妊娠糖尿病患者肿瘤坏死因子的动态变化与胰岛素抵抗的关系

Alteration of serum tumor necrosis factor-alpha level in gestational diabetes mellitus and correlation with insulin resistance

目的探讨妊娠糖尿病（GDM）患者肿瘤坏死因子α（TNF-α）的动态变化与胰岛素抵抗（IR）的关系。方法选择GDM患者32例（GDM组）、正常孕妇31例（NGT组）为研究对象，分别测定孕25～28周、孕29～32周、孕37—38周、产后6-8周空腹血TNF-α、胰岛素、血糖水平，采用放射免疫法测定TNF-α和胰岛素，葡萄糖氧化酶法测定空腹血糖。以稳态模式评估法的胰岛素抵抗指数（HOMA-IR）评价IR。结果①GDM组、NGT组血清TNF-α水平均随孕期的增加而升高，且均显著高于产后；@GDM患者妊娠各时期TNF-α水平均显著高于NGT（t值分别为7．81、7．05、7．15，P〈0．01）；③血清TNF-α水平与HOMA0IR显著正相关（r=0．571，P〈0．05）。结论GDM患者血清中TNF-α水平随孕期的增加而升高，且显著高于产后，TNF-α的动态变化与IR相关。

Objective To explore the dynamic of tumor necrosis factor-alpha （TNF-α）and its correlation with insulin resistance （IR）during different stages of gestational diabetes mellitus （GDM） . Methods Thirty-two subjects with GDM and 31 cases of normal pregnant women nonnal glucose tolerance, NGT were enrolled in the study, serum TNF-α and insulin were determined by radioimmunoassay. The plasma glucose was measured by using glucose oxidase. Tests repeated for each group according different stages of prenatal 25-28 weeks, 29-32 weeks, 37-38 weeks and postpartum 6-8 weeks. IR was assessed by the homeostasis model of assessment for insulin resistance index （HOMA-IR）. Results ①Serum TNF-α levels in GDM and NGT group rose with gestational age, and both significantly decreased at postpartum. ② Serum TNF-α levels in GDM of above-mentioned four stages respectively were （7.05±0.67） ng/L, （ 7.11 ± 0.75） ng/L, （7.36±0.79） ng/L, （5.46±0.37） ng/L respectively. All significantly increased than those in the same stage group （t=7.81, 7.05, 7.15, P〈0.01）. ③Maternal serum TNF-α levels were in positive correlation with HOMA-IR in GDM （r=0.571, P〈0.05）. Conclusions Serum TNF-α levels in GDM rose with gestational age, but significantly decreased at postpartum. The dynamic changes of serum TNF-α contribute to occurrence of insulin resistance.