妊娠期糖尿病患者乳汁视黄醇结合蛋白4水平变化及意义

The alteration and significance of retinol binding protein 4(RBP4) in breast milk of patients with gestational diabetes mellitus

目的探讨妊娠期糖尿病(GDM)患者母乳中视黄醇结合蛋白4(RBP4)的变化以及临床意义。方法选择GDM孕妇60例,非GDM正常孕妇45人为对照组。GDM组根据母乳喂养量分为高母乳喂养组及低母乳喂养组。分娩时采集脐血、产后收集初乳及成熟乳,分别用放射免疫(RIA)法和酶联免疫(ELASA)法测定胰岛素和RBP4水平;记录新生儿出生体重和产后复查时体重增加量。结果 GDM组脐带血的RBP4和胰岛素(INS)分别为(14.9±2.6)μg/L和(8.3±1.9)μU/m L,均高于对照组的(12.4±2.7)μg/L和(6.0±2.1)μU/m L(P均<0.01)。GDM组初乳RBP4和INS分别为(16.9±4.2)μg/L和(11.3±3.1)μU/m L,均高于对照组的(13.3±4.5)μg/L和(9.2±2.8)μU/m L(P均<0.01);GDM组成熟乳RBP4(16.1±4.0)μg/L明显高于对照组的(12.5±3.1)μg/L(P<0.01);但是两组胰岛素水平比较差异无统计学意义(P>0.05)。GDM组高母乳喂养者的成熟乳RBP4低于低母乳喂养者(P<0.01);GDM组乳汁RBP4水平影响因素分析显示,初乳RBP4水平均与其对应的胰岛素水平呈正相关(r=0.45,P<0.01);初乳RBP4水平与孕期体重增加量呈正相关(r=0.37,P<0.01);GDM组脐血中的RBP4水平与新生儿出生体重呈正相关(r=0.43,P<0.01)。高母乳喂养组成熟乳中RBP4水平与婴儿体重增加呈负相关(r=-0.49,P<0.01)。结论 GDM母乳中RBP4参与婴儿生长发育调节,母乳喂养者体内RBP4水平较低。

Objective To understand the alteration of retinol binding protein 4 （RBP4）in breast milk of women with gestational diabetes mellitus （GDM）and its clinical significance.Methods Sixty pregnant women diagnosed with GDM were selected as the cases.In the case group,breastfeeding amount reached more than 80% were defined as high -breastfeeding group while less than 20% were defined as low -breastfeeding.At the same time,45 nomal pregnant women were selected as the controls.Cord blood samples were collected during the delivery.Colostrums and mature milk samples were collected after the delivery.RBP4 and insulin concentrations were measured using enzyme -linked immunosorbent assay （ELISA ） and radioimmunoassay （RIA ） respectively.Infant birth weight and weight gain during postpartum reexamination were recorded.Results The concentrations of RBP4 and insulin in cord blood of GDM group （1 4.9 ± 2.6 μg/L and 8.3 ±1 .9 μU /mL）were higher than that in control group（1 2.4 ±2.7 μg/L and 6.0 ±2.1 μU /mL,P 〈0.001 ）.RBP4 and insulin concentrations in colostrums of GDM group （1 6.9 ±4.2 μg/L and 1 1 .3 ±3.1 μU /mL）were higher than in controls （1 3.3 ±4.5 μg/L and 9.2 ±2.8 μU /mL,P 〈0.01 ）.While in mature milk,RBP4 concentrations of GDMgroup were higher than that in controls （1 6.1 ±4.0 μg/L vs.1 2.5 ±3.1 μg/L,P 〈0.01 ）.Insulin concentrationsof two groups were not significantly different.Comparing with low -breastfeeding group,RBP4 concentrations in mature milk of high -breastfeeding group were significantly lower （P 〈0.01 ）.Cord blood RBP4 levels were positively correlated with infant birth weight （r =0.43,P 〈0.01 ）.At the same time,in the colostrums,RBP4 levels were positively correlated with insulin levels （r =0.45,P 〈0.01 ）and maternal weight gain during pregnancy （r =0.37,P 〈0.01 ）.RBP4 concentrations in mature milk of high -breastfeeding group were negatively correlated with weight gain of infants （r =-0.49,P 〈0.01 ）.Conclusion RBP4 in breast milk may be involved in the regulation of infant growth.Breastfeeding may reduce the RBP4 levels in women with GDM.