妊娠期糖尿病与肥胖症、炎症因子、25-(OH)D_3和胰岛素抵抗的关系

The relationship between gestational diabetes and obesity,inflammation factors,25-hydroxy vitamin D_3 and insulin resistance in pregnant women

目的通过检测肥胖症孕妇及妊娠期糖尿病患者体内高敏C反应蛋白(hs-CRP),25羟维生素D3[25-(OH)D3]水平,探讨其与胰岛素抵抗的相关性。方法选择2012年12月—2014年12月于秦皇岛市第一医院符合肥胖诊断标准的孕妇70例,其中糖耐量正常者40例(肥胖组),糖耐量异常诊断妊娠期糖尿病患者30例(病例组);正常对照组40例(对照组)。测定三组空腹血糖(FPG)、体质指数(BMI)、空腹胰岛素(FINS)、甘油三脂(TC)、总胆固醇(TC)、高密度脂蛋白胆固醇(HDL-C)、25-(OH)D3、hs-CRP、糖化血红蛋白(Hb A1c)。Pearson线性相关分析及多元线性回归分析比较hs-CRP与25-(OH)D3及胰岛素抵抗指数(HOMA-IR)的关系。结果 FINS、甘油三酯、HOMA-IR、hs-CRP三组间两两比较差异均有统计学意义,且按对照组,肥胖症,病例组的顺序呈增高趋势(P<0.05),25-(OH)D3三组比较有差异,呈递减趋势(P<0.05)。对照组与肥胖组的FBG、糖化血红蛋白之间均有差异,且都低于病例组(P<0.05);肥胖症与病例组的BMI均高于对照组(P<0.05)。多元线性回归分析显示,HOMA-IR与25–(OH)D3相关性最强;HOMA-IR与25-(OH)D3呈负相关,与hs-CRP呈正相关(P<0.05)。结论孕妇体内高敏C反应蛋白及25羟维生素D3与妊娠期糖尿病有明显相关性,且两者都是胰岛素抵抗的主要影响因素。

Objective To examine the levels of high-sensitivity C-reactive protein（hs-CRP）and 25-hydroxy vitamin D3[25-（OH）D3] in pregnant obese women without or with gestational diabetes,and to explore its correlation with insulinresistance. Methods We chose 70 cases of pregnant women diagnosed as obesity in The First Hospital of Qinhuangdaobetween December 2012 and December 2014,among them,40 patients with normal glucose tolerance（obesity group）,and 30 cases diagnosed as gestational diabetes with abnormal glucose tolerance（case group）. Forty healthy pregnant women served asnormal control（control group）. Fasting plasma glucose（FPG）,body mass index（BMI）,fasting insulin（FINS）,triglycerides（TG）,total cholesterol（TC）,high-density lipoprotein cholesterol（HDL-C）,25-（OH）D3,hs-CRP and glycated hemoglobin（Hb A1c）were determined in the three groups. The relationship among hs- CRP,25-（OH）D3and the index of insulinresistance（HOMA- IR）was examined by Pearson linear correlation analysis and multivariate linear regression analysis.Results There was significant differences in FINS,TG,HOMA-IR and hs-CRP among the three groups with the highestlevels in case group followed by obesity and control groups（P〈0.05 respectively）. 25-（OH）D3level was the lowest in casegroup followed by obesity and control groups（P〈0.05）. FBG and Hb A1 c had significant difference between obesity group andcontrol group,which were both lower than case group（P〈0.05）. BMI in obesity group and case group was significantly higherthan control group（P〈0.05）. By multiple linear regression analysis HOMA-IR was strongly and inversely correlated with 25-（OH）D3,and positively correlated with hs-CRP（P〈0.05 respectively）. Conclusion Hs-CRP and 25-（OH）D3significantlycorrelated with gestational diabetes mellitus,and both are main influencing factors of insulin resistance.