妊娠期糖尿病患者血清FGF-23、PGRN水平与糖脂代谢及胰岛素抵抗的关系

Relationship between serum FGF-23,PGRN levels and glucose and lipid metabolism and insulin resistance in patients with gestational diabetes mellitus

目的探讨妊娠期糖尿病患者血清成纤维细胞生长因子-23(FGF-23)、前颗粒体蛋白(PGRN)水平与糖脂代谢及胰岛素抵抗的关系。方法选择2018年11月至2020年3月葫芦岛市中心医院诊治的90例妊娠期糖尿病患者作为糖尿病组,选择同期在我院健康体检的90例健康孕妇作为对照组。检测并比较两组孕妇的空腹血糖(FPG)、空腹胰岛素(FINS)、FGF-23、PGRN、甘油三酯(TG)、总胆固醇(TC)、谷草转氨酶(AST)、谷丙转氨酶(ALT)、高密度脂蛋白(HDL)和低密度脂蛋白(LDL)水平,计算胰岛素抵抗指数(HOMA-IR)、胰岛素敏感性指数(ISI)和胰岛β细胞功能指数(HOMA-β)。采用Pearson相关性分析检验上述各临床指标的相关性,多元线性逐步回归分析血清FGF-23、PGRN与其他指标的关系。结果糖尿病组孕妇的体质量指数(BMI)、TG、TC、FPG、FINS、HOMA-IR、FGF-23、PGRN水平分别为(27.49±2.06)kg/m2、(3.36±0.91)mmol/L、(5.79±1.06)mmol/L、(10.97±1.73)mmol/L、(28.09±4.85)mU/L、13.70±2.73、(15.68±2.37)ng/L、(33.49±6.85)ng/mL,明显高于对照组的(25.06±3.35)kg/m2、(1.38±0.27)mmol/L、(3.08±0.89)mmol/L、(5.28±0.92)mmol/L、(10.73±1.62)mU/L、2.52±0.79、(11.47±2.04)ng/L、(13.32±1.89)ng/mL;ISI和HOMA-β分别为0.40±0.09、75.21±9.63,明显低于对照组的0.57±0.13、120.56±15.37,差异均具有统计学意义(P<0.05);Pearson相关性分析结果显示,血清FGF-23、PGRN与ISI和HOMA-β均呈负相关(P<0.05),与BMI、TG、TC、FPG、FINS、HOMA-IR均呈正相关(P<0.05);经多元线性逐步回归分析结果显示,ISI和HOMA-IR是影响FGF-23水平最显著的因素(P<0.05),而FPG和TC是影响PGRN水平最显著的因素(P<0.05)。结论妊娠期糖尿病患者血清FGF-23、PGRN水平异常升高,并与糖脂代谢和胰岛素抵抗密切相关,在妊娠期糖尿病的诊断和治疗中具有一定的临床价值。

Objective To investigate the relationship between serum fibroblast growth factor-23(FGF-23),progranulin(PGRN) levels and glucose and lipid metabolism and insulin resistance in patients with gestational diabetes mellitus. Methods Ninety patients with gestational diabetes who were diagnosed and treated in Huludao Central Hospital from April 2018 to November 2019 were selected as the diabetes group, and 90 healthy pregnant women who underwent physical examination in the hospital during the same period were selected as the control group. Fasting plasma glucose(FPG), fasting insulin(FINS), FGF-23, PGRN, triglyceride(TG), total cholesterol(TC), aspartate aminotransferase(AST), alanine aminotransferase(ALT), high density lipoprotein(HDL), and low density lipoprotein(LDL) levels were detected and compared between the two groups. Homeostasis model assessment of insulin resistance(HOMA-IR), insulin sensitivity index(ISI), and Homeostasis model assessment of β cell function(HOMA-β) were calculated. Pearson correlation analysis was used to test the correlation of clinical indicators, and multiple linear stepwise regression analysis of the relationship between serum FGF-23, PGRN and other indicators. Results The body mass index(BMI), TG, TC,FPG, FINS, HOMA-IR, FGF-23, PGRN levels in the diabetes group were(27.49 ± 2.06) kg/m2,(3.36 ± 0.91) mmol/L,(5.79±1.06) mmol/L,(10.97±1.73) mmol/L,(28.09±4.85) mU/L, 13.70±2.73,(15.68±2.37) ng/L,(33.49±6.85) ng/mL,which were higher than(25.06±3.35) kg/m2,(1.38±0.27) mmol/L,(3.08±0.89) mmol/L,(5.28±0.92) mmol/L,(10.73±1.62) mU/L, 2.52±0.79,(11.47±2.04) ng/L,(13.32±1.89) ng/mL in the control group. ISI and HOMA-β were 0.40±0.09,75.21±9.63, which were lower than 0.57±0.13, 120.56±15.37 in the control group(P<0.05). Pearson correlation analysis showed that, serum FGF-23, PGRN were negatively correlated with ISI and HOMA-β(P<0.05), and were positively correlated with BMI, TG, TC, FPG, FINS, HOMA-IR(P<0.05). Multiple linear stepwise regression analysis showed that ISI and HOMA-IR were the most significant factors affecting FGF-23 level(P<0.05), while FPG and TC were the most significant factors affecting PGRN level(P<0.05). Conclusion Serum FGF-23, PGRN levels in patients with gestational diabetes mellitus are abnormally elevated, and it is closely related to glucose and lipid metabolism and insulin resistance, which has certain clinical value in the diagnosis and treatment of gestational diabetes mellitus.