妊娠期糖尿病胰岛素抵抗与同型半胱氨酸水平的相关性

Correlation between insulin resistance and homocysteine level in gestational diabetes mellitus

目的探讨妊娠期糖尿病(gestational diabetes mellitus,GDM)胰岛素抵抗与血清同型半胱氨酸(homocysteine,Hcy)水平的相关性。方法以2015年4月—2016年10月期间至南京中医药大学附属张家港医院妇产科定期产检并住院分娩的53例GDM患者(GDM组)和52例同期正常妊娠孕妇(对照组)作为研究对象,在两组孕妇妊娠24~28周时行口服葡萄糖耐量试验(oral glucose tolerance test,OGTT)。收集孕妇空腹静脉血,检测并比较GDM组和对照组孕妇空腹血糖(fasting plasma glucose,FBG)、空腹胰岛素(fasting insulin,FINS)、糖化血红蛋白(glycosylatedhemoglobin,HbA1c)以及三酰甘油(triglyceride,TG)、低密度脂蛋白(low density lipoproteins,LDL)、高密度脂蛋白(highdensity lipoproteins,HDL)等脂质代谢指标;收集孕妇外周血浆和新生儿脐带血,检测外周血浆和脐带血中Hcy含量。分析FBG、FINS含量和胰岛素抵抗指数(homeostasis model assessment of insulin resistance index,HOMA-IR)与Hcy水平的相关性。结果 GDM组孕妇TG、HbA1c、FBG水平和HOMA-IR值分别为(4.02±0.22)mmol/L、(7.94±0.33)%、(5.01±0.12)mmol/L和2.45±0.23,均高于对照组的(3.43±0.15)mmol/L、(5.35±0.25)%、(4.16±0.08)mmol/L和1.86±0.16(P<0.05)。GDM组孕妇OGTT试验中0、1、2 h血糖值分别为(5.02±0.14)mmol/L、(9.32±0.48)mmol/L和(8.01±0.36)mmol/L,均高于对照组的(4.13±0.11)mmol/L、(7.56±0.33)mmol/L和(6.58±0.42)mmol/L(P<0.05)。GDM组孕妇外周血浆和新生儿脐带血Hcy水平分别为(12.75±5.73)μmol/L和(11.83±3.57)μmol/L,高于对照组的(6.20±4.25)μmol/L和(6.31±2.41)μmol/L(P<0.05)。多元逐步回归分析显示,GDM孕妇血浆Hcy水平与血清HbA1c(r=0.176,P=0.026)、FBG水平(r=0.428,P=0.004)及HOMA-IR(r=0.361,P=0.006)呈正相关。结论 GDM孕妇血浆Hcy水平较正常孕妇升高,其水平与胰岛素抵抗程度呈正相关。

Objective To examine the correlation between insulin resistance and serum homocysteine（Hcy）concentration in gestational diabetes mellitus（GDM）. Methods A total of 53 cases with GDM（GDM group） and 52 normalpregnant women（control group） who received periodical pregnant check-ups and inpatient delivery in Zhangjiagang HospitalAffiliated to Nanjing University of Chinese Medicine during the period from April 2015 to October 2016 were enrolled. The oralglucose tolerance test（OGTT） was performed in the pregnant women in both groups from 24 to 28 weeks of gestation. Fastingvenous blood samples were collected from all pregnant women, and the serum levels of fasting plasma glucose（FBG）,fasting insulin（FINS）, glycosylated hemoglobin（HbA1c） and lipid metabolic parameters including triglyceride（TG）, lowdensity lipoproteins（LDL）, and high density lipoproteins（HDL） were tested and compared between the two groups. Thepregnant women＇s peripheral plasma and newborns＇ umbilical cord blood were sampled, and the Hcy levels were determined.The associations of Hcy levels with serum FBG, FINS levels and homeostasis model assessment of insulin resistance index（HOMA-IR） were assessed. Results The serum TG, HbA1c, FBG levels and HOMA-IR were（4.02 ± 0.22）mmol/L,（7.94± 0.33）%,（5.01 ± 0.12）mmol/L and 2.45 ± 0.23 in the DGM group, which were significantly higher than those（3.43 ±0.15）mmol/L,（5.35 ± 0.25）%,（4.16 ± 0.08）mmol/L and 1.86 ± 0.16 in the control group（P〈0.05）. In the OGTT test, the0, 1 and 2 h glucose levels were（5.02 ± 0.14）mmol/L,（9.32 ± 0.48）mmol/L and（8.01 ± 0.36）mmol/L in the DGM group,which were significantly higher than those（4.13 ± 0.11）mmol/L,（7.56 ± 0.33）mmol/L and（6.58 ± 0.42）mmol/L in thecontrol group（P〈0.05）. The Hcy levels were（12.75 ± 5.73）μmol/L and（11.83 ± 3.57）μmol/L in the pregnant women＇speripheral plasma and newborns＇ umbilical cord blood in the DGM group, respectively, which were significantly higher than those（6.20 ± 4.25）μmol/L and（6.31 ± 2.41）μmol/L in the control group（P〈0.05）. Multivariate stepwise regressionanalysis revealed that the plasma Hcy level positively correlated with the serum HbA1c（r =0.176, P=0.026） and FBG（r =0.428, P=0.004） levels and HOMA-IR（r=0.361, P=0.006） in the pregnant women with GDM. Conclusion A significantlyelevated plasma Hcy level is detected in the pregnant women with GDM than in normal pregnant women, and plasma Hcy levelis positively associated with the degree of insulin resistance in pregnant women with GDM.