早孕期血清脂联素、瘦素、肿瘤坏死因子α、C反应蛋白水平与胰岛素抵抗的相关性

Relationship of serum levels of adiponectin, leptin, tumor necrosis factor-alpha and c-reactive protein with insulin resistance during first trimester pregnancy

目的 探讨早孕期血清脂联素、瘦素、肿瘤坏死因子（TNF）α、C-反应蛋白（CRP）水平与胰岛素抵抗指数（IR）的关系.方法 选取2007年10月至2008年7月年在北京安贞医院连续产检并分娩342例为研究对象,跟踪随访至晚孕期根据糖耐量试验分为妊娠期糖尿病组、妊娠期糖耐量受损组、正常妊娠组,测定3组孕妇早孕期血清脂联素、瘦素、TNFα及CRP水平,分析以上细胞因子与IR的关系.结果 342例中有13例患妊娠期糖尿病,19例存在妊娠期糖耐量受损.在其余正常孕妇中选择35名作为对照组.3组孕妇早孕期血清脂联素、瘦素及TNFα、CRP水平有统计学意义.脂联素与IR呈负性相关,瘦素、CRP、TNFα、体质量指数（BMI）与IR呈正相关.结论 早孕期脂联素、瘦素、TNFα及CRP与胰岛素抵抗指数存在相关性,其中TNFα的作用最显著,有可能成为早期预测妊娠期糖尿病的指标.

Objective To explore the relationships between serum levels of adiponectin, leptin,TNF-alpha and CRP （c-reactive protein） versus insulin resistance in early pregnancy. Methods A total of 342 pregnant women delivering at our hospital were recruited from October 2007 to July 2008. Their clinical data were collected and analyzed. According to the 50-g 1-hour oral glucose screening test, they were divided into 3 groups：gestational diabetes, gestational impaired glucose tolerance and normal pregnancy. The serum levels of adiponectin, leptin, TNF-alpha and CRP were determined by ELISA （enzyme-linked immunosorbent assay） and multivariate correlation analysis was used to analyze their relationships with the indices of insulin resistance. Results Among them, there were gestational diabetes （ n = 13） and gestational impaired glucose tolerance （n = 19 ）. Thirty-five normal pregnant women were selected as the control group. The result of analysis of variance indicted that adiponectin, leptin and TNF-alpha had significant statistical differences among three groups. Through the multivariate correlation analysis, adiponectin had a adverse correlation with the indices of insulin resistance. Leptin, CRP, TNF-alpha and BMI （body mass index） had positive correlations with the indices of insulin resistance. Conclusion Adiponectin, leptin,TNF-alpha and CRP are correlated with the indices of insulin resistance. And TNF-alpha may become an important predictor of gestational diabetes in early pregnancy.