血浆脂联素水平预测妊娠期糖尿病的前瞻性研究

Prospective study on the value of plasma level of adiponectin in predicting gestational diabetes mellitus

目的:探讨血浆脂联素水平预测妊娠期糖尿病的应用价值。方法:选择妊娠期糖尿病高危因素孕妇,所有孕妇于孕14～18周进行常规体检测身高、体重、血压、血浆脂联素、空腹血糖及胰岛素、总胆固醇、甘油三脂。孕24～28周复查血浆脂联素、OGTT葡萄糖耐量及胰岛素,计算胰岛素抵抗指数,跟踪孕妇至分娩,根据糖耐量结果分为妊娠期糖尿病组与正常妊娠妇女组。总结妊娠期糖尿病发病情况,将妊娠期糖尿病孕早、中期血浆脂联素水平及其他检验指标进行比较。结果:GDM组14～18周及24～28周血清脂联素水平均明显低于NGT组,差异有统计学意义(P<0.001);孕14～18周血清脂联素与孕前体重指数、孕晚期体重指数、空腹血糖、空腹胰岛素、胰岛素抵抗指数、新生儿体重,存在显著负相关性。结论:脂联素水平是预测妊娠期糖尿病的敏感指标,孕14～18周脂联素水平已明显下降,即在临床上诊断妊娠期糖尿病前体内脂联素水平已有下降,脂联素水平可以早期预测妊娠期糖尿病。

Objective：To investigate the value of plasma level of adiponectin in predicting gestational diabetes mellitus（GDM）,then to provide scientific evidence for early prediction of GDM.Methods：Pregnant women with high risk factors of GDM were enrolled into this study,body height,body weight,blood pressure,plasma adiponectin,fasting blood glucose and insulin,total cholesterol,triglyceride were tested at 14～18 weeks of pregnancy.And plasma adiponectin,oral glucose tolerance test（OGTT）,blood insulin were tested again at 24～28 weeks of pregnancy,then the insulin resistance index was calculated.According to the result of OGTT,two groups were divided,including GDM group and normal glucose tolerance（NGT） group to summary the incidence of GDM and compare all the test indexes at early and midtrimester pregnancy.Results：The plasma level of adiponectin in GDM group was significantly lower than that in NGT group at 14～18 weeks and 24～28 weeks of pregnancy（P0.001）.Plasma adiponectin correlated negatively with body weight index（BWI） before pregnancy,fasting blood glucose and insulin,insulin resistance index（IRI） and body weight of neonates.Conclusion：Plasma level of adiponectin is a sensitive index in predicting GDM,it descends significantly at 14～18 weeks of gestation,being before clinical diagnosis of GDM,so it can be used to predict GDM.