血清脂肪细胞因子与妊娠期糖尿病关系的研究

目的:探讨妊娠期糖尿病(GDM)孕妇血清脂肪因子脂联素、瘦素、肿瘤坏死因子(TNF-α)水平变化及其与胰岛素抵抗的相关性。方法:随机抽取孕周15～20周的孕妇测定空腹血糖(FBG)、空腹胰岛素(FINS)、血脂联素、瘦素、TNF-α水平,孕24～28周行OGTT检查,按结果分为3组,糖耐量正常组(NGT)59例,GDM组41例,GIGT组50例,比较各组胰岛素抵抗指数(HOMA-IR)、胰岛素分泌指数(HBCI)及孕前、孕中期的BMI的差异,分析血脂联素、瘦素、TNF-α与IR的关系。结果:①GDM组及GIGT组HOMA-IR较NGT组明显升高,差异有统计学意义(P<0.05),3组间HBCI比较差异无统计学意义(P>0.05)。②GDM组及GIGT组血清脂联素水平显著低于NGT组(P<0.05),血清瘦素水平及TNF-α水平则显著高于NGT组(P<0.05)。③脂联素与HOMA-IR呈负相关,相关系数为-0.65;而瘦素、TNF-α与HOMA-IR呈正相关,相关系数分别为0.58、0.47。结论:妊娠期糖尿病血清脂联素、瘦素、TNF-α水平的改变与妊娠期胰岛素抵抗有关,可作为GDM的重要预测因子。

Study on the relationship between serum adipocytokines and gestational diabetes mellitus

Objective:To explore the changes of serum adiponectin,leptin and tumor necrosis factor-α(TNF-α) levels in women with gestational diabetes mellitus(GDM) and their association with insulin resistance. Methods:The pregnant women of 15～20 gestational weeks were selected randomly,their fasting blood glucose,fasting insulin,serum adiponectin,leptin and TNF-α levels were detected,oral glucose tolerance test(OGTT) was carried out during 24～28 gestational weeks,then the pregnant women were divided into three groups according to the results: normal glucose tolerance(NGT) group(59 women),GDM group(41 women) and gestational impaired glucose tolerance(GIGT) group(50 women);the differences of HOMA-IR and HBCI among different groups and the difference of BMI during the first and second trimester of pregnancy were compared;the relationship between serum adiponectin,leptin,TNF-α and insulin resistance was analyzed. Results:HOMA-IR in GDM group and GIGT group were significantly higher than that in NGT group(P<0.05),there was no significant difference in HBCI among the three groups(P>0.05).The serum adiponectin levels in GDM group and GIGT group were significantly lower than that in NGT group(P<0.05),while the serum leptin and TNF-α levels in GDM group and GIGT group were significantly higher than those in NGT group(P<0.05).There was a negative correlation between adiponectin and HOMA-IR(γ=-0.65);leptin and TNF-α were positively correlated with HOMA-IR,respectively(γ=0.58;γ=0.47). Conclusion:The changes of serum adiponectin,leptin and TNF-α levels are related to insulin resistance in women with GDM.The factors can be used as important predictive factors of GDM.