妊娠期糖尿病孕妇血清Apo A5 SPARC Nesfatin-1及CTRP6水平和糖脂代谢胰岛素抵抗的关系

Relationships between serum Apo A5,SPARC,Nesfatin-1,CTRP6 and glucose metabolism,lipid metabolism,insulin resistance in pregnant women with gestational diabetes mellitus

目的分析妊娠期糖尿病(GDM)孕妇血清载脂蛋白A5(Apo A5)、富含半胱氨酸酸性分泌蛋白(SPARC)、人新饱食分子蛋白-1(Nesfatin-1)及C1q/肿瘤坏死因子相关蛋白6(CTRP6)水平和糖脂代谢、胰岛素抵抗的关系。方法选取2016年1月-2020年1月收治的300例GDM孕妇为GDM组,糖耐量正常的322例孕妇为对照组。比较两组血清Apo A5、SPARC、Nesfatin-1及CTRP6水平,糖脂代谢指标[空腹血糖(FPG)、餐后2 h血糖(2 h PG)、糖化血红蛋白(HbA1c)、总胆固醇(TC)、三酰甘油(TG)、高密度脂蛋白胆固醇(HDL-C)及低密度脂蛋白胆固醇(LDL-C)]水平,胰岛素抵抗相关指标[空腹胰岛素(FINS)、胰岛β细胞功能指数(HOMA-β)及胰岛素抵抗指数(HOMA-IR)]水平。分析GDM孕妇血清Apo A5、SPARC、Nesfatin-1及CTRP6水平与糖脂代谢、胰岛素抵抗相关指标的相关性。采用多元Logistic回归分析法分析GDM发病的危险因素。结果GDM组血清Apo A5水平为(66.35±9.48)μg/L,低于对照组的(102.51±16.49)μg/L,血清SPARC、Nesfatin-1及CTRP6水平分别为(5.35±1.64)μg/L、(2.25±0.63)μg/L及(689.40±36.75)μg/L,高于对照组的(2.63±0.69)μg/L、(1.02±0.35)μg/L及(572.35±31.64)μg/L,差异均有统计学意义(t=33.210,P=0.000;t=27.183,P=0.000;t=30.365,P=0.000;t=42.652,P=0.000)。GDM孕妇血清Apo A5与TG、FPG、FINS、2 h PG、HbA1c及HOMA-IR呈负相关(P<0.05),与HOMA-β呈正相关(P<0.05);GDM孕妇血清SPARC、Nesfatin-1及CTRP6水平与TG、FPG、FINS、2 h PG、HbA1c及HOMA-IR呈正相关(P<0.05),与HOMA-β呈负相关(P<0.05)。多元Logistic回归分析结果显示:血清Apo A5水平降低,血清SPARC、Nesfatin-1、CTRP6及HOMA-IR水平升高是GDM发病的危险因素(均P<0.05)。结论GDM孕妇血清Apo A5水平降低,血清SPARC、Nesfatin-1及CTRP6水平升高,4项指标均与GDM发病、糖脂代谢异常及胰岛素抵抗有关。

Objective To analyze the relationships between serum apolipoprotein A5(Apo A5),secreted protein acidic and rich in cysteine(SPARC),Nesfatin-1,and C1 q/tumor necrosis factor related protein 6(CTRP6)levels and glucose metabolism,lipid metabolism,insulin resistance in pregnant women with gestational diabetes mellitus(GDM).Methods From January 2016 to January 2020,300 patients with GDM were selected as GDM group,322 pregnant women with normal glucose tolerance were selected as control group.The levels of serum Apo A5,SPARC,Nesfatin-1,and CTRP6,glucose metabolism and lipid metabolism indexes[fasting plasma glucose(FPG),2-hour postprandial blood glucose(2 h PG),glycosylated hemoglobin(HbA1 c),total cholesterol(TC),triacylglycerol(TG),high-density lipoprotein cholesterol(HDL-C),and low-density lipoprotein cholesterol(LDL-C)],insulin resistance indexes[fasting insulin(FINS),HOMA-β,and HOMA-IR]in the two groups were compared.The correlations between serum Apo A5,SPARC,Nesfatin-1,CTRP6 and glucose metabolism,lipid metabolism,insulin resistance in pregnant women with GDM were analyzed.The risk factors of GDM were analyzed using multivariate Logistic regression analysis.Results The level of serum Apo A5 in GDM group was(66.35±9.48)μg/L,which was lower than that in control group[(102.51±16.49)μg/L],the levels of serum SPARC,Nesfatin-1,and CTRP6 in GDM group were(5.35±1.64)μg/L,(2.25±0.63)μg/L,and(689.40±36.75)μg/L,respectively,which were higher than those in control group[(2.63±0.69)μg/L,(1.02±0.35)μg/L,and(572.35±31.64)μg/L,respectively],there were statistically significant differences(t=33.210,P=0.000;t=27.183,P=0.000;t=30.365,P=0.000;t=42.652,P=0.000).The level of serum Apo A5 in GDM group was negatively correlated with TG,FPG,FINS,2 h PG,HbA1 c,and HOMA-IR(P<0.05),which was positively correlated with HOMA-β(P<0.05);the levels of serum SPARC,Nesfatin-1,and CTRP6 in GDM group were positively correlated with TG,FPG,FINS,2 h PG,HbA1 c,and HOMA-IR(P<0.05),which was negatively correlated with HOMA-β(P<0.05).Multivariate Logistic regression analysis showed that low serum Apo A5 level,high serum SPARC,Nesfatin-1,CTRP6,and HOMA-IR levels were risk factors of GDM(P<0.05).Conclusion In GDM pregnant women,serum Apo A5 level decreases,serum SPARC,Nesfatin-1,and CTRP6 levels increase,the four indexes are related to occurrence of GDM,abnormal glucose and lipid metabolism,and insulin resistance.