CAJ | 학술논문

目的探讨妊娠糖尿病( GDM)患者胰岛素抵抗(IR)、胰岛细胞功能与空腹血清成纤维细胞生成因子(FGF21)之间的关系。方法选取妊娠24~28周孕妇90例,根据口服葡萄糖耐量试验(OGTT)结果均分为GDM组和正常对照(NGT)组,并根据空腹血糖(FPG)是否大于7.0 mmol/L,将GDM组分为GDM1组(5.1 mmol/L≤FPG<7.0 mmol/L,n=27)和 GDM2组(FBG≥7.0 mmol/L,n=18)两亚组。采用酶联免疫吸附( ELISA)法检测各组空腹血清FGF21水平,同时测定各受试者的体格指标及OGTT各点血糖、胰岛素和C肽等,并计算稳态模型胰岛素抵抗指数(HO-MA-IR)、胰岛β细胞功能指数(HOMA-β)、胰岛素曲线下面积(AUCINS)/血糖曲线下面积(AUCGLU)和早期胰岛素分泌功能指数(△I30/△G30),分析FGF21与这些指标之间的关系。结果GDM1组和GDM2组的FGF21水平均显著高于正常对照组,差异均有统计学意义(P<0.01)；GDM2组的FGF21水平高于GDM1组,差异有统计学意义(P<0.01)。Pearson相关分析显示,FGF21与孕前体重指数(BMI)、FPG、30minPG、1hPG、2hPG、HOMA-IR、AUCGLU呈正相关,与HO-MA-β呈负相关。多元逐步线性回归分析显示,FPG是影响FGF21水平的独立影响因素。结论FGF21与 IR呈正相关,与胰岛细胞功能负相关,其可能在GDM的发病机制中发挥一定作用。
목적탐토임신당뇨병( GDM)환자이도소저항(IR)、이도세포공능여공복혈청성섬유세포생성인자(FGF21)지간적관계。방법선취임신24~28주잉부90례,근거구복포도당내량시험(OGTT)결과균분위GDM조화정상대조(NGT)조,병근거공복혈당(FPG)시부대우7.0 mmol/L,장GDM조분위GDM1조(5.1 mmol/L≤FPG<7.0 mmol/L,n=27)화 GDM2조(FBG≥7.0 mmol/L,n=18)량아조。채용매련면역흡부( ELISA)법검측각조공복혈청FGF21수평,동시측정각수시자적체격지표급OGTT각점혈당、이도소화C태등,병계산은태모형이도소저항지수(HO-MA-IR)、이도β세포공능지수(HOMA-β)、이도소곡선하면적(AUCINS)/혈당곡선하면적(AUCGLU)화조기이도소분비공능지수(△I30/△G30),분석FGF21여저사지표지간적관계。결과GDM1조화GDM2조적FGF21수평균현저고우정상대조조,차이균유통계학의의(P<0.01)；GDM2조적FGF21수평고우GDM1조,차이유통계학의의(P<0.01)。Pearson상관분석현시,FGF21여잉전체중지수(BMI)、FPG、30minPG、1hPG、2hPG、HOMA-IR、AUCGLU정정상관,여HO-MA-β정부상관。다원축보선성회귀분석현시,FPG시영향FGF21수평적독립영향인소。결론FGF21여 IR정정상관,여이도세포공능부상관,기가능재GDM적발병궤제중발휘일정작용。
Objective To investigate serum fibroblast growth factor 21 levels in gestational diabetes mellitus in re-lation to insulin resistance(IR) and pancreatic beta-cell function. Methods A 75-g oral glucose tolerance test (OGTT) was performed among ninty pregnant women between 24 to 28 gestational weeks. The ninty pregnant women were averagely divided into gestational diabetes mellitus(GDM) group and normal control(NGT) group ac-cording to OGTT. Meanwhile, based on fasting plasma glucose(FPG) weather higher than 7.0 mmol/L, the GDM group was divided into GDM1 group (5.1 mmol/L≤FPG<7.0 mmol/L,n=27) and GDM2 group (FBG≥7.0 mmol/L,n=18). Fasting serum FGF21 levels were measured by enzyme-linked immunosorbent assay( ELISA). Meanwhile, the anthropometric parameters, glucose, insulin, c-peptide were alse measured and HOMA-insulin re-sistance index(HOMA-IR), HOMA-β-cell insulin secretion index(HOMA-β),area under insulin(AUCINS)/area under glucose ( AUCGLU) and early insulin secretion index (△I30/△G30 ) were calculated. The associations of FGF21 with these parameters were analyzed. Results Serum FGF21 levels were significantly higher in patients with GDM1 and GDM2 than in controls( P <0.01),and GDM2 group was also higher than GDM1 group( P <0.01). Fasting serum FGF21 was found to correlate positively with body mass index ( BMI) before pregnancy, FPG, 30minPG, 1hPG, 2hPG, HOMA-IR, and AUCGLU, but negatively with HOMA-β. Furthermore,multiple stepwise regression analysis showed that FPG was the independent influencing factor of serum FGF21 level. Con-clusion FGF21 positively correlates with IR,while negatively correlates with pancreatic beta-cell functionl. FGF21 may play a role in the pathogenesis of GDM.