不同糖耐量状态孕妇血清成纤维细胞生长因子21水平与胰岛β细胞功能的相关性研究

Association between fibroblast growth factor 21 and islet β cell function in pregnant women with different glucose tolerance status

目的探讨不同糖耐量状态孕妇血清成纤维细胞生长因子21(FGF21)水平与胰岛β细胞功能的关系。方法选取妊娠24~28周于我院接受50 g糖负荷试验(GCT)阳性的孕妇441例,1周后再行75 g OGTT,根据结果分为GDM组228例、妊娠期IGT(GIGT)组122例及妊娠期NGT(GNGT)组91名。ELISA检测血清FGF21水平,胰岛素抵抗指数(HOMA-IR),胰岛素敏感指数(Matsuda指数),胰岛β细胞功能指数(HOMA-β),第1、2时相胰岛素分泌指数及胰岛β细胞代偿胰岛素抵抗的分泌能力(ISSI)评估胰岛β细胞功能。FGF21与胰岛β细胞功能的相关性采用Pearson相关分析。结果 (1)GDM组和GIGT组BMI,0、1、2、3hPG及1、2、3 hIns均高于GNGT组和GIGT组(P<0.05或P<0.01)。GDM组SBP、DBP、0 hIns和HbA_1c高于GNGT组和GIGT组(P<0.05或P<0.01);(2)GNGT组、GIGT组及GDM组FGF21水平[(101.74±20.40)vs(137.93±25.52)vs(185.69±31.61)ng/L]和HOMA-IR依次升高[1.74(0.91,2.85)vs2.39(1.31,4.87)vs3.38(2.19,6.75)],Matsuda指数[(58.74±15.68)vs(41.62±15.65)vs(39.73±18.98)]和HOMA-β[(157.69±88.41)vs(144.35±78.98)vs(107.30±87.23)]及ISSI[(72253.55±15167.53)vs(42313.91±7112.47)vs(30032.50±11500.24)]依次降低(P<0.05或P<0.01)。GDM组第1、2时相胰岛素分泌指数低于GNGT组和GIGT组(P<0.01),但GNGT组与GIGT组比较,差异无统计学意义(P>0.05);(3)Pearson相关分析显示,FGF21与HOMA-IR呈正相关(r=0.255,P=0.030),与Matsuda指数、HOMA-β、第1、2时相胰岛素分泌指数及ISSI呈负相关(r=0.289、-0.256、-0.224、-0.230、-0.277,P=0.019、0.037、0.045、0.040、0.023)。结论随着糖代谢受损逐渐加重,FGF21水平升高,且与胰岛β细胞功能相关,可能与GDM的发生发展有关。

Objective To explore the relationship between fibroblast growth factor 21（FGF21） and islet β cell function in pregnant women with different glucose tolerance status. Methods A total of 441 pregnant women were selected in this study from our hospital. Their 50 g GCT at 24 - 28 gestational weeks were all positive. One week later, all the subjects were treated with 75 g OGTT, and divided into three groups according to their test results： GDM group （n = 228）, GIGT group （n= 112） and GNGT group （n=91）. Serum FGF21 level was tested by ELISA. Islet β cell function was evaluated by HOMA- IR, ISI-Matsuda, HOMA-IS, Stumvoll first, second phase secretion and ISSI. The correlation between FGF21 and islet β cell function was evaluated by Pearson correlation analysis. Results （1） BMI, 0 h, 1 h,2 h,3 hPG and 1 h,2 h,3 bins were higher in GDM group and GIGT group than in GNGT group,and highest in GDM group （P〈0.05 or P〈0. 01）. SBP,DBP,0 bins and HbAlc were higher in GDM group than in GNGT group and GIGT group（P〈0.05 or P〈0.01）; （2） From GNGT group, GIGT group to DC-M group,the levels of FGF21[（101.74±20. 40） vs （137.93±25.52） vs （185.69±31.61） ng/L] and HOMA-IR[1.74（0. 91,2.85） vs 2.39 （1.31, 4. 87） vs 3.38 （2.19, 6.75）1 were increased, while ISI- Matsuda[（58. 74± 15.68） vs （41.62 ± 15.65） vs （39.73 ± 18. 98）1, HOMA-IS[（157. 69± 88.41） vs （144. 35±78.98） vs （107.30±87.23）] and ISSI[（72253.55±15167, 53） vs （42313.91±7112.47） vs （30032. 50±11500. 24）] were decreased （P〈0. 05 or P〈0.01）. The stumvoll first, second phase secretion were lower in GDM group than in GNGT group and GIGT group（P〈0.01）, but there was no statistical significance between GNGT and GIGT group（P〉0. 05）. （3）Pearson correlation analysis showed that FGF21 was positively correlated with HOMA-IR（r=0. 255, P=-0. 030） and was negatively correlated with ISI-Matsuda, HOMA-β, Stumvoll first, second phase secretion and ISSI （r =- 0. 289,- 0. 256, -0.224,-0.230,-0.277,P=0.019,0.037,0.045,0.040,0.023）. Conclusion Along with the worsening of glucose metabolic damage, the FGF21 level is increased gradually. FGF21 is related to islet β cell function, and may enroll in the occurrence and development of GDM.