摘要
目的探讨肥胖型妊娠期糖尿病(gestational diabetes mellitus,GDM)患者血清视黄醇结合蛋白-4(retinol binding protein 4,RBP-4)表达变化及临床意义。方法选取2016年6月至2017年12月于河北省保定市妇幼保健院正规建卡产检且孕前体质量指数(body mass index,BMI)>25 kg/m^2,孕期体质量增加低于20 kg的40例肥胖型GDM患者为观察组,同时选择同期产检且孕前BMI为18.5～25.0 kg/m^2,孕期体质量增加低于20 kg的40例非肥胖型GDM患者为对照组。观察两组患者孕24～28周的糖脂生化指标,使用酶联免疫吸附法检测患者血清RBP-4表达情况,比较两组患者空腹胰岛素(fasting insulin,FINS)、胰岛素抵抗指数(homeostasis model assessment for insulin resistance,HOMA-IR)、肿瘤坏死因子-α(tumor necrosis factor-α,TNF-α)、血清脂联素(adiponectin,APN)水平。结果观察组患者空腹血糖(fasting blood glucose,FBG)水平明显高于对照组(P<0.05);两组患者餐后2 h血糖、糖化血红蛋白比较,差异无统计学意义(P>0.05);观察组患者甘油三酯(triglyceride,TG)水平高于对照组(P<0.05);两组患者血清总胆固醇(total cholesterol,TC)、高密度脂蛋白胆固醇(HDL-cholesterol,HDL-Ch)、低密度脂蛋白胆固醇(LDL-cholesterol,LDL-C)比较,差异无统计学意义(P>0.05);观察组患者RBP-4、FINS、HOMA-IR、TNF-α水平高于对照组,APN水平低于对照组(P<0.05);血清RBP-4与患者孕前BMI、FBG、TG、FINS、HOMA-IR、TNF-α呈正相关(r=0.274、0.317、0.501、0.668、0.503、0.527,P<0.05),与APN呈负相关(r=-0.385,P<0.05);经多元线性回归分析显示,孕前BMI是影响GDM患者血清RBP-4的独立相关因素(r=-0.361,P<0.05)。结论肥胖型GDM患者血清RBP-4明显高于非肥胖型GDM患者,其水平与肥胖程度、FINS、HOMA-IR、TNF-α呈正相关,与ANP呈负相关,提示血清RBP-4参与了GDM和肥胖的发生、发展,高水平RBP-4易引起GDM和肥胖,可作为肥胖型GDM的诊断指标应用。
Objective To investigate the expression and clinical significance of serum retinol binding protein 4(RBP-4) in obese gestational diabetes mellitus(GDM) patients. Methods 80 cases with the formal card establishment of Baoding Maternal and Child Health Hospital from June 2016 to December 2017 was selected, 40 patients with obesity GDM and the body mass index(BMI) was >25 kg/m^2, and the body weight increased less than 20 kg during pregnancy were included in the observation group, and 40 patients with non-obese GDM who underwent concurrent physical examination and had a pre-pregnancy mass index of 18.5~25.0 kg/m^2 and a body mass increase of less than 20 kg during pregnancy were selected as the control group. The biochemical parameters of glycolipids in the two groups were observed from 24 to 28 weeks after pregnancy. The expression of RBP-4 in serum was detected by enzyme-linked immunosorbent assay(ELISA). The fasting insulin(FINS), islet resistance index,tumor necrosis factor-α(TNF-α) and serum adiponectin(APN) levels were compared between the two groups. Results The fasting plasma glucose(FPG) level of the patients was significantly higher than that of the control group(P<0.05). There was no significant difference in the 2 h PG and HbA1 C between the two groups(P>0.05). The levels of triglyceride(TG) in patients were significantly higher than those in the control group(P<0.05). Total cholesterol(TC) and high-density lipoprotein cholesterol(HDL-Ch) were used in the two groups. There was no significant difference in low-density lipoprotein cholesterol(LDL-C)(P>0.05). The levels of RBP-4, FINS, insulin resistance index(HOMA-IR) and TNF-α in the observation group were significantly higher than those in the control group, and the APN level was significantly lower than that in the control group(P<0.05). Serum RBP-4 was positively correlated with pre-pregnancy BMI, FPG, TG, FINS, HOMA-IR, TNF-α(r=0.274, 0.317, 0.501, 0.668, 0.503, 0.527,P<0.05), and negatively correlated with APN(r=-0.385, P<0.05);Multiple linear regression analysis showed that pre-pregnancy BMI was an independent factor affecting serum RBP-4 in patients with GDM(r=-0.361, P<0.05).Conclusion Serum RBP-4 was significantly higher in obese GDM patients than in non-obese GDM patients. The level was positively correlated with obesity, FINS, HOMA-IR, TNF-α, and negatively correlated with ANP, suggesting that serum RBP-4 is involved in GDM and the occurrence and development of obesity, high level of RBP-4 easily cause GDM and obesity, and can be used as a diagnostic indicator for obese GDM.
作者
程策
王雅慧
赵霞
郭占坤
CHENG Ce;WANG Ya-hui;ZHAO Xia;GUO Zhan-kun(Department of Obstetrics, Baoding Maternal and Child Health Hospital, Baoding Hebei 071000, P. R. China)
出处
《中国计划生育和妇产科》
2019年第4期69-72,共4页
Chinese Journal of Family Planning & Gynecotokology
基金
河北省保定市科学技术研究计划(项目编号:14ZF008)
