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目的探讨妊娠期糖尿病(GDM)患者血清孤独G蛋白偶联受体(apelin)和视黄酸受体反应蛋白2(chemerin)水平及其与胰岛素抵抗的关系。方法选择2009年3月至2011年12月于泰安市中心医院门诊做产前检查的孕妇70名,其中糖耐量正常组(NGT)孕妇30名,妊娠期糖尿病组(GDM)孕妇40名。计算每个个体体重指数(BMI),以及胰岛素抵抗指数(HOMA-IR),测定空腹以及糖负荷后2h血清apelin、chemerin水平,空腹血清胰岛素(FINS)以及糖负荷2h后血清胰岛素(2h PINS)。结果 GDM组与NGT组相比较,体重指数差异有统计学意义(28.92±2.25kg/m2vs 23.83±1.46 kg/m2,P<0.05),并且空腹胰岛素[(19.08土3.65μIU/L vs 14.16±2.42μIU/L),P<0.05]、糖负荷2h后胰岛素[(45.14±30.56μIU/L vs36.52±21.23μIU/L),P<0.05]以及胰岛素抵抗指数差异也有统计学意义(3.98±0.76,2.85±0.48,P<0.05);与NGT组比较,GDM组空腹(468.34±31.25 pg/mL vs 392.74±17.35pg/mL)以及糖负荷2h后(575.61±40.48 pg/mL vs 452.64±21.91 pg/mL)血清apelin差异有统计学意义(均P<0.05),与NGT组比较,GDM组空腹(72.26±16.63μg/L vs 60.81±17.27μg/L)以及糖负荷2h后(75.87±22.14μg/L vs 65.86±20.22μg/L)血清chemerin差异有统计学意义(均P<0.05)。同时发现apelin与chemerin水平呈正相关(r=0.45,P<0.05),血清apelin、chemerin与BMI呈正相关(r=0.47,P<0.05;r=0.68,P<0.01),与FINS呈正相关(r=0.36,P<0.05,r=0.26,P<0.05),与2h PINS呈正相关(r=0.28,P>0.05;r=0.22,P<0.05),与HOMA-IR呈正相关(r=0.45,P<0.05;r=0.49,P<0.05)。结论妊娠期糖尿病患者血清apelin、chemerin水平与胰岛素抵抗密切相关,apelin、chemerin可能参与了妊娠期糖尿病患者代谢的改变。
Objective To investigate the relationship between serum apelin and chemerin levels and insulin resistance in patients with gestational diabetes mellitus (GDM). Methods Seventy pregnant women who had antenatal examination in Tai’an Central Hospital from March 2009 to December 2011 were selected, including 30 pregnant women with normal glucose tolerance group (NGT) and 40 pregnant women with gestational diabetes mellitus (GDM). The body mass index (BMI) and insulin resistance index (HOMA-IR) of each individual were measured. Serum apelin and chemerin levels, fasting serum insulin (FINS) and serum insulin (2h PINS) . Results Compared with NGT group, the difference of body mass index in GDM group was statistically significant (28.92 ± 2.25kg / m2 vs 23.83 ± 1.46 kg / m2, P <0.05), and fasting insulin [(19.08 ± 3.65μIU / L vs 14.16 ± 2.42 (P <0.05) and insulin resistance index (3.98 ± 0.76, P <0.05), P <0.05]. There was also a significant difference in insulin resistance index after 2h of glucose load [(45.14 ± 30.56μIU / L vs36.52 ± 21.23μIU / L) , 2.85 ± 0.48, P <0.05). Compared with the NGT group, the GDM group had a significantly higher rate of fasting (468.34 ± 31.25 pg / mL vs 392.74 ± 17.35 pg / mL) and after 2h of glucose loading (575.61 ± 40.48 pg / mL vs 452.64 ± 21.91 pg / mL) (P <0.05). Compared with NGT group, the fasting serum (72.26 ± 16.63μg / L vs 60.81 ± 17.27μg / L) and the glucose load of GDM group (75.87 ± 22.14μg / / L vs 65.86 ± 20.22μg / L), serum chemerin had statistical significance (all P <0.05). Apelin was positively correlated with chemerin level (r = 0.45, P <0.05). Serum apelin and chemerin were positively correlated with BMI (r = 0.47, P <0.05; (R = 0.28, P> 0.05; r = 0.22, P <0.05), and had a positive correlation with HOMA-IR (r = 0.36, P 0. 05, r 0.26, P <0.05; r = 0.49, P <0.05). Conclusion Serum apelin and chemerin levels in gestational diabetes mellitus are closely related to insulin resistance. Apelin and chemerin may be involved in metabolic changes in gestational diabetes mellitus.