妊娠糖尿病患者胰岛素抵抗影响因素的探讨

Relationship between insulin resistance and serum levels of adiponectin,leptin and erythrocyte membrane insulin receptor in patients with gestational diabetes

目的探讨妊娠糖尿病患者脂联素、瘦素水平和红细胞膜胰岛素受体的变化及与胰岛素抵抗的关系。方法对40例妊娠糖尿病患者(GDM 组)和34例止常糖耐量妊娠妇女(对照组)测定代谢指标、血清脂联素、瘦素,并检测高、低亲和力红细胞膜胰岛素受体数日和高、低亲和力常数。结果 GDM 组瘦素水平为(11.7±2.8)μg/L,明显高于对照组(P<0.05);脂联素为(7.8±1.6)μg/L,明显低于对照组(P<0.05)。高、低亲和力红细胞膜胰岛素受体数目分别为(43±9)和(2297±525)个/红细胞,明显降低于对照组(P<0.05)。GDM 组胰岛素抵抗指数(3.6±1.3)明显高于对照组(P<0.05)。GDM 组经多元线性逐步回归分析,进入回归方程的因素有孕前体重指数、脂联素、瘦素和低亲和力红细胞膜胰岛素受体数目(P<0.01)。结论脂联素、瘦素和红细胞膜胰岛素受体数日的改变参与了 GDM 患者胰岛素抵抗的发生过程,可能与 GDM 的糖脂代谢紊乱有关。

Objectives To investigate changes in serum levels of adiponectin, leptin and erythrocyte membrane insulin receptor among patients with gestational diabetes （ GDM ） , and to study their relation to insulin resistance. Methods Fasting plasma glucose （FPG） , fasting serum insulin （FINS） , serum levels of adiponectin and leptin, indices of lipid metabolism, 2 h plasma glucose during oral glucose tolerance test （2 h PG） , 2 h serum insulin during oral glucose tolerance test （2 h INS） , as well as number of erythrocyte membrane insulin receptors with high and low appetency and its constants, were determined in 40 patients with GDM and 34 controls with normal glucose tolerance. Insulin resistance index （IRI） was calculated. Results ①Serum levels of leptin and adiponectin were （ 11.7 ± 2.8 ） μg/L and （7.8 ＋ 1.6） μg/L, respectively, and number of high appetency erythrocyte membrane insulin receptor （ R1 ） and low appetency erythrocytemembrane insulin receptor （R2 ） was （43 ± 9 ） / red cell and （2297 ±525 ） / red cell, respectively. Serum level of leptin was significantly higher in those with GDM than those of normal controls （ P 〈 0. 05 ）. Serum level of adiponectin, and R1 and R2 were significantly lower in those with GDM than those of normal controls （ P 〈 0. 05 ）. ②IRI was significantly higher in those with GDM than those of normal controls （ P 〈 0. 05 ）. ③ Linear multivariate regression analysis indicated that body mass index before pregnancy, serum levels of adiponectin, leptin, and R2 were independent factors that associated with IRI （P 〈0. 01 ）. Conclusions Serum levels of adiponectin and leptin and number of insulin receptor on erythrocyte membrane may play an important role in pathogenesis of insulin resistance in pregnant women with GDM.