妊娠糖尿病患者空腹血清Apelin-36水平变化及相关性研究

Changes of fasting serum Apelin-36 and relative factors in patients with gestational diabetes mellitus

目的探讨妊娠糖尿病(GDM)患者空腹血清Apelin-36水平变化及其与临床指标的相关性。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组和正常糖耐量(NGT)组,并根据孕前体质量指数(BMI孕前)24 kg/m2为切割点,将GDM组和NGT组分别再分为体质量正常组和超重组。采用酶联免疫吸附(ELISA)法检测各组空腹血清Apelin-36水平,同时检测各受试者三酰甘油(TG)、胆固醇(TC)、低密度脂蛋白(LDL)及OGTT各点血糖、胰岛素和C肽等指标,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)和混合胰岛素敏感度指数(ISIcomp),分析Apelin-36与这些指标之间的关系。结果 GDM组Apelin-36水平显著高于NGT组,差异有统计学意义(P<0.05);GDM-OB组Apelin-36水平高于GDM-NW组,差异有统计学意义(P<0.05),而NGT-NW组和NGT-OB组Apelin-36水平差异无统计学意义(P>0.05)。Pearson相关分析显示,Apelin-36与BMI孕前、FPG、30 min PG、1 h PG、2 h PG、FINS、TC、HOMA-IR正相关,与HOMA-β、ISIcomp负相关。多元逐步线性回归分析显示,BMI孕前及FINS是影响Apelin-36水平的独立相关因素。结论 Apelin-36与胰岛素抵抗正相关,与胰岛细胞功能负相关,提示其可能与GDM的发病有一定的关联。

Objective To evaluate the fasting serum Apelin-36 levels and their relative factors in gestational diabetes melli-tus.Methods A 75-g oral glucose tolerance test(OGTT)was performed among 90 pregnant women between 24 to 28 gestational weeks.The pregnant women were averagely divided into gestational diabetes mellitus(GDM)group and normal glucose tolerance(NGT)group according to OGTT.Meanwhile,based on body mass index (BMI)higher than 24 kg/m2 or not,the GDM group and NGT group were subdivided into normal weight group and overweight group.Fasting Apelin-36 levels were measured by enzyme-linked immunosorbent assay(ELISA).Mean-while,the anthropometric parameters,glucose,insulin,c-peptide,triglycerides,cholesterol(TC),low density lipoprotein(LDL)were also meas-ured,and HOMA-insulin resistance index(HOMA-IR),HOMA-β-cell insulin secretion index(HOMA-β),composite insulin sensitivity(ISI-comp)were calculated.The associations of Apelin-36 with these parameters were analyzed.Results Serum Apelin-36 levels were significant-ly higher in patients with GDMthan in NGT group,and the difference was statistically significant(P<0.05);serum Apelin-36 levels in GDM-OB group was also higher than those in GDM-NW group,and the difference was statistically significant(P<0.05);the difference in Apelin-36 between NGT-NW group and NGT-OB group was not statistically significant.According to Pearson analysis,fasting serum Apelin-36 was corre-lated positively with BMI before pregnancy,FPG,30 min PG,1 h PG,2 h PG,FINS,TC and HOMA-IR,but negatively with HOMA-βand ISI-comp.Furthermore,multiple stepwise regression analysis showed that BMI before pregnancy and FINS were the independent influencing factors of serum Apelin-36 levels.Conclusions Apelin-36 is positively correlated with insulin resistance,but negatively correlated with pancreatic beta-cell function,indicating that it may be in relation to the pathogenesis of GDM.