孕期部分应激激素改变与妊娠期糖尿病致病关系探讨

Relationship between the change of some stress hormones and the pathogenesis of gestational diabetes mellitus during pregnancy

目的分析妊娠期糖尿病（GDM）患者应激激素改变与胰岛素抵抗的关系。方法选择2014年1月至2015年5月在烟台毓璜顶医院产前检查确诊为GDM的140例患者作为病例组，按照年龄段1：1配对，选择同期产检正常孕妇140名作为对照组。检测两组患者血糖、胰岛素、应激激素（皮质醇、去甲肾上腺素、肾上腺素）、氧化应激（丙二醛、超氧化物歧化酶）水平，并利用稳态模型胰岛素抵抗指数（HOMA-IR）评价两组胰岛素抵抗程度，采用多元线性回归法分析应激激素及氧化应激水平与胰岛素抵抗的相关性。结果病例组HOMA-IR、肾上腺素、去甲肾上腺素水平均高于对照组[分别为：2．2±0．4比1．7±0．4、（415±102）比（388±96）ng/L、（146±40）比（130±53）ng／L，t=3．153、3．679、2．283；均P〈0．05]，两组间皮质醇水平差异无统计学意义（t=1．899，P〉0．05）。多元线性回归结果提示两组孕妇应激激素水平（肾上腺素、去甲肾上腺素、皮质醇）与HOMA-IR均呈正相关（r=0．272、0．423、0．275，均P〈0．05）；两组孕妇氧化应激指标中，丙二醛与HOMA-IR均呈正相关（r=0．3S5、0．592，均P〈0．05），而超氧化物歧化酶与HOMA-IR均呈负相关（r=-0．289、-0．476，P〈0．05）。结论GDM中较高的应激激素水平，即轻度的应激适应障碍，可能与GDM的发病机制相关。

Objective To investigate the relationship of the change of stress hormones with insulin resistance in gestational diabetes mellitus（GDM） patients. Methods We collected 140 pregnant women diagnosed as GDM in pregnant check-up from January 2014 to May 2015 in Yantai Yuhuangding Hospital. One hundred and forty healthy pregnant women were enrolled as control group. Patients from two groups were matched according to the age stages. Blood glucose, insulin, stress hormone（cortisol, norepinephrine （NE）, epinephrine） and oxidative stress level （malnodialdehyde （MDA）, superoxide dismutase （SOD）） were detected. Homeostasis model assessment-insulin resistance（HOMA-IR） was used to evaluate insulin resistance status between two groups. We analyzed the correlation between stress hormone, oxidative stressand insulin resistance by multiple liner regression analysis. Results HOMA-IR （2.2±0.4 vs 1.7±0.4）, NE （（415±102） vs （388±96） ng/L） and epinephrine （（146±40） vs （130±53） ng/L）in GDM group was higher than control group （t=3.153,3.679,2.283, respectively, all P〈0.05）. There was no significant difference in cortisol level between two groups （t=1.899,P〉0.05）. Multiple liner regression analysis show that stress hormone （cortisol, epinephrine, NE） were positively correlated with HOMA-IR in both groups （r=0.272, 0.423,0.275, respectively, P〈0.05 all above）. In oxidative stress indexes, MDA was positively correlated with HOMA-IR in both groups （r=0.355, 0.592, respectively,P〈0.05）, however SOD was negatively correlated with HOMA-IR in both groups （r=-0.289,-0.476, respectively,P〈0.05）. Conclusion High level of stress hormone means slightly dysfunction in stress adaptation, suggesting that this dysfunction may be related to hyperglycemia, and is associated with pathogenesis of GDM.