妊娠期糖尿病母亲乳汁中胃生长素、脂联素、瘦素、真胰岛素水平及其与婴儿生长的关系

Ghrelin, adiponectin, leptin and true insulin levels in human milk from mothers with gestational diabetes mellitus and its relationship with infant growth

目的：探讨妊娠期糖尿病（gestational diabetes mellitus，GDM）产妇初乳和成熟乳中胃生长素、脂联素、瘦素、真胰岛素的水平及其与婴儿体格发育的关系。方法2010年1月至8月在中国医学科学院北京协和医院产科及北京妇产医院产科分娩的妊娠26周确诊为GDM、单胎妊娠、足月分娩、无其他合并症的孕妇及其健康新生儿，共52对，作为GDM组。同期单胎妊娠、足月分娩、无任何合并症的健康产妇及其健康新生儿，共49对，作为对照组。取产妇初乳和90 d的成熟乳，采用酶联免疫吸附试验检测乳汁中胃生长素、脂联素、瘦素及真胰岛素水平，婴儿90日龄时测量体重、身长及头围。采用两独立样本t检验、秩和检验及Spearman相关分析进行统计分析。结果（1）与对照组相比，GDM组胃生长素水平在初乳[136.7（102.7-181.4）与175.4（137.5-235.0）ng/L，t=－2.737]和成熟乳中[111.8（77.5-184.2）与210.9（147.3-381.9）ng/L，t=－3.268]均较低，脂联素水平在初乳[21.7（14.6-51.8）与57.0（23.1-113.9）μg/L，t=－2.858]和成熟乳中[11.7（8.4-14.4）与15.1（11.9-18.5）μg/L，t=－2.625]也较低，真胰岛素水平在初乳[22.8（13.4-50.2）与20.4（7.8-30.8） mU/L，t=－2.007]和成熟乳中[33.6（22.5-54.1）与23.5（13.5-31.6） mU/L，t=－2.009]较高，差异均有统计学意义（P值均＜0.05）。（2）GDM组初乳中，真胰岛素水平与胃生长素水平负相关（r=－0.342），与脂联素水平正相关（r=0.305）；在对照组中，成熟乳中的真胰岛素水平与初乳（r=0.456）和成熟乳中的瘦素水平正相关（r=0.629）；差异均有统计学意义（P值均＜0.05）。（3）GDM组初乳中，脂联素水平与新生儿出生体重负相关（r=－0.323），瘦素/脂联素比值与出生体重（r=－0.403）和出生头围（r=－0.327）负相关；成熟乳中脂联素水平与婴儿90日龄时身长负相关（r=－0.406）。对照组初乳中瘦素/脂联素比值与新生儿出生头围负相关（r=－0.370）；成熟乳中脂联素水平与婴儿90日龄时体重正相关（r=0.432）。差异均有统计学意义（P值均＜0.05）。结论 GDM组母乳中的激素水平与对照组不同，可能共同参与了对婴儿生长的调控作用。

Objective To evaluate the levels of ghrelin, adiponectin, leptin and true insulin in human milk from mothers with and without gestational diabetes mellitus （GDM）, and to assess the effects of these parameters on infant growth. Methods Fifty-two GDM mothers and their healthy infants （GDM group） and 49 non-GDM mothers and their healthy infants （control group） were enrolled from Beijing Obstetrics and Gynecology Hospital and Peking Union Medical College Hospital from January 2010 to August 2010. The levels of ghrelin, adiponectin, leptin and true insulin in colostrum and human milk 90 days postpartum （mature milk） were determined by enzyme-linked immunosorbent assay. Infant weight, length and head circumference at birth and at 90 days old were measured. The two-sample t-test, sum-rank test and Spearman correlation analysis were used for statistical analysis. Results Compared with the control group, ghrelin was significantly lower in human milk from GDM mothers both in colostrum [136.7 （102.7-181.4） vs 175.4 （137.5-235.0） ng/L, t= -2.737] and mature milk [111.8 （77.5-184.2） vs 210.9 （147.3-381.9） ng/L, t= -3.268]. Adiponectin was also significantly lower in human milk from GDM mothers both in colostrum [21.7 （14.6-51.8） vs 57.0 （23.1-113.9）μg/L, t=-2.858] and mature milk [11.7 （8.4-14.4） vs 15.1 （11.9-18.5）μg/L, t=-2.625], however, true insulin level was higher in colostrum [22.8 （13.4-50.2） vs 20.4 （7.8-30.8） mU/L, t=-2.007] and mature milk [33.6 （22.5-54.1） vs 23.5 （13.5-31.6） mU/L, t=-2.009]. The differences were statistically significant （all P 〈 0.05）. （2） In the colostrums of the GDM group, true insulin level was negatively associated with ghrelin （r=-0.342）, but positively associated with adiponectin （r=0.305）. In the control group, the level of true insulin in mature milk was positive associated with leptin in colostrums（ r=0.456）and mature milk（r=0.629）. The differences were statistically significant （all P 〈 0.05）. （3） In the GDM group, adiponectin level in colostrum was negatively associated with neonatal birth weight （r= - 0.323, P=0.025）; the leptin/adiponectin ratio was negatively associated with neonatal birth weight （r= -0.403, P=0.005） and head circumference （r= -0.327, P=0.039） at birth. Adiponectin level in mature milk was negatively associated with infant length 90 days postpartum （r=-0.406, P=0.040）. In the control group, the leptin/adiponectin ratio in colostrum was negatively associated with neonatal head circumference at birth （r= -0.370, P=0.024）. Adiponectin level in mature milk was positively associated with infant weight 90 days postpartum （r=0.432, P=0.007）. Conclusion Women with GDM have different levels of ghrelin, adiponectin and true insulin in their milk from the normal controls, which may affect infant growth.