妊娠期糖尿病患者血清炎症指标与胰岛素抵抗的相关性

Correlation between serum inflammatory markers levels of pregnant women with gestational diabetes mellitus and their insulin resistance

目的:探究妊娠期糖尿病(GDM)患者血清炎症指标-C反应蛋白(CRP)、降钙素原(PCT)、血沉(ESR)表达与患者胰岛素抵抗的关系。方法:回顾性分析2017年9月-2020年9月本院产科确诊的孕24~28周GDM患者83例为GDM组,糖耐量异常、孕周水平相当但未发展为GDM患者85例为糖耐量异常组,糖耐量正常且孕周水平相当的健康孕妇90例为对照组。收集研究对象一般资料,包括三酰甘油(TG)、总胆固醇(TC)、低密度脂蛋白胆固醇(LDL-C)、高密度脂蛋白胆固醇(HDL-C)、糖化血红蛋白(HbA1c)等指标,检测血清CRP、PCT水平,血浆ESR水平,空腹血糖(FPG)、空腹血胰岛素(FINS)水平计算胰岛素抵抗指数(HOMA-IR),Pearson法分析血清CRP、PCT、ESR水平与GDM患者胰岛素抵抗以及HbA1c的相关性,多元线性回归法分析影响胰岛素抵抗的相关因素。结果:3组年龄、孕前体质指数、孕周、TG、TC、HDL-C无差异(P>0.05);对照组、糖耐量异常组、GDM组LDL-C、HbA1c、CRP、PCT、ESR、FPG、FINS、HOMA-IR水平均依次升高(P<0.05);血清CRP与FPG、HOMA-IR正相关(r=0.552、0.576,P<0.05),血清PCT、血浆ESR与HOMA-IR正相关(r=0.547、0.545,P<0.05);CRP、PCT、ESR均为影响胰岛素抵抗的因素(P<0.05)。结论:炎症因子PCT、CRP、ERS与GDM患者胰岛素抵抗密切相关,可能参与了GDM的发病。

Objective: To explore the correlation between the expression levels of serum inflammatory markers, such as C-reactive protein(CRP), and procalcitonin(PCT), and erythrocyte sedimentation rate(ESR), of pregnant women with gestational diabetes mellitus(GDM) and their insulin resistance. Methods: 83 pregnant women with GDM during 24-28 gestational weeks from September 2017 to September 2020 in group A were analyzed retrospectively. 85 pregnant women with abnormal glucose tolerance and without GDM during 24-28 gestational weeks were selected in group B, and 90 healthy pregnant women during 24-28 gestational weeks were selected in group C. The general data, the levels of triacylglycerol(TG), total cholesterol(TC), low-density lipoprotein cholesterol(LDL-C), high-density lipoprotein cholesterol(HDL-C), glycosylated hemoglobin(HbA1 c), and other indicators of the women in the three groups were collected. The serum CRP and PCT levels, plasma ESR level, and the levels of serum fasting blood glucose(FPG) and fasting insulin(FINS) of the women in the three groups were detected. The value of homeostasis model assessment of insulin resistance(HOMA-IR) of the women in the three groups was calculated. Pearson method was used to analyze the correlation between the serum CRP and PCT levels, and the ESR value of the women with GDM and their insulin resistance and HbA1 c level. Multiple linear regression was performed to analyze the factors of the women affecting their insulin resistance. Results: There were no significant differences in the age, and the pre-pregnancy body mass index, gestational weeks, and the levels of TG, TC, and HDL-C of the women among the three groups(P>0.05). The levels of LDL-C, HbA1 c, CRP, PCT, FPG, FINS, the ESR value, and the HOMA-IR value of the women in group C, group B, and group A had increased in turn(P<0.05). The serum CRP level of the women was positively correlated with their FPG level and HOMA-IR value(r=0.552,0.576,P<0.05),and the serum PCT level and the plasma ESR value of the women were positively correlated with their HOMA-IR value(r=0.547,0.545,P<0.05).The levels of PCT,CRP,and the ESR value of the women with GDM were all the factors affecting their insulin resistance(P<0.05).Conclusion:The inflammatory factors,such as the levels of PCT and CRP,and the ESR value of the women with GDM are closely related to their insulin resistance,and which may be involved in the pathogenesis of GDM.