可溶性CD163与妊娠期糖尿病发生发展关系的研究

Correlation between soluble CD163 and the progression of gestational diabetes mellitus

目的观察可溶性CD163(sCD163)在晚期孕妇血清中浓度的变化,探讨sCD163与糖脂代谢以及胰岛素抵抗的关系。方法选择2017年5月—2018年5月在常州市妇幼保健院产科门诊就诊的孕妇,根据妊娠24~28周75 g口服葡萄糖耐量试验(OGTT)结果,最终确诊为妊娠期糖尿病(GDM)的孕妇60例为病例组(即GDM组),并以同期随机选择的OGTT正常孕妇60例为对照组〔即糖耐量正常(NGT)组〕。检测两组血糖、血脂、胰岛素和血清sCD163浓度,计算体质指数(BMI)和稳态模型胰岛素抵抗指数(HOMA-IR)值。结果与NGT组比较,GDM组的血清总胆固醇(TC)、低密度脂蛋白胆固醇(LDL-C)水平呈下降趋势,但差异均无统计学意义(均P>0.05),而GDM组三酰甘油(TG)水平高于NGT组(mmol/L:3.93±1.87比3.31±0.93,P<0.05),HDL-C水平低于NGT组(mmol/L:1.63±0.43比2.03±0.62,P<0.01)。GDM组空腹血糖(FBG)较NGT组呈上升趋势,但差异无统计学意义(P>0.05);而GDM组空腹胰岛素(FINS)、、HOMA-IR及sCD163浓度均高于NGT组,差异均有统计学意义〔FINS(mU/L):19.75±9.35比12.46±7.29,HOMA-IR:3.67±1.23比3.15±1.19,sCD163(μg/L):42.96±19.88比29.35±12.67,均P<0.05〕。相关性分析显示,血清sCD163浓度与产前BMI、TG、FINS、HOMA-IR呈正相关〔相关系数(r)分别为0.402、0.603、0.512、0.614,均P<0.05〕,与HDL呈负相关(r为-0.326,P<0.05)。结论sCD163在GDM患者糖脂代谢过程中发挥重要作用,可能参与机体胰岛素抵抗,从而加重了胰岛β细胞的损害,与GDM发病关系密切。

Objective To investigate the changes of soluble CD163(sCD163)in the serum of the third trimesters pregnant women and the relationship with insulin resistance,metabolism of glucose and lipid.Methods According to the results of 75 g oral glucose tolerance test(OGTT)at 24 to 28 weeks of gestation,60 pregnant women diagnosed with GDM were selected from May 2017 to May 2018 in obstetrics clinic of Changzhou Maternal and Child Health Hospital as the case group(GDM group),and 60 normal pregnant women with OGTT were randomly selected as the control group[normal glucose tolerance(NGT)group]during the same period.Blood glucose,lipid profile,insulin concentration and serum sCD163 levels were measured in both groups,and body mass index(BMI)and homeostasis model insulin resistance index(HOMA-IR)values were calculated.Results Compared with the NGT group,the levels of total cholesterol(TC)and low density lipoprotein cholesterol(LDL-C)in the GDM group showed a downward trend,but the differences were not statistically significant(both P>0.05),the level of triglyceride(TG)in the GDM group was higher than that in the NGT group(mmol/L:3.93±1.87 vs.3.31±0.93,P<0.05),the level of HDL-C was lower than that of NGT group(mmol/L:1.63±0.43 vs.2.03±0.62,P<0.01).The fasting blood glucose(FBG)in the GDM group showed an upward trend compared with the NGT group,but the difference was not statistically significant(P>0.05).The concentrations of fasting insulin(FINS),HOMA-IR and s CD163 in the GDM group were higher than those in the NGT group,and the differences were statistically significant[FINS(mU/L):19.75±9.35 vs.12.46±7.29,HOMA-IR:3.67±1.23 vs.3.15±1.19,sCD163(μg/L):42.96±19.88 vs.29.35±12.67,all P<0.05].Correlation analysis showed that serum sCD163 concentration was positively correlated with prenatal BMI,TG,FINS,and HOMA-IR[correlation coefficients(r)were 0.402,0.603,0.512,and 0.614,all P<0.05];and negatively correlated with HDL(r was-0.326,P<0.05).Conclusion s CD163 plays an important role in the glucose and lipid metabolism of GDM patients,and may be involved in the body’s insulin resistance,thus aggravating the damage of isletβ-cells and closely related to the incidence of gestational diabetes.