CAJ | 학술논문

目的研究血清脂联素（APN）水平及其基因单核苷酸多态性（SNP）+45T/G与妊娠期糖尿病（GDM）妊娠结局的相关性。方法采用ELISA法测定152例GDM孕妇、128例妊娠期糖耐量异常（GIGT）孕妇及120例糖耐量正常孕妇（对照组）血清脂联素水平，用PCR-RFLP方法检测脂联素基因+45T/G位点的多态性，分析该位点多态性与妊娠结局的相关性。结果(1)GDM组及GIGT组APN均显著低于对照组（均P＜0.01），空腹血糖、胰岛素、甘油三酯、低密度脂蛋白及HOMA-IR均明显高于对照组（均P＜0.01）；GDM组APN明显低于GIGT组（P＜0.01），HOMA-IR显著高于GIGT组（P＜0.01）。(2)APN与空腹血糖、胰岛素、HOMA-IR及总胆固醇呈负相关（P＜0.01），多元回归分析提示HOMA-IR是影响血清APN最显著的因素（P＜0.05）。(3)GDM组、GIGT组及对照组基因型差异均无统计学意义（均P＞0.05），GDM组和GIGT组的G等位基因频率均高于对照组（均P＜0.05）。携带G等位基因的新生儿低血糖、巨大儿及新生儿窒息的发生率均明显高于阴性表达组（均P＜0.05）。结论(1)GDM患者存在明显的胰岛素抵抗及糖脂代谢紊乱，且随着病情发展加重。(2) GDM患者APN明显降低，且与糖代谢异常的严重程度相关，APN与胰岛素抵抗及GDM的发生发展密切相关。(3)APN基因+45T/G位点基因多态性与GDM的发生存在一定的相关性，亦与其妊娠结局有关。
목적연구혈청지련소（APN）수평급기기인단핵감산다태성（SNP）+45T/G여임신기당뇨병（GDM）임신결국적상관성。방법채용ELISA법측정152례GDM잉부、128례임신기당내량이상（GIGT）잉부급120례당내량정상잉부（대조조）혈청지련소수평，용PCR-RFLP방법검측지련소기인+45T/G위점적다태성，분석해위점다태성여임신결국적상관성。결과(1)GDM조급GIGT조APN균현저저우대조조（균P＜0.01），공복혈당、이도소、감유삼지、저밀도지단백급HOMA-IR균명현고우대조조（균P＜0.01）；GDM조APN명현저우GIGT조（P＜0.01），HOMA-IR현저고우GIGT조（P＜0.01）。(2)APN여공복혈당、이도소、HOMA-IR급총담고순정부상관（P＜0.01），다원회귀분석제시HOMA-IR시영향혈청APN최현저적인소（P＜0.05）。(3)GDM조、GIGT조급대조조기인형차이균무통계학의의（균P＞0.05），GDM조화GIGT조적G등위기인빈솔균고우대조조（균P＜0.05）。휴대G등위기인적신생인저혈당、거대인급신생인질식적발생솔균명현고우음성표체조（균P＜0.05）。결론(1)GDM환자존재명현적이도소저항급당지대사문란，차수착병정발전가중。(2) GDM환자APN명현강저，차여당대사이상적엄중정도상관，APN여이도소저항급GDM적발생발전밀절상관。(3)APN기인+45T/G위점기인다태성여GDM적발생존재일정적상관성，역여기임신결국유관。
Objective To study the association between plasma adiponectin level and 45T/G polymorphism in adiponectin gene and gestational diabetes mellitus with pregnant outcomes.Methods ELISA technology was used to determine the plasma adiponectin levels on 152 cases of pregnant women with gestational diabetes mellitus(GDM) and 128 cases of pregnant women with gestational impaired glucose tolerance(GIGT) and 120 cases of pregnant women with normal glucose tolerance(NGT) as control group.PCR-RFLP method was used to determine the distribution of allele and genotype frequency of SNP+45T/G polymorphism in adiponectin gene. Meanwhile,association of the pregnancy outcomes and the SNP+45T/G polymorphism in three groups were analyzed.Results (1)The plasma adiponectin level in GIGT and GDM group was significantly lower than that in the control group(P<0.01),fasting plasma glucose,insulin,triglyceride,low density lipoprotein and HOMA-IR in GIGT and GDM group were significantly higher than those in the control group(P<0.01).The plasma adiponectin level in GDM group was also significantly lower than GIGT group(P<0.01),and HOMA-IR was signiifcantly higher than GIGT group(P<0.01).(2)Adiponectin had a negative relationship with fasting plasma glucose,insulin,HOMA-IR and total cholesterol(P<0.01).Multiple regression analysis showed that HOMA-IR was the most significant factors that affects plasma adiponectin level(P<0.05).(3)There was no significant difference in the distribution of genotype of SNP+45T/G in the GDM group,the GIGT group and the control group(P>0.05),the frequency of G allele of the GDM group and GIGT group was higher than the control group(P<0.05).The incidences of fetal macrosomia,neonatal hypoglycemia and neonatal asphyxia of pregnant women with G allele were all signiifcantly higher than the negative group(all P<0.05).Conclusions (1)GDM patients have obvious insulin resistance and glucolipid metabolic disorder which develop as the illness aggravating.(2) The plasma adiponectin level signiifcantly decreases in GDM patients,and associates with the severity of the sugar metabolic abnormalities. Adiponectin has a close relationship with insulin resistance and the occurrence of GDM. (3)SNP+45T/G has some relationship with the occurrence of GDM and pregnancy outcome.