瘦素、脂联素、抵抗素、内肥素与妊娠糖尿病胰岛素抵抗的相关性研究

Relationship of leptin,adiponectin,resistin,visfatin and insulin resistance in gestational diabetes mellitus

目的:探讨脂肪因子瘦素、脂联素、抵抗素、内肥素与妊娠糖尿病(GDM)胰岛素抵抗的相关性。方法:实验分为正常育龄妇女组(44例)、正常妊娠妇女组(62例)和妊娠糖尿病患者组(63例),用ELISA方法分别检测3组瘦素(Leptin),脂联素(Adiponectin),抵抗素(Resistin),内肥素(Visfatin)的水平,用葡萄糖氧化酶法检测血糖水平,免疫发光法检测胰岛素水平,用HOMA-IR(稳态模型胰岛素抵抗指数)表示胰岛素抵抗状态,HOMA-IR=空腹血糖×空腹血胰岛素÷22.5,用SPSS11.5统计软件进行统计分析。结果:妊娠糖尿病患者组的瘦素水平明显高于正常妊娠妇女组[(13.50±7.14)ng/ml、(7.78±3.82)ng/ml,P<0.001],正常妊娠妇女组明显高于正常育龄妇女组[(7.78±3.82)ng/ml、(1.73±0.70)ng/ml,P<0.001]差异具有统计学意义;GDM组的内肥素水平明显低于正常妊娠妇女组[(15.67±5.78)ng/ml、(22.43±5.68)ng/ml,P<0.001],正常妊娠妇女组明显低于正常育龄妇女组[(22.43±5.68)ng/ml、(36.46±13.34)ng/ml,P<0.001],差异具有统计学意义;GDM组的脂联素水平低于正常妊娠妇女组[(5491.71±2986.00)ng/ml、(6692.34±2583.51)ng/ml,P=0.029],差异有统计学意义,正常妊娠妇女组明显低于正常育龄妇女组[(6692.34±2583.51)ng/ml、(11076.82±3694.75)ng/ml,P<0.001],差异具有统计学意义;GDM组抵抗素水平与正常妊娠妇女组比较差异没有统计学意义。在妊娠糖尿病患者组,HOMA-IR与瘦素(r=0.352,P=0.005)正相关,与内肥素(r=-0.255,P=0.046)呈负相关。结论:妊娠糖尿病患者瘦素水平升高,内肥素和脂联素水平降低,瘦素和内肥素与胰岛素抵抗有关,瘦素和内肥素参与了妊娠糖尿病胰岛素抵抗的发生发展;脂联素和抵抗素与胰岛素抵抗不具有相关性,脂联素和抵抗素可能与妊娠糖尿病胰岛素抵抗的发生无关。

Objective：To investigated the correlation between adipocytokines of leptin,adiponectin,resistin,visfatin and insulin resistance in gestational diabetes mellitus.Methods：Using 3-hour VPG-measured 75 g-OGTT for GDM diagnosis,63 pregnant women with GDM and 62 age-matched unaffected pregnant women were recruited,44 age-matched non-pregnant women without diabetes mellitus as the cortrol.Plasma leptin,adiponectin,resistin,visfatin levels were analyzed with enzyme-linked immunosorbent assay.Results：Plasma leptin level was significantly higher in GDM comparing with that of the unaffected pregnant women（13.50±7.14 ng/ml vs 7.78±3.82 ng/ml,P〈0.001）.Plasma leptin level in unaffected pregnant women was significantly higher than normal non-pregnant women（7.78±3.82 ng/ml vs 1.73±0.70 ng/ml,P〈0.001）.Plasma visfatin level was significantly lower in GDM than in the unaffected pregnant women（15.67±5.78 ng/ml vs 22.43±5.68 ng/ml,P〈0.001）,and plasma visfatin level in unaffected pregnant women was significantly lower than normal non-pregnant women（22.43±5.68 ng/ml vs 36.46±13.34 ng/ml,P〈0.001）.Plasma adiponectin level was significantly lower in GDM compared with unaffected pregnant women（5 491.71±2 986.00 ng/ml vs 6 692.34±2 583.51 ng/ml,P=0.029）.Plasma adiponectin level in unaffected pregnant women was significantly lower than in the normal non-pregnant women（6 692.34±2 583.51 ng/ml vs 1 1076.82±3 694.75 ng/ml,P〈0.001）.Plasma resistin level was not significantly difference in GDM comparing with unaffected pregnant women（13.63±3.97 ng/ml vs 12.52±3.40 ng/ml,P=0.081）,but significantly difference occurred in unaffected pregnant women and normal non-pregnant women（12.52±3.40 ng/ml vs 9.64±3.02 ng/ml,P〈0.001）.In GDM group,HOMA-IR was correlated positively with concentrations of leptin（r=0.352,P=0.005）and negatively correlated with those of visfatin（r=-0.255,P=0.046）.Conclusion：Normol pregnant women are exhibited physiological insulin resistance,whereas in GDM exists serious pathological insulin resistance.Plasma leptin and visfatin are correlated with insulin resistance,Plasma adiponectin and resistin are not correlated with insulin resistance in GDM group.Leptin and visfatin may play important roles in the etiopathology of gestational diabetes mellitus.