妊娠期糖尿病患者血浆纤维蛋白原、血脂水平与胰岛素抵抗的相关性研究

Relationship between insulin resistance and serum ferritin,blood lipids level in patients with gestational dia-betes mellitus

目的：探讨妊娠期糖尿病（GDM）患者血浆纤维蛋白原（FIB）、血脂水平与胰岛素抵抗（IR）的关系。方法选择孕中期（妊娠24～28周）孕妇127例，按美国糖尿病学会（ADA）2009年 GDM诊断标准，将孕妇分为 GDM组（37例）、妊娠期糖耐量受损组（GIGT 组，30例）和糖耐量正常组（NGT 组，60例），测定三组受试者的身高、体质量、空腹血糖（FBG）、空腹胰岛素（FIN）、血脂、FIB 水平，并计算胰岛素抵抗指数（HOMA-IR）、体质指数（BMI）。结果孕中期，GDM孕妇 BMI、FBG、FIN、HOMA-IR、TC、TG、LDL-C、FIB 水平明显高于GIGT 及 NGT 孕妇，HDL-C 明显低于 GIGT 及 NGT 孕妇，差异均有统计学意义（F ＝69．29、98．15、70．32、141.43、61．92、106．06、157．06、90．59、25．25，均 P ＜0．01）。FIB 与 BMI、FBG、FIN、HOMA-IR、TC、TG、LDL-C水平呈显著正相关（r ＝0．441、0．682、0．506、0．599、0．493、0．591、0．633，均 P ＜0．01），与 HDL-C 呈负相关（r ＝－0．419，P ＜0．01）。多元逐步回归分析提示，BMI、LDL-C、TG、FBG 是影响 FIB 的独立危险因素（t ＝7.683、2．678、3．184、3．844，均 P ＜0．01），FIB、BMI、FBG、FIN、TC 是影响 HOMA-IR 的独立危险因素（t ＝68．784、3．201、29．702、58．100、2.904，均 P ＜0．01）。结论孕中期 GDM孕妇存在 IR 和血脂紊乱，FIB 过量表达与之密切相关。

Objective To explore the relationship between insluin resistance（IR）and plasma fibrinogen, blood lipids levels in patients with gestational diabetes mellitus （GMD）.Methods Totally 127cases pregnant women in their 24 -28 gestational weeks were divided into GDM group（n =37）,gestational impaired glucose tolerance test （GIGT）group（n =30）and normal glucose tolerance（NGT）group（n =60）based on the American Diabetes Associ-ation（ADA）2009 GDMdiagnostic standards.All selected cases＆#39;s height,weight,fasting blood glucose （FBG）,fasting insulin （FIN）,blood lipids and fibrinogen（FIB）level were tested,and their body mass index（BMI）and IR index （HOMA -IR）were calculated.Results During the mid -trimester,the levels of BMI,FIB,HOMA -IR,FBG,FIN, triglyceride （TG）,cholesterol（TC）,low density lipoprotein -cholesterol （LDL -C）in the GDM group were signifi-cantly higher than the GIGT and NGT groups.However,high density lipoprotein -cholesterol （HDL -C）was signifi-cantly lower （F =69.29,98.15,70.32、141.43、61.92,106.06,157.06,90.59,25.25,all P 〈0.01）.FIB was sig-nificantly positively correlated with BMI,FBG,FIN,HOMA -IR,TC,TG,LDL - C （r =0.441,0.682,0.506, 0.599,0.493,0.591,0.633,all P 〈0.01 ）,and negatively correlated with HDL -C（r =-0.419,P 〈0.01 ）.Multiple stepwise regression analysis indicated that BMI,LDL -C,FBG and TG were independent risk factors affect-ing FIB（t =7.683,2.678,3.184,3.844,all P 〈0.01）;FIB,BMI,FBG,FIN and TC were independent risk factors influencing HOMA -IR（t =68.784,3.201,29.702,58.100,2.904,all P 〈0.01）.Conclusion Pregnant women have IR and blood lipid disorders during the mid -trimester,the overexpression of FIB is closely related to it.