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目的探讨妊娠期糖尿病(GDM)患者母乳中视黄醇结合蛋白4(RBP4)的变化以及临床意义。方法选择GDM孕妇60例,非GDM正常孕妇45人为对照组。GDM组根据母乳喂养量分为高母乳喂养组及低母乳喂养组。分娩时采集脐血、产后收集初乳及成熟乳,分别用放射免疫(RIA)法和酶联免疫(ELASA)法测定胰岛素和RBP4水平;记录新生儿出生体重和产后复查时体重增加量。结果 GDM组脐带血的RBP4和胰岛素(INS)分别为(14.9±2.6)μg/L和(8.3±1.9)μU/m L,均高于对照组的(12.4±2.7)μg/L和(6.0±2.1)μU/m L(P均<0.01)。GDM组初乳RBP4和INS分别为(16.9±4.2)μg/L和(11.3±3.1)μU/m L,均高于对照组的(13.3±4.5)μg/L和(9.2±2.8)μU/m L(P均<0.01);GDM组成熟乳RBP4(16.1±4.0)μg/L明显高于对照组的(12.5±3.1)μg/L(P<0.01);但是两组胰岛素水平比较差异无统计学意义(P>0.05)。GDM组高母乳喂养者的成熟乳RBP4低于低母乳喂养者(P<0.01);GDM组乳汁RBP4水平影响因素分析显示,初乳RBP4水平均与其对应的胰岛素水平呈正相关(r=0.45,P<0.01);初乳RBP4水平与孕期体重增加量呈正相关(r=0.37,P<0.01);GDM组脐血中的RBP4水平与新生儿出生体重呈正相关(r=0.43,P<0.01)。高母乳喂养组成熟乳中RBP4水平与婴儿体重增加呈负相关(r=-0.49,P<0.01)。结论 GDM母乳中RBP4参与婴儿生长发育调节,母乳喂养者体内RBP4水平较低。
Objective To investigate the changes of retinol binding protein 4 (RBP4) in breast milk of patients with gestational diabetes mellitus (GDM) and its clinical significance. Methods Sixty pregnant women with GDM and 45 normal pregnant women without GDM were selected as the control group. The GDM group was divided into high breastfeeding group and low breastfeeding group according to the amount of breastfeeding. Umbilical cord blood was collected during childbirth. Colostrum and mature milk were collected after delivery. The levels of insulin and RBP4 were measured by radioimmunoassay (RIA) and enzyme-linked immunosorbent assay (ELASA). The birth weight and weight gain were recorded after birth. Results The RBP4 and INS of umbilical cord blood in GDM group were (14.9 ± 2.6) μg / L and (8.3 ± 1.9) μU / m L, respectively, higher than those in control group (12.4 ± 2.7 μg / L and 6.0 ± 2.1) μU / m L (P <0.01). The RBP4 and INS in colostrum of GDM group were (16.9 ± 4.2) μg / L and (11.3 ± 3.1) μU / mL, respectively, which were significantly higher than those of control group (13.3 ± 4.5 μg / L and 9.2 ± 2.8 μU / (P <0.01). The RBP4 (16.1 ± 4.0) μg / L in mature milk of GDM group was significantly higher than that of control group (12.5 ± 3.1) μg / L (P <0.01), but there was no significant difference in insulin level between the two groups Statistical significance (P> 0.05). The RBP4 level in mature GDM group was significantly lower than that of low breastfeeding group (P <0.01). Analysis of factors affecting the level of RBP4 in GDM group showed that RBP4 level in colostrum was positively correlated with insulin level (r = 0.45, P <0.01). The level of RBP4 in colostrum was positively correlated with weight gain during pregnancy (r = 0.37, P <0.01). RBP4 level in cord blood of GDM group was positively correlated with newborn birth weight (r = 0.43, P <0.01). RBP4 level in mature milk of high breastfeeding group was negatively correlated with infant weight gain (r = -0.49, P <0.01). Conclusions RBP4 in GDM breast milk is involved in the regulation of infant growth and development, and the level of RBP4 in breastfeeding people is low.