人体成分与脂肪细胞因子在妊娠期糖尿病患者中的关系研究

The Relationship between Body Composition and Adipocytokines in Patients with Gestational Diabetes Mellitu

目的:探讨妊娠期女性的人体成分与脂肪细胞因子在妊娠期糖尿病(GDM)风险之间的关系。方法:选择本院常规产前检查单胎自然受孕GDM孕妇90例为GDM组,另选择同期单胎正常妊娠孕妇219例为对照组(NGT组)。在妊娠24~28周时,用生物阻抗法测定其人体成分。分析孕前体质量指数(BMI)、体脂百分比(FMP)、去脂体质量百分比(FFMP)、细胞外液/细胞内液(ECW/ICW)、体脂指数(FMI)等人体成分与GDM的关系。所有入组孕妇同期采用酶联免疫吸附法(ELISA)检测循环脂联素、脂肪酸结合蛋白4(FABP4)、瘦素以及空腹胰岛素(FINS)水平,并分析其与人体成分各指标的关系。结果:①GDM组脂联素低于NGT组,而瘦素高于NGT组(P<0.05)。②GDM组FMP、ECW/ICW、FMI显著高于NGT组(P<0.05),单因素回归分析显示孕前BMI、FMP、FMI、ECW/ICW是GDM的危险因素(OR>1,P<0.05)。而多因素分析显示仅FMP升高与GDM发病风险显著相关,是其发病的独立危险因素(OR>1,P<0.05),FFMP、MP、PP、M/F是GDM的保护因素(OR<1,P<0.05)。③GDM组,胰岛素抵抗指数(HOMA-IR)与FMI呈正相关(r>1,P<0.05),与PP呈负相关(r<1,P<0.05)。④ROC曲线显示,孕前BMI、FMP、ECW/ICW、FMI对GDM的诊断价值相似,孕前BMI、FMP和FMI相比差异无统计学意义(P>0.05),但略优于ECW/ICW(P<0.001)。结论:妊娠期的人体成分与患GDM的风险有关。FMP升高与发展为GDM的风险增加有关,FMP越高,GDM的风险越高。孕前BMI、FMP、FMI对GDM的诊断效能相似。

Objective:To explore the relationship between body composition and the risk of gestational diabetes mellitus(GDM)in pregnant women.Methods:90 pregnant women with spontaneous pregnancy of singleton who underwent routine prenatal examination in our hospital were selected as GDM group,and 219 pregnant women with normal singleton in the same period as control group(NGT).The body composition was determined by bioimpedance method at 24-28 weeks of gestation.The relationship between body mass index(BMI),percentage of body fat(FMP),percentage of fat-free body weight(FFMP),extracellular/intracellular fluid(ECW/ICW),body fat index(FMI)and GDM were analyzed.The levels of circulating adiponectin,fatty acid binding protein 4(FABP4),leptin and fasting insulin(FINS)were measured by enzyme linked immunosorbent assay(ELISA)method,and their relationship with various indicators of human body composition was analyzed.Results:①Adiponectin in GDM group was lower than that in NGT group,while leptin was higher than that in control group(P<0.05).②The FMP,ECW/ICW and FMI in GDM group were significantly higher than those in control group(P<0.05).Univariate regression analysis showed that BMI,FMP,FMI and ECW/ICW before pregnancy were the risk factors of GDM(OR>1,P<0.05),FFMP,MP,PP and M/F was the protective factor of GDM(OR<1,P<0.05).Multivariate analysis showed that only FMP was significantly correlated with the risk of GDM,which was an independent risk factor(OR>1,P<0.05).③In GDM group,HOMA-IR was positively correlated with FMI(r>1,P<0.05)and negatively correlated with PP(r<1,P<0.05).④The ROC curve showed that the diagnostic value of pre-pregnancy BMI、FMP、ECW/ICW and FMI in GDM was similar.There was no significant difference in pre-pregnancy BMI,FMP and FMI(P>0.05),but they were slightly better than ECW/ICW(P<0.001).Conclusions:Body composition during pregnancy is related to the risk of gestational diabetes.The increase in FMP is associated with an increased risk of developing GDM.The higher the FMP,the higher the risk of GDM.The diag nostic efficacy of BMI,FMP and FMI in GDM is Similar.