妊娠期糖尿病孕妇血清载脂蛋白M与胰岛素和瘦素的关系

Relationship of serum apolipoprotein M with insulin and leptin in pregnant women with gestationai diabetes mellitus

目的探讨妊娠期糖尿病（GDM）孕妇血清载脂蛋白M（ApoM）与胰岛素和瘦素之间的关系。方法GDM孕中期组（孕24—28周）87例、孕晚期组（分娩前1周）122例，对照组为同孕期正常孕妇，检测血清中载脂蛋白M（ApoM）、胰岛素、瘦素的表达水平，分析指标间的相关性。结果孕中期GDM孕妇ApoM表达水平（0．029±0．010）g／L显著低于同孕期正常对照组（0．036±0．013）g／L（t=-4．168，P=00001），孕晚期GDM孕妇ApoM表达水平（0．028±0．010）g／L显著高于同孕期正常对照组（0．023±0．008）g／L（t=3．529，P=0．0005）。孕中期GDM组的胰岛素表达水平、胰岛素抵抗指数均高于同孕期正常对照组[胰岛素表达水平：12．975（7．968～22．237）比6．885（4．805—10．015）μg/L，Z=-5．618，P=0．000；胰岛素抵抗指数2．808（1．705～5．158）比1．336（0．897—1．925），Z=-6．305，P=0．000]，瘦素水平[0．026（0．015～0．044）比0．024（0．014—0．036）ng／L]两组比较差异无统计学意义（Z=-0．927，P=0．354）；孕晚期GDM组和同孕期正常对照组比较，胰岛素表达水平[9．5（5．645～13．265）比9．82（6．708—15．885）μg/L，Z=0．971，P=0．332]、胰岛素抵抗指数[1．637（0．977～2．471）比1．781（1．121—2．686），Z=0．904，P=0．366]和瘦素[0．025（0．015—0．044）比0．029（0．015～0．043）ng／L，Z=0．494，P=0．621]差异均无统计学意义。采用多因素非条件Logistic回归分析显示，ApoM表达水平是GDM的独立危险因素。结论妊娠期糖尿病孕妇血清ApoM表达异常，ApoM可能与GDM的发生有一定的关系，但胰岛素和瘦素与ApoM之间无相关性。

Objective To explore the relationship of serum apolipoprotein M （ApoM） with insulin and leptin in pregnant women with gestational diabetes mellitus （GDM）. Methods Totally 209 pregnant women with GDM （87 in the second trimester and 122 in the third trimester） and 221 normal pregnant women （99 in the second trimester and 122 in the third trimester） were enrolled in this study. Serum ApoM, insulin and leptin levels were determined. Results The serum ApoM level of GDM women in the second trimester was significantly lower than that in controls [ （0.029 ±0.010） g/L vs （0.036 ±0.013） g/L, t = -4.168, P= 0. 0001 ） ] ; also, the serum ApoM level of GDM women in the third trimester was significantly higher than that of controls [ （0. 028 ±0. 010） g/L vs （0. 023 ±0. 008） g/L, t =3. 529, P =0. 0005） ]. The serum insulin levels and insulin resistance index of GDM women in the second trimester were significantly higher than those of controls [insulin levels： 12. 975 （7. 968 -22. 237） μg/L vs 6. 885 （4. 805 - 10. 015） μg/L, Z= -5. 618, P =0. 000; insulin resistance index： 2. 808 （ 1. 705 -5. 158） vs 1. 336 （0. 897 - 1. 925）, Z = -6. 305, P = 0. 000 ]. Multivariate non-conditional Logstic regression analysis showed that there was statistical difference of ApoM level between GDM women and controls after adjusting for potential confounders （ GDM in the second trimester, Z = - 3.69, P = 0. 020 ; GDM in the third trimester, Z = - 2. 25, P = 0. 025 ）. Conclusions The serum ApoM levels is abnormal in pregnant women with GDM. ApoM may play a role in the development of GDM; however, no correlation exists between ApoM and insulin/leptin.