CAJ | 학술논문

目的：探讨血清维生素D水平与妊娠糖尿病( GDM)胰岛素敏感性及对脂肪因子脂联素( APN)、视黄醇结合蛋白4( RBP4)、内脂素(visfatin)及肿瘤坏死因子(TNF-α)的影响及作用机制。方法选择妊娠糖尿病患者101例( GDM组)和血糖正常孕妇50例(正常组),检测两组相关生化指标、APN、RBP4、visfatin、TNF-α及25羟化维生素 D3(25OHD3)。在GDM组中将诊断为维生素D缺乏患者24例随机分为治疗组及对照组各12例,治疗组口服1,25二羟维生素D3[1,25(OH)2D3]0.25μg·d-11个月,再行相关生化指标检查。结果GDM组患者25OHD3及APN水平明显低于正常组(P<0.05),而 RBP4、visfatin、TNF-α水平高于正常组(均P<0.05)；治疗组经补充维生素D,胰岛素分泌指数上升,胰岛素抵抗指数下降,而APN水平升高,与25OHD3呈正相关(r=0.526)；RBP4、visfatin、TNF-α降低,与25OHD3呈负相关(r分别为-0.272,-0.153,-0.072)。结论维生素D可降低相关脂肪因子RBP4、visfatin和TNF-α,升高APN,从而对妊娠糖尿病起到防治作用。
목적：탐토혈청유생소D수평여임신당뇨병( GDM)이도소민감성급대지방인자지련소( APN)、시황순결합단백4( RBP4)、내지소(visfatin)급종류배사인자(TNF-α)적영향급작용궤제。방법선택임신당뇨병환자101례( GDM조)화혈당정상잉부50례(정상조),검측량조상관생화지표、APN、RBP4、visfatin、TNF-α급25간화유생소 D3(25OHD3)。재GDM조중장진단위유생소D결핍환자24례수궤분위치료조급대조조각12례,치료조구복1,25이간유생소D3[1,25(OH)2D3]0.25μg·d-11개월,재행상관생화지표검사。결과GDM조환자25OHD3급APN수평명현저우정상조(P<0.05),이 RBP4、visfatin、TNF-α수평고우정상조(균P<0.05)；치료조경보충유생소D,이도소분비지수상승,이도소저항지수하강,이APN수평승고,여25OHD3정정상관(r=0.526)；RBP4、visfatin、TNF-α강저,여25OHD3정부상관(r분별위-0.272,-0.153,-0.072)。결론유생소D가강저상관지방인자RBP4、visfatin화TNF-α,승고APN,종이대임신당뇨병기도방치작용。
Objective To investigate the relationship and mechanism of the serum vitamin D levels with insulin sensitivity and adipokines APN,RBP4,visfatin and TNF-α in patients with gestational diabetes mellitus(GDM). Methods A total of 101 patients with gestational diabetes( GDM group) and 50 pregnant women with normal blood sugar( control group) were recruited to detect the serum levels of correlative biochemical indexes,APN,RBP4,visfatin,TNF-α and 25OHD3 using an HPLC method. Twenty-four patients in the GDM group diagnosed with vitamin D deficiency(<25 nmol·L-1 ) were randomized to receive either 1,25(OH) 2D3(0. 25 μg·d-1) orally or no treatment. Serum levels of correlative biochemical indexes were detected after 1 month. Results GDM patients had 25OHD3 levels significantly lower than the control group(P<0. 05),APN levels lower than the control group,and RBP4,visfatin,TNF-α levels significantly higher than the control group(all P<0. 05). After 1 month of 1,25(OH) 2D3 treatment,HOMA-IR increased,while HOMA-β decreased. APN levels was positively correlated(r= 0. 526) with 25OHD3;RBP4,visfatin,TNF-α decreased and were negatively correlated with 25OHD3( r values were -0. 272,-0. 153,-0. 072). Conclusion Vitamin D can reduce the adipokines RBP4,visfatin,TNF-α,increase APN,and thus play a protective role for gestational diabetes.