妊娠糖尿病患者血清FGF21与胰岛素抵抗及胰岛细胞功能的相关性研究

Serum fibroblast growth factor 21 levels in gestational diabetes mellitus in relation to insulin resistance and pancreatic beta-cell functionl

目的探讨妊娠糖尿病（GDM）患者胰岛素抵抗（IR）、胰岛细胞功能与空腹血清成纤维细胞生成因子（FGF21）之间的关系。方法选取妊娠24～28周孕妇90例，根据口服葡萄糖耐量试验（OGTT）结果均分为GDM组和正常对照（NGT）组，并根据空腹血糖（FPG）是否大于7．0mmol／L，将GDM组分为GDMl组（5．1mmol／L≤FPG〈7．0mmol／L，n=27）和GDM2组（FBG≥7．0mmol／L，n=18）两亚组。采用酶联免疫吸附（ELISA）法检测各组空腹血清FGF21水平，同时测定各受试者的体格指标及OGTT各点血糖、胰岛素和c肽等，并计算稳态模型胰岛素抵抗指数（HOMA—IR）、胰岛β细胞功能指数（HOMA—β）、胰岛素曲线下面积（AUCINS）／血糖曲线下面积（AUCGLU）和早期胰岛素分泌功能指数（△I30／△G30），分析FGF21与这些指标之间的关系。结果GDM1组和GDM2组的FGF21水平均显著高于正常对照组，差异均有统计学意义（P〈0．01）；GDM2组的FGF21水平高于GDM1组，差异有统计学意义（P〈0．01）。Pearson相关分析显示，FGF21与孕前体重指数（BMI）、FPG、30minPG、1hPG、2hPG、HOMA—IR、AUCGLU呈正相关，与HOMA—β呈负相关。多元逐步线性回归分析显示，FPG是影响FGF21水平的独立影响因素。结论FGF21与IR呈正相关，与胰岛细胞功能负相关，其可能在GDM的发病机制中发挥一定作用。

Objective To investigate serum fibroblast growth factor 21 levels in gestational diabetes mellitus in relation to insulin resistance （IR） and pancreatic beta-cell function. Methods A 75-g oral glucose tolerance test （OGTT） was performed among ninty pregnant women between 24 to 28 gestational weeks. The ninty pregnant women were averagely divided into gestational diabetes meLlitus（GDM） group and normal control（NGT） group according to OGTT. Meanwhile, based on fasting plasma glucose（FPG） weather higher than 7.0 retool/L, the GDM group was divided into GDM1 group （5. 1 mmol/L ≤ FPG 〈 7.0 retool/L, n = 27） and GDM2 group （ FBG ≥7.0 mmol/L,n = 18）. Fasting serum FGF21 levels were measured by enzyme-linked immunosorbent assay（ELISA）. Meanwhile, the anthropometrie parameters, glucose, insulin, e-peptide were alse measured and HOMA-insulin resistance index （ HOMA-IR）, HOMA-β-cell insulin secretion index （ HOMA-β ）, area under insulin （ AUCINS ）/area under glucose （AUCGLU） and early insulin secretion index （△I30/△G30）were calculated. The associations of FGF21 with these parameters were analyzed. Results Serum FGF21 levels were significantly higher in patients with GDM1 and GDM2 than in controls （P 〈 0. 01 ） , and GDM2 group was also higher than GDM1 group （ P 〈 0.01 ）. Fasting serum FGF21 was found to correlate positively with body mass index （BMI） before pregnancy, FPG, 30minPG, lhPG, 2hPG, HOMA-IR, and AUCGLU, but negatively with HOMA-β. Furthermore, multiple stepwise regression analysis showed that FPG was the independent influencing factor of serum FGF21 level. Conclusion FGF21 positively correlates with IR, while negatively correlates with pancreatic beta-cell functionl. FGF21 may play a role in the pathogenesis of GDM.