CAJ | 학술논문

目的：探讨妊娠期糖尿病（gestational diabetes mellitus，GDM）产妇初乳和成熟乳中胃生长素、脂联素、瘦素、真胰岛素的水平及其与婴儿体格发育的关系。方法2010年1月至8月在中国医学科学院北京协和医院产科及北京妇产医院产科分娩的妊娠26周确诊为GDM、单胎妊娠、足月分娩、无其他合并症的孕妇及其健康新生儿，共52对，作为GDM组。同期单胎妊娠、足月分娩、无任何合并症的健康产妇及其健康新生儿，共49对，作为对照组。取产妇初乳和90 d的成熟乳，采用酶联免疫吸附试验检测乳汁中胃生长素、脂联素、瘦素及真胰岛素水平，婴儿90日龄时测量体重、身长及头围。采用两独立样本t检验、秩和检验及Spearman相关分析进行统计分析。结果（1）与对照组相比，GDM组胃生长素水平在初乳[136.7（102.7~181.4）与175.4（137.5~235.0）ng/L，t=－2.737]和成熟乳中[111.8（77.5~184.2）与210.9（147.3~381.9）ng/L，t=－3.268]均较低，脂联素水平在初乳[21.7（14.6~51.8）与57.0（23.1~113.9）μg/L，t=－2.858]和成熟乳中[11.7（8.4~14.4）与15.1（11.9~18.5）μg/L，t=－2.625]也较低，真胰岛素水平在初乳[22.8（13.4~50.2）与20.4（7.8~30.8） mU/L，t=－2.007]和成熟乳中[33.6（22.5~54.1）与23.5（13.5~31.6） mU/L，t=－2.009]较高，差异均有统计学意义（P值均＜0.05）。（2）GDM组初乳中，真胰岛素水平与胃生长素水平负相关（r=－0.342），与脂联素水平正相关（r=0.305）；在对照组中，成熟乳中的真胰岛素水平与初乳（r=0.456）和成熟乳中的瘦素水平正相关（r=0.629）；差异均有统计学意义（P值均＜0.05）。（3）GDM组初乳中，脂联素水平与新生儿出生体重负相关（r=－0.323），瘦素/脂联素比值与出生体重（r=－0.403）和出生头围（r=－0.327）负相关；成熟乳中脂联素水平与婴儿90日龄时身长负相关（r=－0.406）。对照组初乳中瘦素/脂联素比值与新生儿出生头围负相关（r=－0.370）；成熟乳中脂联素水平与婴儿90日龄时体重正相关（r=0.432）。差异均有统计学意义（P值均＜0.05）。结论 GDM组母乳中的激素水平与对照组不同，可能共同参与了对婴儿生长的调控作用。目的：探討妊娠期糖尿病（gestational diabetes mellitus，GDM）產婦初乳和成熟乳中胃生長素、脂聯素、瘦素、真胰島素的水平及其與嬰兒體格髮育的關繫。方法2010年1月至8月在中國醫學科學院北京協和醫院產科及北京婦產醫院產科分娩的妊娠26週確診為GDM、單胎妊娠、足月分娩、無其他閤併癥的孕婦及其健康新生兒，共52對，作為GDM組。同期單胎妊娠、足月分娩、無任何閤併癥的健康產婦及其健康新生兒，共49對，作為對照組。取產婦初乳和90 d的成熟乳，採用酶聯免疫吸附試驗檢測乳汁中胃生長素、脂聯素、瘦素及真胰島素水平，嬰兒90日齡時測量體重、身長及頭圍。採用兩獨立樣本t檢驗、秩和檢驗及Spearman相關分析進行統計分析。結果（1）與對照組相比，GDM組胃生長素水平在初乳[136.7（102.7~181.4）與175.4（137.5~235.0）ng/L，t=－2.737]和成熟乳中[111.8（77.5~184.2）與210.9（147.3~381.9）ng/L，t=－3.268]均較低，脂聯素水平在初乳[21.7（14.6~51.8）與57.0（23.1~113.9）μg/L，t=－2.858]和成熟乳中[11.7（8.4~14.4）與15.1（11.9~18.5）μg/L，t=－2.625]也較低，真胰島素水平在初乳[22.8（13.4~50.2）與20.4（7.8~30.8） mU/L，t=－2.007]和成熟乳中[33.6（22.5~54.1）與23.5（13.5~31.6） mU/L，t=－2.009]較高，差異均有統計學意義（P值均＜0.05）。（2）GDM組初乳中，真胰島素水平與胃生長素水平負相關（r=－0.342），與脂聯素水平正相關（r=0.305）；在對照組中，成熟乳中的真胰島素水平與初乳（r=0.456）和成熟乳中的瘦素水平正相關（r=0.629）；差異均有統計學意義（P值均＜0.05）。（3）GDM組初乳中，脂聯素水平與新生兒齣生體重負相關（r=－0.323），瘦素/脂聯素比值與齣生體重（r=－0.403）和齣生頭圍（r=－0.327）負相關；成熟乳中脂聯素水平與嬰兒90日齡時身長負相關（r=－0.406）。對照組初乳中瘦素/脂聯素比值與新生兒齣生頭圍負相關（r=－0.370）；成熟乳中脂聯素水平與嬰兒90日齡時體重正相關（r=0.432）。差異均有統計學意義（P值均＜0.05）。結論 GDM組母乳中的激素水平與對照組不同，可能共同參與瞭對嬰兒生長的調控作用。
목적：탐토임신기당뇨병（gestational diabetes mellitus，GDM）산부초유화성숙유중위생장소、지련소、수소、진이도소적수평급기여영인체격발육적관계。방법2010년1월지8월재중국의학과학원북경협화의원산과급북경부산의원산과분면적임신26주학진위GDM、단태임신、족월분면、무기타합병증적잉부급기건강신생인，공52대，작위GDM조。동기단태임신、족월분면、무임하합병증적건강산부급기건강신생인，공49대，작위대조조。취산부초유화90 d적성숙유，채용매련면역흡부시험검측유즙중위생장소、지련소、수소급진이도소수평，영인90일령시측량체중、신장급두위。채용량독립양본t검험、질화검험급Spearman상관분석진행통계분석。결과（1）여대조조상비，GDM조위생장소수평재초유[136.7（102.7~181.4）여175.4（137.5~235.0）ng/L，t=－2.737]화성숙유중[111.8（77.5~184.2）여210.9（147.3~381.9）ng/L，t=－3.268]균교저，지련소수평재초유[21.7（14.6~51.8）여57.0（23.1~113.9）μg/L，t=－2.858]화성숙유중[11.7（8.4~14.4）여15.1（11.9~18.5）μg/L，t=－2.625]야교저，진이도소수평재초유[22.8（13.4~50.2）여20.4（7.8~30.8） mU/L，t=－2.007]화성숙유중[33.6（22.5~54.1）여23.5（13.5~31.6） mU/L，t=－2.009]교고，차이균유통계학의의（P치균＜0.05）。（2）GDM조초유중，진이도소수평여위생장소수평부상관（r=－0.342），여지련소수평정상관（r=0.305）；재대조조중，성숙유중적진이도소수평여초유（r=0.456）화성숙유중적수소수평정상관（r=0.629）；차이균유통계학의의（P치균＜0.05）。（3）GDM조초유중，지련소수평여신생인출생체중부상관（r=－0.323），수소/지련소비치여출생체중（r=－0.403）화출생두위（r=－0.327）부상관；성숙유중지련소수평여영인90일령시신장부상관（r=－0.406）。대조조초유중수소/지련소비치여신생인출생두위부상관（r=－0.370）；성숙유중지련소수평여영인90일령시체중정상관（r=0.432）。차이균유통계학의의（P치균＜0.05）。결론 GDM조모유중적격소수평여대조조불동，가능공동삼여료대영인생장적조공작용。
Objective To evaluate the levels of ghrelin, adiponectin, leptin and true insulin in human milk from mothers with and without gestational diabetes mellitus (GDM), and to assess the effects of these parameters on infant growth. Methods Fifty-two GDM mothers and their healthy infants (GDM group) and 49 non-GDM mothers and their healthy infants (control group) were enrolled from Beijing Obstetrics and Gynecology Hospital and Peking Union Medical College Hospital from January 2010 to August 2010. The levels of ghrelin, adiponectin, leptin and true insulin in colostrum and human milk 90 days postpartum (mature milk) were determined by enzyme-linked immunosorbent assay. Infant weight, length and head circumference at birth and at 90 days old were measured. The two-sample t-test, sum-rank test and Spearman correlation analysis were used for statistical analysis. Results Compared with the control group, ghrelin was significantly lower in human milk from GDM mothers both in colostrum [136.7 (102.7-181.4) vs 175.4 (137.5-235.0) ng/L, t= -2.737] and mature milk [111.8 (77.5-184.2) vs 210.9 (147.3-381.9) ng/L, t= -3.268]. Adiponectin was also significantly lower in human milk from GDM mothers both in colostrum [21.7 (14.6-51.8) vs 57.0 (23.1-113.9)μg/L, t=-2.858] and mature milk [11.7 (8.4-14.4) vs 15.1 (11.9-18.5)μg/L, t=-2.625], however, true insulin level was higher in colostrum [22.8 (13.4-50.2) vs 20.4 (7.8-30.8) mU/L, t=-2.007] and mature milk [33.6 (22.5-54.1) vs 23.5 (13.5-31.6) mU/L, t=-2.009]. The differences were statistically significant (all P < 0.05). (2) In the colostrums of the GDM group, true insulin level was negatively associated with ghrelin (r=-0.342), but positively associated with adiponectin (r=0.305). In the control group, the level of true insulin in mature milk was positive associated with leptin in colostrums( r=0.456)and mature milk(r=0.629). The differences were statistically significant (all P < 0.05). (3) In the GDM group, adiponectin level in colostrum was negatively associated with neonatal birth weight (r= - 0.323, P=0.025); the leptin/adiponectin ratio was negatively associated with neonatal birth weight (r= -0.403, P=0.005) and head circumference (r= -0.327, P=0.039) at birth. Adiponectin level in mature milk was negatively associated with infant length 90 days postpartum (r=-0.406, P=0.040). In the control group, the leptin/adiponectin ratio in colostrum was negatively associated with neonatal head circumference at birth (r= -0.370, P=0.024). Adiponectin level in mature milk was positively associated with infant weight 90 days postpartum (r=0.432, P=0.007). Conclusion Women with GDM have different levels of ghrelin, adiponectin and true insulin in their milk from the normal controls, which may affect infant growth.