中性粒细胞/淋巴细胞比值与妊娠期糖尿病患者胰岛素抵抗的相关性

Association of neutrophil-to-lymphocyte ratio with insulin resistance in gestational diabetes mellitus

目的分析妊娠期糖尿病(GDM)患者中性粒细胞与淋巴细胞比值(NLR)与胰岛素抵抗的关系。方法 2011年12月~2012年12月在河北省沧州市中心医院产科门诊对孕前无糖尿病和糖耐量异常的妊娠24~28周的孕妇142例进行筛查并分组:选择诊断为GDM的72例孕妇作为GDM组,无糖尿病的正常孕妇70例作为NGT组,同期健康体检的孕龄女性65例作为对照组。检测各组全血细胞计数、空腹血糖(FBG)、空腹胰岛素(FIns)水平,计算NLR、稳态模型胰岛素抵抗指数(HOMA-IR)和分泌指数(HOMA-β)。分析比较不同变量与胰岛素抵抗的相关性。结果 GDM组HOMA-IR、FBG、FIns、NLR均显著高于NGT组及对照组(均P<0.01),NGT组HOMA-IR、FIns及NLR高于对照组(P<0.05或P<0.01)。GDM组HOMA-β低于NGT组和对照组(P<0.01),NGT组HOMA-β低于对照组(P<0.01)。Pearson相关分析显示,FBG、FIns、NLR及孕期体重增加值与HOMA-IR呈正相关(r=0.308、0.439、0.867、0.257,均P<0.05);多元线性逐步回归分析显示,FBG、FIns、NLR均是HOMA-IR的危险因素。结论 GDM患者NLR水平显著升高,提示炎症可能通过多种机制加重胰岛素抵抗。

Objective To investigate the relationship between neutrophil-to-lymphocyte ratio （NLR） and insulin resis- tance in gestational diabetes mellitus （GDM）. Methods 142 pregnant women without diabetes pre-pregnant and abnormal glucose tolerance （based on 75 g oral glucose tolerance at weeks 24-28） admitted to Obstetrics Clinic of Central Hospital of Cangzhou City from December 2011 to December 2012 were collected. Among those women, 72 cases were GDM pa- tients （GDM group）, 70 cases were normal glucose tolerance （NGT group）, 65 healthy women of child-bearing age （con- trol group） were included in this study. The complete blood count, FBG, Fins were recorded in each groups; the NLR, HOMA-IR, HOMA-[3 were calculated; and the correlation between chemical parameters and insulin resistance was analyzed. Results Compared with NGT group and control group, the mean levels of HOMA-IR, FBG, Fins, NLR in GDM group were significantly increased （all P 〈 0.01 ）, the levels of HOMA-IR, Fins and NLR in NGT group were higher than those of the control group （P 〈 0.05 or P 〈 0.01）. HOMA-13 of GDM group was lower than those of the NGT group and control group （P 〈 0.01）, HOMA-β of the NGT group was lower than that of the control group （P 〈 0.01）. Pear- son correlation analysis showed that, FBG, Fins, NLR and gestational weight growing had positive correlation with HOMA- IR （r=0.308, 0.439, 0.867, 0.257, all P 〈 0.05）. Logistic regression analysis showed that, elevated FBG, Fins and NLR were the independent variable for predicting HOMA-IR. Conclusion NLR is elevated in women with GDM, which in- flammation may aggravate the insulin resistance of GDM through various mechanisms.