妊娠期不同糖代谢状态血清脂联素、C反应蛋白的变化及其与胰岛素抵抗的关系

The changes in serum levels of adiponectin and C-reactive protein and their relations with insulin resistance in pregnant women with various glycometabolism states

目的研究妊娠期不同糖代谢状态血清脂联素(APN)和C反应蛋白(C-RP)变化与胰岛素抵抗(IR)的关系。方法测定48例妊娠期糖尿病(GDM)患者、30例妊娠期糖耐量减低(GIGT)患者和26名正常糖耐量(NGT)孕妇血清APN和C-RP水平,计算胰岛素抵抗指数(HOMA-IR)、胰岛β细胞功能指数(HOMA-β)和胰岛素敏感性指数(ISI)。结果 GDM组和GIGT组HOMA-IR分别为0.53±0.47、0.50±0.49,APN分别为5.85±2.97mg/L、6.56±3.12mg/L,与NGT组HOMA-IR(0.15±0.04)、APN(10.13±5.89mg/L)比较差异有统计学意义;GDM组HOMA-β(4.80±0.63)低于GIGT组(5.34±0.86)和NGT组(5.73±1.24),差异均有统计学意义;三组C-RP差异无统计学意义。多元回归分析显示,FPG、HOMA-IR为影响APN的显著因素,孕前BMI是影响C-RP的显著因素。结论随糖耐量异常进展,血清APN水平逐步下降;孕妇APN水平降低与FPG和IR密切相关;孕前BMI是影响孕期C-RP变化的主要因素。

Objective To analyze the relationship of the levels of APN and C-RP with insulin resistance in pregnancy with various glucose tolerance states. Methods APN and C-RP were measured in 48 patients with GDM,30 GIGT and 26 NGT. HOMA-IR, HOMA-β and ISI were analyzed in three groups. Results HOMA IR and APN in GDM group（0.53±0. 47, 5.85 ± 2.97mg/L respectively） and GIGT group （0. 50±0.49, 6. 56 ± 3.12mg/L respectively） were significantly different from those in NGT group（0.15±0.04,10.13±5.89mg/L respectively）. HOMA-β was significantly decreased in GDM group （4.80±0. 63）versus GIGT（5.34±0. 86）and NGT group（5.73±1.24）. No significant difference in C-RP was found in three groups. Multiple regression analysis showed that FPG and HOMA-IR were significiantly independent determinants for serum APN. Pre-gestation BMI was significiantly independent determinants for C-RP. Conclusions With the deterioration of glucose metabolism from NGT to GDM, the level of APN is progressively decreased. APN in pregnancy is more significantly correlated with hyperglycemia and IR. C-RP is significantly associated with pre-pregnancy BMI.