中华临床营养杂志
中華臨床營養雜誌
중화림상영양잡지
Chinese Journal of Clinical Nutrition
2015年
4期
203-208
,共6页
袁涛%王相清%赵维纲%付勇%董颖越%李嘉佩
袁濤%王相清%趙維綱%付勇%董穎越%李嘉珮
원도%왕상청%조유강%부용%동영월%리가패
妊娠期糖尿病%脂肪细胞因子%胰岛素敏感性
妊娠期糖尿病%脂肪細胞因子%胰島素敏感性
임신기당뇨병%지방세포인자%이도소민감성
Gestational diabetes mellitus%Adipocytokine%Insulin sensitivity
目的 评估不同糖耐量状态孕妇的临床特征、胰岛素敏感性及血清脂肪因子水平,探索妊娠糖尿病的血清预测因子.方法 入选2009年1月至2012年6月在北京协和医院定期产前随诊的74例50 g葡萄糖负荷试验(GCT)阳性孕妇,记录临床资料,进一步在妊娠24～28周行100 g口服葡萄糖耐量试验,根据血糖值分为妊娠糖尿病(GDM)组25例、糖耐量异常(IGT)组25例、糖耐量正常(NGT)组24例.各组均用酶联免疫吸附试验(ELISA)检测血清成纤维细胞生长因子(FGF)-19、FGF-21、内脏脂肪特异性丝氨酸蛋白酶抑制剂(vaspin)、瘦素、胰岛素样生长因子结合蛋白-1(IGFBP-1)和脂联素水平.并将3组资料对比,分析各种因子与患者基线资料和代谢指标的相关性.结果 GDM组GCT血糖值[(9.21±0.75) mmoL/L]、糖化血红蛋白(HbAlc)[(5.39±0.34)％]显著高于NGT组[(8.52±0.50) mmol/L、(5.18±0.20)％;均P＜0.05],但与IGT组[(9.14±0.64) mmol/L、(5.28±0.28)％;均P＞0.05]比较差异无统计学意义.各组孕妇在年龄、孕早期收缩压、孕早期舒张压、孕前体质量指数(BMI)、孕期BMI增加值、血清总胆固醇、三酰甘油、高密度脂蛋白胆固醇、低密度脂蛋白胆固醇、C反应蛋白水平差异均无统计学意义(均P＞0.05).从NGT到IGT到GDM组,OGTT血糖曲线下面积(AUCBG)[(19.84±1.95)、(23.20±1.51)、(26.58±2.02) mmol/(L·h)]和胰岛素曲线下面积(AUCINS)[(1.84±0.91)、(1.85±1.15)、(2.49±1.36)×103pmol/(L·h)]均逐渐升高,GDM组胰岛素抵抗指数(HOMA-IR)显著高于NGT组[3.0(1.5,5.2)比2.5 (1.5,3.4),P＜0.05],但胰岛β细胞功能指数(HOMA-β)低于NGT组[230.5 (144.6,311.6)比235.6 (168.1,350.0),P＜0.05].GDM组、IGT组、NGT组FGF-19[(284.42±78.16)、(268.17±72.97)、(283.86±79.74) ng/L]、FGF-21[(798.16±273.57)、(882.43±322.17)、(842.75±343.01) ng/L]、vaspin[(22.36±7.27)、(23.53±7.90)、(22.63±9.11) μg/L]、瘦素[(5.51±1.44)、(5.58±1.58)、(5.48±1.47) μg/L]、脂联素[(798.85±255.14)、(863.44±252.18)、(828.36±249.32) μg/L]和IGFBP-1[(40.44±16.41)、(49.57±12.60)、(43.80±16.58) μg/L]水平差异均无统计学意义(均P＞0.05).结论 妊娠期不同糖耐量状态下多种脂肪细胞因子水平均无显著差异,并未发现妊娠糖尿病的有效血清学预测因子,脂肪细胞因子在妊娠糖尿病发病中的作用还有待进一步研究.
目的 評估不同糖耐量狀態孕婦的臨床特徵、胰島素敏感性及血清脂肪因子水平,探索妊娠糖尿病的血清預測因子.方法 入選2009年1月至2012年6月在北京協和醫院定期產前隨診的74例50 g葡萄糖負荷試驗(GCT)暘性孕婦,記錄臨床資料,進一步在妊娠24～28週行100 g口服葡萄糖耐量試驗,根據血糖值分為妊娠糖尿病(GDM)組25例、糖耐量異常(IGT)組25例、糖耐量正常(NGT)組24例.各組均用酶聯免疫吸附試驗(ELISA)檢測血清成纖維細胞生長因子(FGF)-19、FGF-21、內髒脂肪特異性絲氨痠蛋白酶抑製劑(vaspin)、瘦素、胰島素樣生長因子結閤蛋白-1(IGFBP-1)和脂聯素水平.併將3組資料對比,分析各種因子與患者基線資料和代謝指標的相關性.結果 GDM組GCT血糖值[(9.21±0.75) mmoL/L]、糖化血紅蛋白(HbAlc)[(5.39±0.34)％]顯著高于NGT組[(8.52±0.50) mmol/L、(5.18±0.20)％;均P＜0.05],但與IGT組[(9.14±0.64) mmol/L、(5.28±0.28)％;均P＞0.05]比較差異無統計學意義.各組孕婦在年齡、孕早期收縮壓、孕早期舒張壓、孕前體質量指數(BMI)、孕期BMI增加值、血清總膽固醇、三酰甘油、高密度脂蛋白膽固醇、低密度脂蛋白膽固醇、C反應蛋白水平差異均無統計學意義(均P＞0.05).從NGT到IGT到GDM組,OGTT血糖麯線下麵積(AUCBG)[(19.84±1.95)、(23.20±1.51)、(26.58±2.02) mmol/(L·h)]和胰島素麯線下麵積(AUCINS)[(1.84±0.91)、(1.85±1.15)、(2.49±1.36)×103pmol/(L·h)]均逐漸升高,GDM組胰島素牴抗指數(HOMA-IR)顯著高于NGT組[3.0(1.5,5.2)比2.5 (1.5,3.4),P＜0.05],但胰島β細胞功能指數(HOMA-β)低于NGT組[230.5 (144.6,311.6)比235.6 (168.1,350.0),P＜0.05].GDM組、IGT組、NGT組FGF-19[(284.42±78.16)、(268.17±72.97)、(283.86±79.74) ng/L]、FGF-21[(798.16±273.57)、(882.43±322.17)、(842.75±343.01) ng/L]、vaspin[(22.36±7.27)、(23.53±7.90)、(22.63±9.11) μg/L]、瘦素[(5.51±1.44)、(5.58±1.58)、(5.48±1.47) μg/L]、脂聯素[(798.85±255.14)、(863.44±252.18)、(828.36±249.32) μg/L]和IGFBP-1[(40.44±16.41)、(49.57±12.60)、(43.80±16.58) μg/L]水平差異均無統計學意義(均P＞0.05).結論 妊娠期不同糖耐量狀態下多種脂肪細胞因子水平均無顯著差異,併未髮現妊娠糖尿病的有效血清學預測因子,脂肪細胞因子在妊娠糖尿病髮病中的作用還有待進一步研究.
목적 평고불동당내량상태잉부적림상특정、이도소민감성급혈청지방인자수평,탐색임신당뇨병적혈청예측인자.방법 입선2009년1월지2012년6월재북경협화의원정기산전수진적74례50 g포도당부하시험(GCT)양성잉부,기록림상자료,진일보재임신24～28주행100 g구복포도당내량시험,근거혈당치분위임신당뇨병(GDM)조25례、당내량이상(IGT)조25례、당내량정상(NGT)조24례.각조균용매련면역흡부시험(ELISA)검측혈청성섬유세포생장인자(FGF)-19、FGF-21、내장지방특이성사안산단백매억제제(vaspin)、수소、이도소양생장인자결합단백-1(IGFBP-1)화지련소수평.병장3조자료대비,분석각충인자여환자기선자료화대사지표적상관성.결과 GDM조GCT혈당치[(9.21±0.75) mmoL/L]、당화혈홍단백(HbAlc)[(5.39±0.34)％]현저고우NGT조[(8.52±0.50) mmol/L、(5.18±0.20)％;균P＜0.05],단여IGT조[(9.14±0.64) mmol/L、(5.28±0.28)％;균P＞0.05]비교차이무통계학의의.각조잉부재년령、잉조기수축압、잉조기서장압、잉전체질량지수(BMI)、잉기BMI증가치、혈청총담고순、삼선감유、고밀도지단백담고순、저밀도지단백담고순、C반응단백수평차이균무통계학의의(균P＞0.05).종NGT도IGT도GDM조,OGTT혈당곡선하면적(AUCBG)[(19.84±1.95)、(23.20±1.51)、(26.58±2.02) mmol/(L·h)]화이도소곡선하면적(AUCINS)[(1.84±0.91)、(1.85±1.15)、(2.49±1.36)×103pmol/(L·h)]균축점승고,GDM조이도소저항지수(HOMA-IR)현저고우NGT조[3.0(1.5,5.2)비2.5 (1.5,3.4),P＜0.05],단이도β세포공능지수(HOMA-β)저우NGT조[230.5 (144.6,311.6)비235.6 (168.1,350.0),P＜0.05].GDM조、IGT조、NGT조FGF-19[(284.42±78.16)、(268.17±72.97)、(283.86±79.74) ng/L]、FGF-21[(798.16±273.57)、(882.43±322.17)、(842.75±343.01) ng/L]、vaspin[(22.36±7.27)、(23.53±7.90)、(22.63±9.11) μg/L]、수소[(5.51±1.44)、(5.58±1.58)、(5.48±1.47) μg/L]、지련소[(798.85±255.14)、(863.44±252.18)、(828.36±249.32) μg/L]화IGFBP-1[(40.44±16.41)、(49.57±12.60)、(43.80±16.58) μg/L]수평차이균무통계학의의(균P＞0.05).결론 임신기불동당내량상태하다충지방세포인자수평균무현저차이,병미발현임신당뇨병적유효혈청학예측인자,지방세포인자재임신당뇨병발병중적작용환유대진일보연구.
Objective To evaluate clinical features,insulin sensitivity,and serum adipocytokines levels in pregnant women with different glucose tolerance status and to investigate the possible serum predictive biomarkers of gestational diabetes mellitus (GDM).Methods We included 74 pregnant women with positive results of 50 g glucose challenge test (GCT),who received regular obstetrical follow-up in Peking Union Medical College Hospital from January 2009 to June 2012.A further 100 g oral glucose tolerance test was performed in 24-28 gestational weeks,based on which the 74 pregnant women were divided into GDM group (n =25),impaired glucose tolerance (IGT) group (n =25) and normal glucose tolerance (NGT) group (n =24).The clinical data were recorded in detail.Serum fibroblast growth factor (FGF)-19,FGF-21,visceral adiposespecific serine protease inhibitor (vaspin),leptin,insulin-like growth factor binding protein-1 (IGFBP-1),and adiponectin levels of the 3 groups were measured by enzyme-linked immunosorbent assay (ELISA) and compared.The associations of these adipocytokines with the patients' baseline data and metabolic indexes were analyzed.Results The blood glucose after GCT and glycosylated hemoglobin A1c in the GDM group were significantly higher than those in the NGT group [(9.21 ±0.75) mmol/L vs.(8.52 ±0.50) mmol/L,P ＜0.05;(5.39 ± 0.34) ％ vs.(5.18 ± 0.20) ％,P ＜ 0.05],but not significantly different from those in the IGT group [(9.14 ± 0.64) mmol/L,P ＞ 0.05;(5.28 ± 0.28) ％,P ＞ 0.05].Age,systolic blood pressure and diastolic blood pressure in the first trimester,pre-gestational body mass index (BMI),increment of BMI during pregnancy,serum total cholesterol,triglyceride,high-density lipoprotein cholesterol,low-density lipoprotein cholesterol,and C-reactive protein levels in the three groups showed no significant differences (all P ＞0.05).From the NGT group to the IGT group to the GDM group,the area under curve of blood glucose (AUCBG) [(19.84±1.95),(23.20±1.51),(26.58±2.02) mmol/(L · h)] and AUC of insulin (AUCINS) [(1.84± 0.91) ×103,(1.85 ±1.15) ×103,(2.49 ±1.36) ×103 pmol/(L · h)] both gradually increased.Compared with the NGT group,the GDM group had significantly higher HOMA-IR [3.0 (1.5,5.2) vs.2.5 (1.5,3.4),P ＜0.05] significantly lower HOMA-β [230.5 (144.6,311.6) vs.235.6 (168.1,350.0),P ＜ 0.05].Among the GDM,the IGT,and the NGT groups,there were no significant differences in serum FGF-19 [(284.42±78.16),(268.17 ±72.97),(283.86 ±79.74) ng/L],FGF-21 [(798.16±273.57),(882.43 ±322.17),(842.75 ±343.01) ng/L],vaspin [(22.36 ±7.27),(23.53 ±7.90),(22.63±9.11) μag/L],leptin [(5.51 ± 1.44),(5.58 ± 1.58),(5.48 ± 1.47) μg/L],adiponectin [(798.85 ± 255.14),(863.44 ± 252.18),(828.36 ± 249.32) μg/L] and IGFBP-1 [(40.44 ± 16.41),(49.57±12.60),(43.80±16.58) μg/L] levels (all P＞0.05).Conclusions There are no significant differences of a variety of adipocytokines in pregnant women with different glucose tolerance status,and no effective serum predictors of GDM are found.The effect of adipocytokines in the pathogenesis of GDM remains to be further investigated.
