妊娠糖尿病患者血清脂联素水平变化及其与炎症因子和胰岛素抵抗的关系

The altered serum adiponectin level and its correlations with inflammatory factors/insulin resistance in patients with gestational diabetes mellitus

目的探讨妊娠糖尿病(GDM)患者血清脂联素(APN)水平变化及其与炎症因子、胰岛素抵抗的关系。方法收集2009年7月至2011年12月在我院妇产科行常规产前检查的孕妇100名,根据糖耐量结果分为GDM45例,正常糖耐量组(NGT)55例,同时收集50名非妊娠健康育龄妇女作为对照组。使用酶联免疫吸附试验(ELISA)检测APN、白细胞介素(IL)-6、肿瘤坏死因子(TNF)-α水平,免疫比浊法检测高敏C反应蛋白(hs-CRP)水平。结果与非妊娠对照组相比,妊娠期妇女血清IL-6、hs-CRP、TNF-α、空腹胰岛素(Fins)、甘油三酯(TG)水平及稳态胰岛素评估模型胰岛素抵抗(HOMA-IR)明显升高而APN水平明显降低(P<0.01或<0.05);GDM组血清IL-6、hs-CRP、TNF-α以及HOMA-IR又较NGT组显著升高,而APN水平则明显降低(均P<0.01)。在妊娠期妇女中,APN与hs-CRP、IL-6、TNF-α、TG水平及HOMA-IR呈负相关(r=-0.391、-0.373、-0.381、-0.352,-0.407,均P<0.01);在校正了年龄、孕周、体质量及胰岛素抵抗的影响后APN与hs-CRP、IL-6、TNF-α仍呈负相关(r=-0.322、-0.324、-0.314,均P<0.01)。结论 GDM患者APN水平明显降低,其可造成GDM患者炎症反应失衡,可能是导致GDM患者胰岛素抵抗的重要危险因素。

Objective To investigate the altered serum adiponectin level and its correlations with inflammatory factors/insulin resistance in patients with gestational diabetes mellitus （GDM）. Methods Between July 2009 and December 2011, 100 pregnant women undergoing prenatal routine examination in obstetrics and gynecology department of our hospital were collected and divided into GDM group （n=45） and NGT group （n=55） according to glucose tolerance. Meanwhile, 50 normal fertile women were collected as controls. The levels of APN, IL-6 and TNF-α were detected by ELISA and the hs-CRP level by immunoturbidimetry. Results Compared with the control group, the pregnant women had significantly increased IL-6, hs-CRP, TNF-α, Fins, TG and HOMA-IR but decreased APN （P0.01 or 0.05）. Notably, GDM group had higher IL-6, hs-CRP, TNF-α and HOMA-IR but lower APN as compared with NGT group （both P0.01）. In pregnant women, Spearman correlation analysis showed a significant negative correlation of APN and levels of hs-CRP, IL-6, TNF-α, TG and HOMA-IR （r=-0.391, -0.373, -0.381, -0.352, -0.407; both P0.01）; partial correlation analysis showed that APN was still negatively correlated with hs-CRP, IL-6 and TNF-α after rectification age, gestational weeks, weight and the effect of insulin resistance （r=-0.322, -0.324, -0.31; both P0.01）. Conclusion The APN level was significantly decreased in GDM patients, which could lead to inflammatory response imbalance. Thus, APN level might be an important risk factor to cause insulin resistance in GDM patients.