption of its associated factors take important roles in gestational hypertension which can be used as the potential biomarkers of diagnostic and therapeutic.