妊娠期糖尿病患者内脏脂肪素水平与胰岛素抵抗的关系

The Relationship between Visfatin Level and Insulin Resistant Degree in Gestational Diabetic Patients

目的:探讨妊娠期糖尿病患者血清内脏脂肪素(visfatin)水平与胰岛素抵抗(IR)的相关性。方法:106例妊娠女性根据美国糖尿病学会(ADA)标准分为妊娠期糖尿病(GDM,n=50)组、妊娠期糖耐量受损(GIGT,n=24)组及糖耐量正常(NGT,n=32)3组。酶法检测总胆固醇(TC)和三酰甘油(TG)水平;高效液相色谱法检测糖化血红蛋白(HbA1c)水平。双抗体夹心酶标免疫(ELISA)分析法检测血清visfatin水平,化学发光法检测空腹血清胰岛素(FINS)水平。结果:GDM组visfatin水平高于GIGT组、NGT组,GIGT组高于NGT组;与NGT组比较,GDM及GIGT组均有较高的FINS水平;GDM组IR指数(HOMA-IR)、HbA1c、TC及TG水平均高于GIGT和NGT组,差异有统计学意义(均P<0.01)。visfatin与HOMA-IR呈正相关,visfatin、HOMA-IR与FINS、孕期体质量增加、HbA1c、TC、TG均呈正相关,血清FINS、visfatin及孕期体质量增加是HOMA-IR的主要影响因素。结论:妊娠女性visfatin高水平表达增加了组织IR程度,通过影响糖脂代谢参与了妊娠期糖尿病的发生。

Objective：To investigate the correlation between the serum visfatin level and insulin resistant（IR） degree in gestational diabetic patients.Methods：According to the ADA standard,106 pregnant women were divided into three groups,including gestational diabetes mellitus group（GDM,n=50）,gestational impaired glucose tolerance group（GIGT,n=24）,and normal glucose tolerance group（NGT,n=32）.The serum levels of total cholesterol（TC）,trigalloyl glycerol（TG） and glycosylated hemoglobin（HbA1c） were detected.Serum levels of visfatin were measured by ELISA method,and fasting insulin（FINS） levels were measured by chemiluminescence.Results：The serum visfatin level was higher in GDM group than that of GIGT group and NGT group（P 〈 0.01）.The serum levels of FINS were higher in GDM and GIGT groups than those in NGT group（P 〈 0.01）.The values of HOMA-IR,HbA1c,TC and TG were higher in GDM group than those of GIGT and NGT group（P 〈 0.01）.There was a positive correlation between serum visfatin level and HOMA-IR.There were also positive correction between visfatin level,HOMA-IR,FINS,the weight gain,HbA1c,TC and TG during whole pregnancy.The serum levels of FINS,visfatin and the weight gain during the whole pregnancy were the independent factors for insulin-resistance.Conclusion：The high-expression of visfatin enhanced the insulin-resistance in pregnant women.Visfatin involved in the metabolic disturbance in glucose and lipid,which maybe a mechanism of GDM occurrence.