不同糖耐量孕妇血清脂联素水平与胰岛素抵抗相关性研究

Study on relationship between serum adiponectin and insulin resistance in pregnant women with different glucose tolerance

目的：了解妊娠期不同糖耐量孕妇血清脂联素（APN）水平变化情况,并探讨其与胰岛素抵抗的关系.方法：以2012年1月至2014年3月进行产检的90例孕妇作为研究对象,根据50 g葡萄糖负荷试验和糖耐量试验结果将其分为糖耐量正常组（NGT）、糖耐量受损组（GIGT）和妊娠期糖尿病组（GDM）.采用葡萄糖氧化酶法检测血糖值,放射免疫法检测胰岛素（INS）水平,ELISA法检测血清APN水平,分析各指标在3组间的差异及相关性.结果：3组孕妇年龄、孕周和孕前体质量指数（BMI）差异均无统计学意义（P〉0.05）,3 组孕妇孕晚期BMI差异有统计学意义（P〈0.01）.血清空腹血糖（FPG）、FINS水平在NGT组、GIGT组和GDM组水平逐渐升高,胰岛素抵抗指数（HOMA-IR）亦逐渐升高,而 APN水平在3 组间逐渐降低（P〈0.01）.以年龄、孕周作为控制变量进行的偏相关分析结果显示,血清APN水平与孕晚期BMI及血清FPG、FINS以及HOMA-IR水平均呈显著负相关关系（P〈0.05~P〈0.01）.以APN为应变量进行的多元回归分析显示,年龄、FPG、FINS水平均是血清APN水平改变的影响因素（P〈0.05~P〈0.01）.结论：GDM组血清APN水平最低,且APN水平与HOMA-IR呈负性相关,提示APN作为GDM的保护因子之一,是INS的增敏剂.

Objective：To investigate the serum level of adiponectin,and its correlation with insulin resistance in pregnant women with different glucose tolerance. Methods：Ninety pregnant women were divided into the normal pregnant women（NGT group）,impaired glucose tolerance（GIGT group） and gestational diabetes mellitus（GDM group） according to the results of 50 g glucose load test and glucose tolerance test from January 2012 to March 2014（30 cases each group）. The levels of fasting blood glucose（FPG）,insulin（INS） and APN in all cases were detected by glucose oxidase method, radioimmunoassay and enzyme linked immunosorbent assay, respectively. The differences and correlations of each index in three groups were analyzed. Results：The age,gestational weeks and pre-pregnancy body mass index（BMI） were not statistically different（P〉0. 05）,BMI of pregnant late term in 3 groups were statistically different（P〈0. 01）. In the NGT,GIGT and GDM groups,the levels of FPG and FINS,and HOMA-IR were gradually increased,the concentration of APN was gradually decreased（P 〈0. 01）. With age and pregnant weeks as control variable,the partial correlation analysis showed that the serum APN level was significantly negative related to the BMI of pregnant late term,levels of FPG,FINS and HOMA-IR（P〈0. 05 to P〈0. 01）. With APN as dependent variable,the multiple regression showed that the age,serum levels of FPG and FINS were the influencing factors in the serum level change of APN（P〈0. 05 to P〈0. 01）. Conclusions：The serum APN level in pregnant women with GDM is significantly low,and a negative relationship between APN and HOMA-IR,which suggest that APN is one of the protection factors of GDM,and also is a sensitizer of INS.