妊娠糖尿病患者血清脂联素水平变化及其与炎症因子胰岛素抵抗的关系

The Relationship of Adiponectin Levels in Serum and Inflammatory Cytokines Insulin Resistance of Gestational Diabetes

目的:研究妊娠糖尿病患者血清脂联素(APN)水平变化及其炎症因子、胰岛素抵抗的关系。方法:选取2012年6月至2014年6月产检孕妇为妊娠组(n=110例),根据糖耐量的结果将孕妇分为妊娠糖尿病组(n=48例)和非妊娠糖尿病组(n=62例),另选取非妊娠的健康育龄妇女为对照组(n=60例),应用酶联免疫吸附实验(ELISA)检测入选者的APN、肿瘤坏死因子-a(TNF-a)、白细胞介素(IL)-6,应用免疫比浊法测定高敏C反应蛋白(hs-CRP)的水平,并测定所有入选者的空腹胰岛素(Fins)、稳态胰岛素评估模型胰岛素抵抗(HOMA-IR)以及甘油三脂水平。结果:妊娠组血清IL-6、hs-CRP、TNF-a、TG、Fins和HOMA-IR分为为(29.1±0.4)pg/m L、(4.3±0.2)ng/m L、(31.3±0.5)pg/m L、(1.8±0.1)mmo L/L、(9.4±0.2)m U/L、(2.1±0.3)均显著高于对照组,比较差异具有统计学意义(t=8.792,9.173,9.068,10.026,9.957,9.819,P=0.038,0.027,0.029,0.021,0.023,0.025),APN水平(10.2±0.2)mg/L显著低于对照组,比较差异具有统计学意义(t=8.968,P=0.032);妊娠糖尿病组血清IL-6、hs-CRP、TNF-a和HOMA-IR分别为(36.1±0.3)pg/m L、(6.9±0.3)ng/m L、(46.7±0.9)pg/m L和(3.0±0.2)显著高于非妊娠糖尿病组,两组比较差异具有统计学意义(t=10.021,9.796,8.935,9.012,P=0.026,0.031,0.034,0.029),APN水平(7.1±0.2)mg/L显著低于非妊娠糖尿病组,比较差异具有统计学意义(t=9.052,P=0.019);APN和IL-6、hs-CRP、TNF-a、TG、Fins、HOMA-IR具有负相关关系(r=-0.389,-0.381,-0.382,-0.402,-0.391,P=0.019,0.023,0.025,0.018,0.031)。结论:妊娠糖尿病患者的APN水平会显著降低,会引起炎症反应失衡,可能是胰岛素抵抗的重要因素。

Objective：To study the relationship of adiponectin levels in serum and inflammatory cyto-kines, insulin resistance of gestational diabetes. Method： 110 pregnant were selected as pregnancy group from our hospital from June 2012 to June 2014, they were divided into gestational diabetes group （ n = 48 patients） and non-pregnant diabetic group （ n = 62 patients） according to the results of glucose tolerance, healthy women of child bearing age were also selected as the control group（n = 60 patients）, the APN, tumor necrosis factor-a （ TNF-a）, interleukin （ IL） -6 of inductees were detected in enzyme-linked immu-nosorbent assay （ ELISA）, the level of high-sensitivity C-reactive protein （ hs-CRP ） were detected in im-munoturbidimetry, the fasting insulin （ Fins ）, homeostasis model assessment of insulin resistance insulin （ HOMA-IR） and triglyceride level of all inductees were detected. Result： The level of IL-6, hs-CRP, TNF-a, TG, Fins and HOMA-IR of the pregnancy group were （29.1 ± 0.4） pg / mL, （4.3 ± 0.2） ng /mL, （31.3 ± 0.5） pg / mL, （1.8 ± 0.1） mmoL / L, （9.4 ± 0.2） mU / L, （2.1 ± 0.3） significantly high-er than the control group, the difference was statistically significant（t=8.792,9.173,9.068,10.026,9.957, 9.819,P=0.038,0.027,0.029,0.021,0.023,0.025）, the level of APN was （10.2±0.2）mg/L significantly lower than the control group, the difference was statistically significant （ t=8.968,P=0.032）;the IL-6, hs-CRP, TNF-a and HOMA-IR of the gestational diabetes group were （36.1 ± 0.3） pg / mL, （6.9 ± 0.3） ng/ mL, （46.7 ± 0.9） pg / mL and （3.0 ± 0.2） significantly higher than the non-pregnant diabetic group, the difference was statistically significant（t=10.021,9.796,8.935,9.012,P=0.026,0.031,0.034,0.029）, the level of APN was （7.1±0.2）mg/L,which was significantly lower than the non-pregnant diabetic group, the difference was statistically significant（ t=9.052,P=0.019）; APN and IL-6, hs-CRP, TNF-a, TG, Fins, HOMA-IR had a negative correlation（ r=-0.389,-0.381,-0.382,-0.402,-0.391,P=0.019,0.023, 0.025,0.018,0.031）. Conclusion： The level of APN of gestational diabetes can significantly reduce, can cause inflammation imbalance, may be an important factor in insulin resistance.