妊娠期糖尿病视黄醇结合蛋白4与炎症因子、胰岛素抵抗相关分析

The relationship between serum retinol binding protein 4 and inflammatory factors, insulin resist.ance in patients with Gestational diabetes mellitus

目的探讨RBP-4与妊娠期糖尿病患者炎症因子超敏C反应蛋白（hs-CRP）、游离脂肪酸（FFA）及胰岛素抵抗的关系。方法97例就诊产科及内分泌科门诊的妊娠期女性，正常葡萄糖耐量（NGT）组50例、糖耐量异常（IGT）组20例、妊娠期糖尿病组（GDM）组27例，按BMl分为正常体重组（NW）42例及超重／肥胖组（OW／OB）55例。用ELISA测定血清RBP-4。全自动生化仪检测hs-CRP．游离脂肪酸（FFA）、甘油三酯（TG）、总胆固醇（TC）；化学发光法检测胰岛素。结果IGT组、GDM组In（HOMA—IR）、FFA、ln（hs-CRP）均高于NGT组（P〈0．05），OW／OB组的FFA[（0．90±0．31）mmol／LVS（0．71±0．28）mmol／L，t=2．73，P〈0．05j、ln（hs-CRP）（0．62±1．00VS-0．17±1．07，t=2．90，P〈0．05）、In（HOMA-IR）、lnRBP（0．56±0．27VS0．30±0．14，t=2．86，P〈0．05）高于NW组，差异有统计学意义。单因素简单相关分析显示，GDM组与OW／OR组中，lnRBP-4与FFA及In（hs-CRP）均呈正相关（r=0．23I，0．237，0．371，O．247，P〈0．05）。而NGT、IGT组及NW组lnRBP-4与FFA、In（hs-CRP）无相关。NGT组、OW／OB组InRBP-4与1n（HOMA-IR）呈正相关（r=oJ276，0．290，P〈oJ05）。IGT组、GDM组及NW组InRBP-4与In（HOMA-IR）均无相关。逐步多元线性回归分析显示，ln（hs-CRP）、FFA、In（HOMA．IR）均非lnRBP-4的独立影响因素。结论在GDM患者中，RBP-4可作为一种新的炎症标志物。

Objective To investigate the relationships between serum concentration of RBP-4 and inflammatory factors, insulin resistance in patients with gestational diabetes mellitus. Methods 20 patients newly diagnosed with impaired glucose tolerance （IGT） , 27 patients newly diagnosed with gestational diabetes mellitus（GDM） and 50 subjects with normal glucose tolerance（NGT） were enrolled in this cross-sectional study. Additionally, another subset analysis was performed, subjects were divided on the basis of BMI into normal weight （NW） and overweight or obesity （OW/OB）. Serum RBP-4 was measured with ELISA; serum concentrations of hs-CRP, free fatty acids （FFA）, triglyeride（TG）, total cholesterol （TC） and insulin were measured in fasting status. Insulin resistance was assessed by HOMA-IR. Results Ln（ HOMAIR） and the concentrations of FFA, ln（hs-CRP） in IGT or in GDM were significantly higher than that of NGT （ P 〈0. 05）. In the group of OW/OB, FFA[ （0. 90±0. 31 ）mmol/L vs （0. 71±0. 28）mmol/L, t =2. 73, P 〈0.05）], ln（hs-CRP） （0.62 ± 1.00 vs -0. 17 ± 1.07, t =2.90, P 〈0.05）, ln（HOMA-IR）, InRBP （0. 56 ± 0. 27 vs O. 30 ±0. 14, t =2. 86, P 〈0. 05）were significantly higher than that of NW. In the group of GDM, InRBP-4 showed a positive relationship with FFA （ r =0. 231, P 〈0. 05）and ln（hs-CRP） （ r = 0. 237, P 〈0. 05）. There was a positive relationship between lnRBP-4 and FFA（ r =0. 371, P 〈0. 05） or In（hs-CRP） （ r =0. 247, P 〈0. 05） in the group of OW/OB, but no association in the group of NGT, IGT or NW. There was no relationship between lnRBP-4 and In （HOMA-IR） in IGT, GDM and NW, while in the group of NGT and OW/OB, lnRBP-4 showed a positive relationship with ln（HOMA-IR） （r =0. 276, 0. 290, P 〈0. 05）. In a multiple linear regression analysis, ln（hs-CRP） , FFA or ln（HOMA-IR） was not the independent factor of lnRBP-4 in any group. Conclusions In patients with gestational diabetes mellitus, lnRBP-4 may be a new marker of inflammation.