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目的探讨正常妊娠和妊娠期高血压产妇胰岛素抵抗及其相关因子的水平改变情况,为明确妊娠期高血压病因和临床早期诊断治疗提供依据。方法分别采用己糖激酶法、放射免疫法、硝酸盐还原酶法等方法对30例妊娠期高血压产妇和30例正常产妇不同孕周的血糖血脂、血胰岛素、胎盘生乳素(human placental lactogen,HPL)、雌二醇(estradiol,E2)、一氧化氮(nitric oxide,NO)和一氧化氮合酶(nitric oxide synthase,NOS)的水平进行检测。结果随着孕周的增加,两组产妇的空腹血糖和胰岛素水平并无明显改变(P>0.05),而血清甘油三酯(triglycerides,TG)、总胆固醇(total cholesterol,TC)、高密度脂蛋白胆固醇(high density lipoprotein cholesterol,HDL-C)和低密度脂蛋白胆固醇(low density lipoprotein cholesterol,LDL-C)、HPL和E2的含量测定值则逐渐升高,且妊娠晚期的各指标水平明显高于妊娠早期(P<0.05)。与正常组相比,妊高组的空腹血糖值亦无显著性改变,但妊高组胰岛素、HDL-C、NO和NOS水平均显著低于正常组,LDL-C则显著增加,差异均具有统计学意义(P<0.05)。值得注意的是,妊娠期高血压组妊娠16周、28周时的E2水平显著高于正常组(P<0.05),而妊娠期高血压组HPL水平则在妊娠28周和分娩时显著低于正常组(P<0.05)。结论胰岛素抵抗及其相关因子的异常是导致妊娠期高血压的主要因素,可作为诊断和治疗妊娠期高血压潜在的生物学标志。
Objective To investigate the changes of insulin resistance and its related factors in normal pregnancy and gestational hypertension maternal and to provide basis for clarifying the etiology and early clinical diagnosis and treatment of hypertension in pregnancy. Methods The blood glucose and blood lipids, blood insulin, placental lactogen (ALT) and plasma lipoproteins in 30 pregnant women with gestational hypertension and 30 normal pregnant women at different gestational weeks were detected by hexokinase, radioimmunoassay and nitrate reductase respectively. HPL, estradiol (E2), nitric oxide (NO) and nitric oxide synthase (NOS) were measured. Results With the increase of gestational age, there was no significant difference in fasting blood glucose and insulin levels between the two groups (P> 0.05). However, serum triglycerides (TG), total cholesterol (TC) The levels of high density lipoprotein cholesterol (HDL-C), low density lipoprotein cholesterol (LDL-C), HPL and E2 in serum were gradually increased, and the levels of each index in late pregnancy were significantly higher Early pregnancy (P <0.05). Compared with the normal group, the fasting blood glucose level did not change significantly in the PIH group, but the levels of insulin, HDL-C, NO and NOS in the PIH group were significantly lower than those in the normal group, while the LDL-C levels were significantly increased Statistical significance (P <0.05). It is noteworthy that the gestational hypertension group at 16 weeks gestation, 28 weeks E2 level was significantly higher than the normal group (P <0.05), while gestational hypertension group HPL levels at 28 weeks of gestation and childbirth was significantly lower than Normal group (P <0.05). Conclusion Abnormal insulin resistance and its related factors are the main factors leading to pregnancy-induced hypertension and can be used as potential biomarkers for the diagnosis and treatment of gestational hypertension.