炎性及脂肪细胞因子与妊娠期糖尿病发病的相关性及在产褥期的变化

Correlations between inflammatory cytokines and adipocytokines and onset of gestational diabetes mellitus and the changes during postpartum period

目的研究分析炎性及脂肪细胞因子与妊娠期糖尿病发病的相关性及在产褥期的变化情况,为妊娠期糖尿病的早期预测、诊断并及时采取针对性预防干预措施改善母婴结局提供临床依据。方法选择2013年6月-2016年6月于长兴县中医院就诊的77例妊娠期糖尿病患者为观察组,另同期选择于本院行产检的77例健康孕产妇为对照组。所有孕产妇均在参与研究时接受全面检查,进行胰岛素抵抗指数(HOMA-IR)计算,并在妊娠期、产褥期进行炎症因子C反应蛋白(CRP)、肿瘤坏死因子α(TNF-α)和脂肪因子瘦素、脂联素含量检测。对比两组孕产妇炎症因子和脂肪因子水平,分析其与妊娠期糖尿病发病的关系,并观察炎症因子和脂肪因子在患者产褥期的变化情况。结果观察组患者妊娠期HOMA-IR、炎症因子CRP、TNF-α和脂肪因子瘦素水平均高于对照组,脂联素水平低于对照组,差异均有统计学意义(P<0.05)。炎症因子CRP、TNF-α和脂肪因子瘦素水平与妊娠期糖尿病发病呈正相关(P<0.05),脂联素水平与妊娠期糖尿病发病呈负相关(P<0.05);产后3 d、4周、6周观察组患者HOMA-IR、炎症因子CRP、TNF-α和脂肪因子瘦素水平均逐渐降低,脂联素水平逐渐升高,差异有统计学意义(P<0.05)。结论炎性及脂肪细胞因子与妊娠期糖尿病发病具有相关性,且随着产褥期胰岛素抵抗的减弱而发生相关变化,可作为妊娠期糖尿病发病及产后恢复情况的评估及预测指标。

Objective To research and analyze the correlations between inflammatory cytokines and adipocytokines and onset of gestational diabetes mellitus（ GDM） and the changes during postpartum period,provide a clinical basis for early prediction and diagnosis of GDM,taking corresponding intervention measures timely,and improving maternal and infantile outcomes. Methods From June 2013 to June 2016,77 patients with GDM were selected from Changxing County Hospital of Traditional Chinese Medicine as observation group,and77 healthy pregnant women receiving prenatal examination in the hospital were selected as control group. General examination was performed among all the pregnant women,HOMA-IR was calculated. The levels of C-reactive protein（ CRP）,tumor necrosis factor α（ TNF-α）,leptin,and adiponectin during pregnancy and puerperium were detected. The levels of inflammatory cytokines and adipocytokines in the two groups were compared. The relationships between them and the onset of GDM were analyzed. The changes of inflammatory factors and adipokines during postpartum period were observed. Results The levels of HOMA-IR,CRP,TNF-α,and leptin during pregnancy in observation group were statistically significantly higher than those in control group,while the level of adiponectin in observation group was statistically significantly lower than that in control group（ P〈0. 05）. CRP,TNF-α,and leptin were positively correlated with onset of GDM（ P〈0. 05）,while the level of adiponectin was negatively correlated with onset of GDM（ P〈0. 05）. At 3 days,4 and 6 weeks after delivery,the levels of HOMA-IR,CRP,TNF-α,and leptin in observation group decreased gradually,while the level of adiponectin increased gradually,there were statistically significant differences（ P〈0. 05）. Conclusion Inflammatory cytokines and adipocytokines are correlated with onset of GDM,which change with the decrease of insulin resistance during puerperium,and they can be used as evaluation and prediction indexes for onset of GDM and postpartum recovery.