胎盘组织中GLUT、IRS、SHBG与妊娠期糖尿病相关性

Relationship between the GLUT, IRS and SHBG levels in placental tissues of pregnant women and their gestational diabetes mellitus occurrence

目的:观察妊娠期糖尿病(GDM)孕妇胎盘组织中葡萄糖转运蛋白(GLUT)、胰岛素信号转导蛋白(IRS)、性激素结合球蛋白(SHBG)表达及与GDM发病相关性。方法:选取2017年12月-2018年12月在本院产前检查并剖宫产的GDM孕妇42例为GDM组,同期剖宫产的健康孕妇42例为对照组,检测两组胎盘组织中GLUT、IRS、SHBG水平并分析其临床意义。结果:GDM组空腹血糖、OGTT 2h血糖、新生儿体重等均高于对照组,胎盘组织中GLUT-3、GLUT-4、IRS-2、P13K p85α、SHBGmRNA水平低于对照组(均P<0.05)。Pearson分析显示,SHBG与GLUT-3、GLUT-4、IRS-2、P13K p85αmRNA水平呈正相关性,IRS-2与GLUT-1、GLUT-4 mRNA水平呈正相关性,IRS-1与GLUT-3、P13K p85αmRNA水平呈负相关性,SHBG与GLUT-3、GLUT-4、IRS-2蛋白水平呈正相关性,IRS-2与GLUT-1、GLUT-4蛋白水平呈正相关性,IRS-1与GLUT-3蛋白水平呈负相关性。结论:GDM孕妇SHBG减少,使性激素代谢紊乱和糖代谢下降引起胰岛素抵抗。当SHBG水平降低时,胰岛素信号转导通路的相关分子水平也发生变化,从而降低胎盘中葡萄糖的摄取和利用率,最终引发GDM。

Objective: To observe the expression of glucose transporter(GLUT), insulin signal transduction protein(IRS), and sex hormone binding globulin(SHBG) in placental tissues of pregnant women with gestational diabetes mellitus(GDM),and to study the relationship between the GLUT, IRS and SHBG levels in placental tissues of pregnant women and their GDM occurrence. Methods: 42 pregnant women with GDM and cesarean section were selected in study group from December 2008 to December 2018,and 42 healthy pregnant women were selected in control group during the same period. The expression of GLUT, IRS and SHBG in placenta tissue of the women in the two groups were detected, and which’s clinical significances were analyzed. Results: The levels of fasting blood glucose and 2 h blood glucose of OGTT of the women, and neonatal weight in study group were all significant higher than those of the women in the control group, but the levels of GLUT-3, GLUT-4, IRS-2, P13 K p85α, and SHBG mRNA in the placenta of the women in the study group were significant lower than those of the women in the control group(all P<0.05). Pearson analysis showed that SHBG level was positive correlated with the levels of GLUT-3, GLUT-4, IRS-2, and P13 K P85α mRNA, and IRS-2 level was positive correlated with GLUT-1 and GLUT-4 mRNA levels. IRS-1 level was negative correlated with GLUT-3 and P13 K P85α mRNA levels, and SHBG level was positive correlated with GLUT-3, GLUT-4, and IRS-2 protein levels, and IRS-2 level was positive correlated with GLUT-3 and GLUT-4 levels. IRS-1 level was negative correlated with GLUT-3 protein level. Conclusion: The decrease of SHBG of pregnant women with GDM leads to the disorder of sex hormone metabolism and decrease of glucose metabolism, and further leads to insulin resistance. When the SHBG level of pregnant women with GDM has reduced, the related molecular levels of insulin signal transduction pathway also change, thus reduce the uptake and utilization of glucose in the placenta,and cause GDM occurrence eventually.