脂联素与妊娠期糖尿病巨大儿发生关系的研究

A study on relation of adiponectin with incidence of macrosomia born by women with gestational diabetes mellitus

妊娠期糖尿病孕妇中巨大儿发生率明显高于正常孕妇，巨大儿是妊娠期糖尿病最多见的围产儿并发症，高血糖一高胰岛素学说是其基本的发病机制。脂联素、瘦素、肿瘤坏死因子一仪、胰岛素样生长因子、成纤维细胞生长因子-Ⅱ、胰岛素抵抗等因素的参与加剧了妊娠期糖尿病，同时这些因素也与胎儿的生长发育密切相关，其以各种方式参与了巨大儿的发生。其中，脂联素可能起着重要作用。脂联素是调节胰岛素和糖代谢的关键因子，而胎儿的生长发育受胰岛素和糖代谢的影响，因此，脂联素可能是调节胎儿宫内发育的候选因子之一。胎盘组织中存在脂联素基因的表达，妊娠期糖尿病孕妇胎盘脂联索基因mRNA表达水平显著降低，表明妊娠期糖尿病孕妇内分泌环境的变化不但严重地影响着胎盘基因的表达，而且能通过影响胎盘调节干扰胎儿的生长发育。

The incidence rate of macrosomia （MS） born by women with gestational diabetes meltitus （GDM） is higher than that born by normal pregnant women. Macrosomia is the most common perineonatal complication of GDM women. Hyperglycemia-hyperinsulinemia theory is basic pathogenesis of MS. The participation of adiponectin （APN）, leptin, TNF-α, IGFs, FGF-Ⅱ , insulin resistance exacerbated GDM, meanwhile, these factors arc closely related to fetal growth and development, so they take part in development of MS. Of which, APN may play important roles in it. APN is a key factor to regulate insulin and glucose metabolism , while fetal growth and development is influenced by insulin and glucose metabolism of the mother, so, APN may be one of the candidate factors to regulate intrauterine growth of the fetus. APN is expressed in placental tissues. While that is significantly decreased in placental tissues of pregnant women with GDM, suggesting that alterations in endocrine environment of GDM pregnant women seriously affect expression of gene and interfere fetal growth and development through influencing regulation of the placenta.