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目的探讨妊娠糖尿病(GDM)患者脂肪细胞因子瘦素、视黄醇结合蛋白4(RBP4)、脂联素与炎症细胞因子白介素6(IL-6)、肿瘤坏死因子α(TNF-α)的关系。方法选择GDM患者60例,正常糖耐量(NGT)孕妇44例,根据体重和身高计算晚孕期体重指数(BMI);检测空腹血糖(FBG)水平,计算胰岛素抵抗指数(HOMA-IR)和胰岛素敏感指数(ISI);酶法检测血清甘油三酯(TG)、总胆固醇(TC);比色法测定游离脂肪酸(FFA)水平;ELISA法检测所有孕妇血清中脂联素和RBP4水平;放射免疫法检测空腹胰岛素(FIns)、瘦素、IL-6、TNF-α水平。将两组孕妇的各指标之间进行Pearson相关分析。结果与NGT组比较,GDM组的FPG、TG、TC、FFA、瘦素、IL-6、TNF-α、RBP4水平均明显升高,脂联素水平明显下降,存在显著的炎性激活及胰岛素抵抗;HO-MA-IR、RBP4、瘦素与IL-6、TNF-α呈正相关;ISI、脂联素与IL-6、TNF-α呈负相关。结论 GDM患者由于过度分泌的脂肪细胞因子和炎性因子导致显著的炎性激活,可能是GDM中胰岛素抵抗发生发展的机制之一。
Objective To investigate the relationship between the levels of leptin, retinol binding protein 4 (RBP4), adiponectin and inflammatory cytokines interleukin 6 (IL-6) and tumor necrosis factor α (TNF-α) in patients with gestational diabetes mellitus (GDM) . Methods Sixty pregnant women with GDM and 44 pregnant women with normal glucose tolerance (NGT) were enrolled in this study. Body mass index (BMI), late pregnancy BMI, fasting blood glucose (FBG) Serum triglyceride (TG) and total cholesterol (TC) were detected by enzyme-linked immunosorbent assay (ELISA); Free fatty acid (FFA) was measured by colorimetry; Serum adiponectin and RBP4 were detected by ELISA; Radioimmunoassay Fasting insulin (FIns), leptin, IL-6 and TNF-α were detected. Pearson correlation analysis between the two groups of indicators of pregnant women. Results Compared with NGT group, the levels of FPG, TG, TC, FFA, leptin, IL-6, TNF-α and RBP4 in GDM group were significantly increased, adiponectin level was significantly decreased, and there was significant inflammatory activation and insulin The levels of IL-6 and TNF-α in HO-MA-IR, RBP4 and leptin were positively correlated. The levels of ISI and adiponectin were negatively correlated with IL-6 and TNF-α. Conclusions GDM patients may have significant inflammatory activation due to over-secretion of adipocytokines and inflammatory cytokines, which may be one of the mechanisms of GDM insulin resistance.