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目的研究妊娠期不同糖代谢状态血清脂联素(APN)和C反应蛋白(C-RP)变化与胰岛素抵抗(IR)的关系。方法测定48例妊娠期糖尿病(GDM)患者、30例妊娠期糖耐量减低(GIGT)患者和26名正常糖耐量(NGT)孕妇血清APN和C-RP水平,计算胰岛素抵抗指数(HOMA-IR)、胰岛β细胞功能指数(HOMA-β)和胰岛素敏感性指数(ISI)。结果 GDM组和GIGT组HOMA-IR分别为0.53±0.47、0.50±0.49,APN分别为5.85±2.97mg/L、6.56±3.12mg/L,与NGT组HOMA-IR(0.15±0.04)、APN(10.13±5.89mg/L)比较差异有统计学意义;GDM组HOMA-β(4.80±0.63)低于GIGT组(5.34±0.86)和NGT组(5.73±1.24),差异均有统计学意义;三组C-RP差异无统计学意义。多元回归分析显示,FPG、HOMA-IR为影响APN的显著因素,孕前BMI是影响C-RP的显著因素。结论随糖耐量异常进展,血清APN水平逐步下降;孕妇APN水平降低与FPG和IR密切相关;孕前BMI是影响孕期C-RP变化的主要因素。
Objective To study the relationship between the changes of serum adiponectin (APN) and C-reactive protein (C-RP) and insulin resistance (IR) in different glycometabolism during pregnancy. Methods Serum levels of APN and C-RP were measured in 48 patients with gestational diabetes mellitus (GDM), 30 pregnant women with impaired glucose tolerance (GIGT) and 26 normal glucose tolerance (NGT) pregnant women. The levels of insulin resistance index (HOMA-IR) , Pancreatic β-cell function index (HOMA-β) and insulin sensitivity index (ISI). Results The HOMA-IR of GDM group and GIGT group were 0.53 ± 0.47,0.50 ± 0.49 and 5.85 ± 2.97mg / L, 6.56 ± 3.12 mg / L, respectively, which were significantly lower than those of NGT group (HOMA-IR 0.15 ± 0.04, APN 10.13 ± 5.89mg / L). The difference of HOMA-β (4.80 ± 0.63) in GDM group was significantly lower than that in GIGT group (5.34 ± 0.86) and NGT group (5.73 ± 1.24) Group C-RP difference was not statistically significant. Multivariate regression analysis showed that FPG and HOMA-IR were the significant factors affecting APN. Pre-pregnancy BMI was a significant factor affecting C-RP. Conclusions With the progression of impaired glucose tolerance, the level of serum APN declines gradually. The decrease of APN level in pregnant women is closely related to FPG and IR. The pre-pregnancy BMI is the main factor that affects the change of C-RP during pregnancy.