非肥胖型妊娠期糖尿病患者视黄醇结合蛋白-4的变化及影响因素

Variations of retinol-binding protein 4 level of patients with non-obese gestational diabetes mellitus and the influence factors

目的观察孕前体质量正常的妊娠期糖尿病（GDM）患者血清视黄醇结合蛋白4（RBP4）的变化,并分析其影响因素。方法选择正规建卡产检、孕前体质量指数（BMI）为16～25 kg/m^2的177例GDM患者为研究对象,并以同期在该院产检的354名年龄和BMI匹配的健康孕妇为对照组。均于孕24～28周行75 g葡萄糖耐量试验（OGTT）,观察指标包括孕24～28周体质量增加值、RBP4、OGTT（0、30、60、120和180 min）血糖浓度及血清胰岛素水平、糖化血红蛋白（HbA1C）、血清总胆固醇（TC）、三酰甘油（TG）、低密度脂蛋白（LDL）、高密度脂蛋白（HDL）、稳态模型胰岛素抵抗（HOMA-IR）指数和稳态模型分析胰岛素分泌指数（HOMA-%B）。结果 GDM组孕期体质量增加显著高于对照组,差异有统计学意义（P〈0.05）。GDM组OGTT各时间点血糖、胰岛素、HOMA-IR指数、HbA1C、TG浓度均显著高于对照组（P〈0.001）,2组间TC、HDL、LDL浓度以及HOMA-%B比较差异无统计学意义（P〉0.05）。Pearson相关分析显示：GDM组的血清RBP4水平与孕中期体质量增加值、TC、HDL、LDL、空腹血糖（FPG）及HbA1C均呈显著正相关（P〈0.05）,与HOMA-%B呈显著负相关（P〈0.05）。逐步多元回归分析结果显示：进入回归方程的参数依次是FPG、孕期体质量增加值和TC（r^2=0.180,P〈0.01）。结论孕前体质量正常的GDM孕妇妊娠中期血清RBP4水平显著升高;孕期体质量增加以及FPG和TC浓度与血清RBP4水平呈正相关。

Objective To observe variations of the serum retinol-binding protein 4（RBP4） level of patients with gestational diabetes mellitus（GDM） whose body mass index（BMI） were normal before pregnancy and to analyze the influence factors. Methods A total of 177 patients with GDM who underwent normal antenatal examinations were selected.Their body mass indexes before pregnancy were 16- 25 kg /m^2. And 354 health pregnant women who underwent antenatal examinations at the same hospital and same period were selected as controls and their age and BMI matched with GDM patients.The 75 g oral glucose tolerance test（ OGTT） was conducted in 24- 28 gestational weeks. Observed indexes included the body mass increase during 24- 28 gestational weeks, RBP4, blood sugar and serum insulin levels form OGTT（ 0, 30, 60, 120, and 180 min）,glycosylated hemoglobin（HbA1C）, total cholesterol（TC）, triacylglycerol（TG）, low density lipoprotein（LDL）, high density lipoprotein（HDL）, homeostasis model assessment of insulin resistance（ HOMA-IR）index, and homeostasis model assessment of β-cell function（HOM A-%B）. Results The mean body mass increase of patients with GDM was significantly higher than that of controls and the difference was statistically significant（ P 〈0. 05）.The plasma glucose and serum insulin levels at each time point of OGTT, HOM A-IR index, HbA1 C, and T G level of patients with GDM were significantly higher than those of controls（ P 〈0. 001）.The differences of TC, HDL, LDL, and HO M A-% B of patients with GDM and controls were not statistically significant（ P〉 0. 05）. Pearson＇s correlation analysis showed that the serum RBP4 level of patients with GDM was significantly and positively correlated with the body mass increase during mid-trimester, TC,HDL, LDL, fasting plasma glucose（ FPG）, and HbA1C（ P〈 0. 05）, and significantly and negatively correlated with HOM A-% B（ P〈 0. 05）. Results of multiple stepwise regression analysis showed that parameters that were included in the regression equation were FPG, body mass increase during pregnancy, and TC（ r^2= 0. 180,P〈 0. 01）. Conclusion The serum RBP4 level of GDM women with normal pre-pregnancy body mass increases significantly during mid-trimester. Body mass increase during pregnancy, FPG level, and TC level were positively correlated with the serum RBP4 level.