内脂素在妊娠期糖尿病发病中的作用及其与胰岛素抵抗的关系

Role of visfatin in the pathogenesis of gestational diabetes mellitus and its relationship with insulin resistance

目的 探讨内脂素在妊娠期糖尿病（GDM）发病中的作用及其与胰岛素抵抗的相关性.方法 选择2013年1月至6月于河北省人民医院妇产科就诊的孕24～ 28周的单胎孕妇58例,根据75 g口服葡萄糖耐量试验（OGTT）结果,分为GDM组30例和健康妊娠（NGT）组28例;同期在体检中心健康体检的糖耐量正常的2型糖尿病一级亲属妇女14例作为高危对照组,糖耐量正常的健康未孕育龄妇女27例为正常对照组.采用葡萄糖氧化酶法检测各组妇女空腹血糖（FPG）、餐后1h及2h血糖水平;采用放射免疫法检测各组妇女空腹胰岛素（FIN）水平并计算稳态模型胰岛素抵抗指数（HOMA-IR）;检测各组妇女的总胆固醇（TC）、甘油三酯（TG）、高密度脂蛋白（HDL）及低密度脂蛋白（LDL）水平;ELISA法测定血清内脂素水平.结果 （1）GDM组、高危对照组和正常对照组妇女的FPG水平[分别为（5.5±0.7）、（5.1±0.6）、（5.2±0.4）mmol/L]明显高于NGT组[（4.5±0.3）mmol/L],分别比较,差异均有统计学意义（P＜0.05）.（2）GDM组妇女FIN水平[（14±6）mU/L]、HOMA-IR（4.0±2.0）、餐后1 h[（10.9±1.8） mmol/L]及2 h[（8.6±1.8） mmol/L]血糖水平,明显高于NGT组[分别为（12±4） mU/L、2.0±1.0、（7.4±1.3）及（6.2±0.9）mmol/L],分别比较,差异均有统计学意义（P＜0.05）.（3）GDM组妇女TC、TG、HDL及LDL水平分别为（5.5±0.9）、（2.8±0.8）、（1.8±0.4）及（3.3±0.8）mmol/L,NGT组妇女分别为（5.9±0.8）、（2.5±0.7）、（1.9±0.4）及（3.4±0.6） mmol/L,两组妇女血脂水平均明显高于高危对照组及正常对照组,分别比较,差异均有统计学意义（P＜0.05）.（4）GDM组及NGT组妇女血清内脂素水平[分别为（43±10）、（45±12） μg/L]显著高于高危对照组及正常对照组[分别为（29±9）、（36±7） μg/L],分别比较,差异均有统计学意义（P＜0.05）;但高危对照组妇女血清内脂素水平则明显低于正常对照组,差异有统计学意义（P＜0.05）;GDM组妇女血清内脂素水平虽略低于NGT组,但差异无统计学意义（P＞0.05）.（5）NGT组妇女内脂素水平与FPG、HOMA-IR和TC呈负相关（r=-0.38、-0.44、-0.47,P＜0.05）.GDM组妇女内脂素水平与FPG、HOMA-IR和TC均无相关性（r=-0.16、-0.01、0.33,P＞0.05）.而正常对照组血清内脂素水平与FPG和餐后2h血糖呈负相关（r=-0.48、-0.42,P＜0.05）.结论 内脂素可能是参与GDM妇女糖及脂肪代谢的重要脂肪因子,并与GDM发病和胰岛素抵抗相关.

Objective To investigate the role of visfatin in the pathogenesis of gestational diabetes mellitus （GDM）and its correlation with insulin resistance.Methods The study recruited 58 pregnant women of 24 to 28 gestational weeks in People＇ s Hospital of Hebei Province from January to June 2013.Among them,30 were patients with GDM （GDM group）,28 had normal oral glucose tolerance test and was referred as healthy pregnancy group （NGT group）.Fourteen age-matched female who were first-degree relatives （FDR1）of type 2 diabetes mellitus patients,and 27 healthy nonpregnant women with normal oral glucose tolerance test were referred as high-risk group and normal controls （NC）,respectively.The fasting plasma glucose （FPG）,1 hour and 2 hours postprandial glucose levels were measured by glucose oxidase method.The fasting insulin （FIN）levels were measured by radioimmunoassay and the homeostatic model assessment-insulin resistance index （HOMA-IR）was calculated.The levels of total cholesterol （TC）,triglycerdes （TG）,high density lipoprotein cholesterol （HDL）and low density lipoprotein cholesterol （LDL）were determined.The visfatin levels were measured by ELISA.Results （1）The levels of FPG were significantly higher in GDM,FDRI and NC group [（5.5±0.7）,（5.1±0.6）,（5.2±0.4） mmol/L] than that in NGT group [（4.5 ± 0.3） mmol/L],respectively （P＜0.05）.（2） The levels of INS [（14 ± 6） mU/L],HO MA-I R （4.0±2.0）,1 hour [（10.9± 1.8） mmol/L] and 2 hours [（8.6± 1.8） mmol/L] postprandial glucose levels of GDM group were significantly higher than those in NGT group [（12±4） mU/L,2.0± 1.0,（7.4± 1.3） and （6.2 ±0.9） mmol/L],respectively （P＜0.05）.（3）The levels of TC,TG,HDL and LDL levels in GDM group were （5.5±0.9）,（2.8±0.8）,（1.8±0.4）and（3.3±0.8） mmol/L,and were（5.9 ± 0.8）,（2.5 ± 0.7）,（1.9 ± 0.4） and （3.4 ± 0.6） mmol/L in NGT group.The levels of lipid in the two groups were significantly higher than those in FDR 1 or NC group,respectively （P＜0.05）.（4） The levels of visfatin in GDM group and NGT group [（43 ± 10）,（45 ± 12） μg/L] were significantly higher than that in FDR1 or NC group [（29±9）,（36±7） μg/L],respectively （P＜0.05）,but the visfatin levels in FDR 1 group were significantly lower than that in NC group （P＜0.05）.The visfatin levels in GDM group were slightly lower than that in NGT group,but the difference was not statistically significant （P＞0.05）.（5）The visfatin levels in NGT group were negatively correlated to the levels of FPG,HOMA-IR and TC（r=-0.38,-0.44,-0.47,respectively,P＜0.05）.But the visfatin levels in GDM group were not correlated with the levels of FPG,HOMA-IR,TC （r=-0.16,-0.01,0.33,respectively,P＞ 0.05）.While in NC group,the levels of visfatin were negatively correlated with FPG and 2 hours postprandial glucose （r=-0.48,-0.42,respectively,P＜0.05）.Conclusion Visfatin may be an important adipokine that involved in the carbohydrate and lipid metabolism in GDM,and is related to the pathogensis of GDM and insulin resistance.