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目的探讨妊娠不同时期脂肪细胞因子的动态变化及其与孕妇胰岛素抵抗的关系。方法选择2004年10月—2005年10月在我院门诊行产前检查的正常孕妇67例,其中妊娠早期18例(妊娠早期组),妊娠中期19例(妊娠中期组),妊娠晚期30例(妊娠晚期组);另选同期正常非孕妇女46例为对照组。采用酶联免疫吸附试验检测各组妇女血清中可溶性肿瘤坏死因子α受体(sTNFR)-Ⅰ、Ⅱ水平;采用放射免疫法测定各组妇女血清中瘦素、脂联素水平;采用免疫组化链霉菌抗生物素蛋白-过氧化物酶连接(SP)法检测妊娠晚期组妇女胎盘及脂肪组织中sTNFR定位与阳性表达。结果(1)妊娠早、中、晚期组及对照组妇女血清中sTNFR-Ⅰ水平分别为(799±173)、(1003±241)、(1278±306)及(729±167)ng/L,妊娠中、晚期组明显高于对照组,分别比较,差异有统计学意义(P<0·001)。(2)妊娠早、中、晚期组及对照组妇女血清中sTNFR-Ⅱ水平分别为(1383±305)、(1772±293)、(1933±498)及(1002±221)ng/L,妊娠早、中、晚期组明显高于对照组,分别比较,差异均有统计学意义(P<0·001)。并随孕期的增加,sTNFR-Ⅱ水平不断升高。(3)妊娠早、中、晚期组及对照组妇女血清中瘦素水平分别为(65±37)、(70±40)、(89±57)及(61±37)μg/L,妊娠晚期组明显高于对照组,两组比较,差异有统计学意义(P<0·05)。(4)妊娠早、中、晚期组及对照组妇女血清中脂联素水平分别为(13±6)、(9±5)、(10±4)及(14±7)mg/L,妊娠中、晚期组明显低于对照组,分别比较,差异有统计学意义(P<0·05)。(5)妊娠晚期组妇女胎盘及脂肪组织中sTNFR-Ⅰ、Ⅱ均呈阳性表达,无阴性表达;sTNFR-Ⅰ阳性染色颗粒主要定位于胎盘绒毛组织中的合体滋养细胞以及细胞滋养细胞中的胞质和胞膜,sTNFR-Ⅱ阳性染色颗粒主要定位于胎盘血管内皮细胞中的胞质和胞膜。结论孕妇血清中sTNFR-Ⅰ、Ⅱ及瘦素水平随孕期的增加不断升高;而脂联素水平则随孕期的增加有所下降,上述变化可能与孕妇的胰岛素抵抗有关。
Objective To investigate the dynamic changes of adipokines in different stages of pregnancy and its relationship with insulin resistance in pregnant women. Methods Sixty-seven normal pregnant women underwent prenatal examinations in our outpatient department from October 2004 to October 2005. Among them, 18 were pregnant during the first trimester (early pregnancy), 19 during the second trimester (middle pregnancy), and 30 were pregnant during the second trimester (Late pregnancy group); another 46 cases of normal non-pregnant women at the same period as the control group. Serum levels of soluble tumor necrosis factor-alpha (sTNFR) -Ⅰ, Ⅱ were measured by enzyme-linked immunosorbent assay (ELISA). The serum levels of leptin and adiponectin were measured by radioimmunoassay. Immunohistochemistry Streptomycin avidin - peroxidase linked (SP) method was used to detect the localization and positive expression of sTNFR in placenta and adipose tissue of the third trimester women. Results Serum levels of sTNFR-Ⅰ were (799 ± 173), (1003 ± 241), (1278 ± 306) and (729 ± 167) ng / L in pregnant women with early, middle and late pregnancy, Pregnancy, late group was significantly higher than the control group, respectively, the difference was statistically significant (P <0.001). (2) Serum levels of sTNFR-Ⅱ in pregnant women with early, middle and late pregnancy and control group were (1383 ± 305), (1772 ± 293), (1933 ± 498) and (1002 ± 221) ng / Early, middle and late groups were significantly higher than the control group, respectively, the difference was statistically significant (P <0.001). And with the increase of pregnancy, sTNFR-Ⅱ levels continue to rise. (3) Serum levels of leptin were (65 ± 37), (70 ± 40), (89 ± 57) and (61 ± 37) μg / L respectively in the third trimester, the third trimester and the third trimester of pregnancy. Group was significantly higher than the control group, the difference between the two groups was statistically significant (P <0.05). (4) Serum levels of adiponectin in early pregnancy, middle and late pregnancy and control group were (13 ± 6), (9 ± 5), (10 ± 4) and (14 ± 7) mg / Middle and late group was significantly lower than the control group, respectively, the difference was statistically significant (P <0.05). (5) The expression of sTNFR-Ⅰ and Ⅱ in placenta and adipose tissue of the third trimester women was positive, but no negative expression was found. The sTNFR-Ⅰpositive staining granule was mainly located in syncytiotrophoblast of placenta villi and cytotrophoblast Quality and cell membrane, sTNFR-Ⅱ positive staining particles located in the placental vascular endothelial cells in the cytoplasm and membrane. Conclusions The levels of sTNFR-Ⅰ, Ⅱ and leptin in pregnant women increase with the increase of gestational age, while the levels of adiponectin decrease with the increase of gestational age. The above changes may be related to the insulin resistance in pregnant women.