妊娠期糖尿病胰岛素抵抗与维生素D、炎性因子、性激素相关性研究

Analysis about vitamin D and inflammatory factors,and sex hormones in Gestational diabetes.

目的通过外周血清维生素D(vitamin D,VitD)、炎性因子及雌激素测定,研究妊娠期糖尿病(gestationaldiabetes mellitus,GDM)妊娠晚期VitD与炎性因子及性激素相关关系。方法 GDM 25例,正常对照25例。采用酶联免疫吸附试验测定25(OH)D3、脂多糖(LPS)、肿瘤坏死因子-α(TNF-α)、白介素-6(IL-6)、雌激素、雄激素、空腹血糖、空腹胰岛素等。探讨维生素D、炎性因子及性激素在妊娠糖尿病免疫调控中的意义。结果 GDM组25(OH)D3(26.47±8.6)ng/L显著低于正常妊娠组(35.0±14.9)ng/L,z=-2.0,P=0.045;GDM组胰岛素抵抗指数(3.68±2.04)显著高于正常对照组(2.59±1.67),t=-2.063,P=0.045;GDM组脂多糖(LPS)(766.9±206)μg/L显著高于正常妊娠组(645.9±127.1)μg/L,z=-2.25,P=0.024;GDM组TNF-α(33.85±15.28)pg/m〉显著高于正常妊娠组(23.0±7.9)pg/mL,z=-2.843,P=0.004;GDM组IL-6(4.71±4.9)pg/m显著高于正常妊娠组(3.59±2.94 pg/mL,t=-0.97,P=0.334;GDM组雌激素(5130.70±999.36)ng/L显著高于正常妊娠组(4463.35±1170.40)ng/L,t=-2.167,P=0.035;但雄激素两组差异不显著。25(OH)D3与胰岛素抵抗指数、LPS、TNF-α成负相关系(分别为r=-0.347,P=0.014;r=-0.379,P=0.007;r=-0.281,P=0.048);而与IL-6、雄激素没有相关性。胰岛素抵抗系数与雌激素比较有相关性(r=0.322,P=0.022)。结论妊娠期糖尿病患者中,VitD可能参与抑制体内慢性免疫炎症反应,从而降低胰岛素抵抗,而雌激素过高亦可能为妊娠糖尿病危险因子。

Objective：The study aimed to explore the relationship between serum vitamin D and inflammatory factors and sex hormones of late pregnancy women with gestational diabetes mellitus（GDM）.Methods： 25 women diagnosed with GDM were selected as GDM group and 25ealthy pregnant women as control group.The serum 25-（OH）D,Lipopolysaccharide（LPS）,Tumor Necrosis Factor-α（TNF-α）,Interleukin-6（IL-6）,estrogen,androgen,Fasting glucose（FBG）,Fasting insulin（FINS） were measured in the period around 36~40 gestational weeks.Results： The level of serum 25-（OH）D in GDM group（26.47±8.6）ng/L is significantly lower than control group（35.0±14.9）ng/L（z=-2.0,P=0.045）.The levels of serum LPS,TNF-α,estrogen and IR in GDM group were significantly higher than control group（z=-2.25,P=0.024;z=-2.843,P=0.004;t=-2.167,P=0.035;t=-2.063,P=0.045）.The serum 25-（OH）D3 median was negatively correlated to LPS,Homa IR and TNF-α（r=-0.379,P=0.007;r=-0.347,P=0.014;r=-0.2843,P=0.004）,but not IL-6 and androgen.Conclusions： Vitamin D may participate in the inhibition of chronic immune inflammatory reaction in women with GDM,accordingly it may reduce the IR.Excessive estrogen also may be risk factors for gestational diabetes.