妊娠期糖尿病患者脂肪组织中血清淀粉样蛋白A的表达和意义

Significance of serum amyloid A expression in adipose tissues of patients with gestational diabetes mellitus

目的 探讨血清淀粉样蛋白A（SAA）在妊娠期糖尿病脂肪组织中的表达及与胰岛素抵抗和体质量指数的关系.方法 选取单胎足月剖宫产分娩的妊娠期糖尿病孕妇30例为研究组,随机选取同期住院分娩的糖耐量正常孕妇30例为对照组.根据身高、体质量计算孕前、分娩时体质量指数及孕期体质量增长值;采用氧化酶法检测空腹血糖（FBG）,放射免疫法检测空腹胰岛素（FINS）水平,计算胰岛素抵抗指数（HOMA-IR）;ELISA法检测孕妇血清SAA水平;RT-PCR检测内脏及皮下脂肪组织中SAA1的mRNA的表达丰度;比较两组孕妇内脏脂肪及皮下脂肪组织的SAA1 mRNA表达量,分析其与血清的SAA、HOMA-IR及体质量指数等各项指标的关系.结果 妊娠糖尿病（GDM）组的内脏及皮下脂肪组织SAA1mRNA的表达丰度（0.447±0.069,0.291±0.067）高于对照组（0.194±0.070,0.231±0.068,P＜0.01）,血清SAA水平[（21.038±6.648）mg/L]及HOMA-IR（4.168±2.416）高于对照组[（14.384±12.770） mg/L,2.045±1.008,P＜0.05];60例孕妇内脏及皮下脂肪组织SAA1 mRNA表达丰度与血清SAA水平呈正相关（r=0.353,0.342,P＜0.01）;内脏脂肪组织SAA1 mRNA表达丰度与孕前及分娩时体质量指数、孕期体质量增长及HOMA-IR呈正相关（r=0.543,0.644,0.340,0.473,P＜0.01）,皮下脂肪组织SAA1mRNA与孕前、分娩时体质量指数及HOMA-IR呈正相关（r=0.788,0.693,0.504,P＜0.01）,而与孕期体质量增长无相关（r=0.013,P＞0.05）.结论 SAA1 mRNA在GDM患者皮下及内脏脂肪组织表达上调,与体质量指数及胰岛素抵抗密切相关,可能通过增加胰岛素抵抗参与GDM的形成,可作为GDM的一种新的监测因子.

Objective To investigate the expression of serum amyloid A （SAA） in patients adipose tissue with gestational diabetes mellitus （GDM） and the correlations between SAA and insulin resistance （IR） and body mass index （BMI）.Methods A total of 60 single full-term pregnant women underwent cesarean section from June 2013 to December 2013 was enrolled in this study （GDM group,n =30;control group,n =30）;serum SAA level was detected with Enzyme-Linked Immunosorbent Assay （ELISA）;and mRNA expression of SAA1 in adipose tissue was determined by reverse transcription PCR （RT-PCR）;SPSS software was used to compare these markers,and the correlations between SAA and HOMA-IR,BMI were analyzed with Pearson correlation method.Results SAA,mRNA expressions in omental and subcutaneous fat in GDM group （0.447 ± 0.069,0.291 ± 0.067） were significantly higher than those in control group （0.194 ± 0.070,0.231 ± 0.068,P 〈 0.01）.Serum SAA levels [（21.038 ± 6.648） mg/L] and homeostasis model assessment of insulin resistance（HOMA-IR） （4.168± 2.416） in GDM group were significantly higher than those in control group [（14.384 ± 12.770） mg/L,2.045 ± 1.008,P 〈 0.05];SAA1 mRNA expression levels in omental and subcutaneous fat were positively correlated with serum SAA （r =0.353,0.342,P 〈 0.01）.SAA1 mRNA expression levels in omental were positively correlated to pregestational BMI,late gestational BMI,weight gain in pregnancy and HOMA-IR （r =0.543,0.644,0.340,0.473,P 〈 0.01）,and SAA1 mRNA expression levels in subcutaneous fat were positively correlated to pregestational BMI,late gestational BMI,and HOMA-IR （r =0.788,0.693,0.504,P 〈 0.01）,but was no correlation with weight gain in pregnancy（r =0.013,P 〉 0.05）.Conclusions SAA mRNA expressions in omental and subcutaneous fat in GDM group and serum SAA levels increase,which is positively correlated with BMI and the degree of insulin resistance,SAA may participate in the formation of GDM by increasing insulin resistance.SAA may be used as a new monitor of GDM.