妊娠期糖尿病患者母儿血清与胎盘瘦素水平及相关性研究（英文）

Changes of Leptin Level in Serum, Cord Venous Blood and Placenta in Women with Gestational Diabetes Mellitus and Correlations with Insulin and C-Peptide

目的探讨妊娠期糖尿病(gestational diabetes mellitus,GDM)患者母儿血清瘦素(leptin,LP)、胰岛素(insulin,INS)水平及胎盘瘦素表达的变化情况,及母儿血清瘦素、胎盘瘦素表达水平与其血清C肽(C-peptide,C-P)的关系。方法 GDM患者40例为GDM组,给予常规的糖尿病饮食指导,血糖监测,必要时应用胰岛素治疗。同期75g葡萄糖耐量试验(oral glucose tolerance test,OGTT)正常的孕妇40例为对照组。采用酶联免疫吸附法测定患者外周血清和脐静脉血清瘦素、胰岛素及C肽水平,免疫组织化学法测定胎盘瘦素表达。结果(1)GDM组患者外周血清存在较高的瘦素、胰岛素及C肽水平,与对照组比较差异有统计学意义(P<0.01,P<0.05,P<0.01)。(2)GDM组患者脐血瘦素、胰岛素水平明显升高,与对照组比较差异有统计学意义(P<0.01,P<0.05);两组脐血C肽水平差异无统计学意义。(3)GDM组患者胎盘瘦素表达水平高,与对照组比较差异有统计学意义(P<0.01);GDM组胎盘瘦素表达水平与脐血瘦素、脐血胰岛素、新生儿体重及新生儿Ponderal指数呈正相关关系(r=0.37,P<0.05;r=0.39,P<0.05;r=0.53,P<0.01;r=0.54,P<0.01),与母血瘦素无相关性。结论(1)妊娠晚期GDM母儿均存在高瘦素血症和高胰岛素血症。(2)GDM母儿瘦素及胰岛素之间相互调节功能紊乱,二者可能存在胰岛素抵抗和瘦素抵抗。

Objective To investigate the changes of leptin levels in serum, cord venous blood and placenta and examine the possible relationships among them in women with gestational diabetes mellitus （GDM）. Methods This case-control study was performed in 40 women with GDM and 40 normal women. The women with GDM received dietary advice, blood glucose monitoring and insulin treatment when necessary. Maternal serum and venous cord blood leptin, insulin and C-peptide levels were detected by ELISA. The expression level of leptin in placenta was measured by an immunohistochemical method. Results 1. Leptin, insulin and C-peptide levels in serum of the women with GDM were significantly higher than those of the normal women （P〈0.01, P〈0.05, P〈0.01）. 2. Cord venous blood leptin and insulin in GDM group were significantly higher than in the normal group （P〈0.01, P〈0.05）. No significant difference was found in cord venous blood C-peptide between two groups. 3. The expression of placenta leptin protein was significantly higher in GDM women than in normal women （P〈0.01）. There were positive correlations between placental leptin, cord venous leptin and insulin, birth weight, ponderal index in GDM women （r=0.37, P〈0.05; r=0.39, P〈0.05; r=0.53, P〈0.01 ; r=0.54, P〈0.01）. However, there was no correlation between placental leptin and serum leptin. Conclusion The women with GDM and their fetuses suffer from hyperleptinaemia and hyperinsulinaemia. In the women with GDM, there was disorder in the interaction between leptin and insulin. The GDM women and their fetuses may be prone to insulin resistance and leptin resistance in late pregnancy.