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

Maternal serum tumor necrosis factor-alpha concentration and correlation with insulin resistance in gestational diabetes

OBJECTIVE: To investigate serum concentration of tumor necrosis factor (TNF)-alpha and its correlation with insulin resistance in pregnant women with gestational diabetes mellitus (GDM). METHODS: Enzyme-linked immunosorbent assay was used to measure the fasting serum TNF-alpha levels of 42 women with GDM (28 approximately 39 gestational weeks), and 40 cases of normal pregnant women in the third trimester. Fasting plasma glucose, insulin, C-peptide and glycosylated hemoglobin (HbA1c) were also measured at the same time. Insulin sensitive index (ISI) was calculated. RESULTS: (1) Significantly elevated serum TNF-alpha was found in the women with GDM (5.2 +/- 1.6) ng/L as compared with the healthy pregnant women in third trimester (4.5 +/- 0.5) ng/L (P < 0.01); ISI between the two groups was significantly different, (-4.3 +/- 0.5) and (...3.8 +/- 0.3) (P < 0.01). (2) fasting plasma glucose, insulin, C-peptide, HbA1c in GDM group were (5.5 +/- 0.7) mmol/L, (13.4 +/- 3.8) mU/L, (1.6 +/- 0.4) nmol/L, (5.6 +/- 0.5)%, being significantly higher than those in the normal pregnant women (P < 0.01 or P < 0.05). (3) Significant negative linear correlation was revealed between TNF-alpha and ISI (r = -0.703, P < 0.01), and positive linear correlations between TNF-alpha and plasma glucose, C-peptide, and HbA1c were found (r = 0.512, 0.629, 0.386); but no correlation between TNF-alpha and insulin was found in GDM group. In normal group the correlation between ISI and TNF-alpha was also found (r = -0.390, P < 0.05), but less significant than that in the GDM group. CONCLUSIONS: Fasting plasma TNF-alpha levels in pregnant women with GDM is significantly higher than in normal pregnant women. A negative relationship between TNF-alpha and insulin sensitivity index is found in GDM, suggesting increased TNF-alpha may contribute to insulin resistance in pregnant women with gestational diabetes.