妊娠期糖尿病孕妇血清肿瘤坏死因子α水平变化与胰岛素抵抗关系的研究  

Maternal serum tumor necrosis factor-α concentration and correlation with insulin resistance in gestational diabetes

作　　者：王胜蓝[1] 刘佩秋[2] 丁钰[3] 彭伟[2] 曲鑫[2] 

机构地区：[1]青岛市立医院产科,266003 [2]青岛大学医学院附属医院产科 [3]青岛大学医学院附属医院检验科

出　　处：《中华妇产科杂志》2004年第11期737-740,共4页Chinese Journal of Obstetrics and Gynecology

摘　　要：目的　探讨妊娠期糖尿病孕妇血清肿瘤坏死因子α(TNF α)水平变化与胰岛素抵抗的关系。方法　采用酶联免疫吸附试验测定 4 2例妊娠期糖尿病孕妇 (GDM组 )、4 0例正常妊娠晚期孕妇 (正常妊娠组 )空腹血清TNF α水平 ;同时测定两组孕妇空腹血糖、C肽、胰岛素、糖化血红蛋白(HbA1c)水平。并且根据公式计算两组孕妇的胰岛素敏感指数 (ISI) ,以评价胰岛素抵抗程度。结果(1)GDM组孕妇空腹血清TNF α水平为 (5 2± 1 6 )ng/L ,正常妊娠组孕妇为 (4 5± 0 5 )ng/L ,两组比较 ,差异有极显著性 (P <0 0 1) ;GDM组孕妇ISI为 - 4 3± 0 4 ,正常妊娠组为 - 3 8± 0 3,两组比较 ,差异有极显著性 (P <0 0 1)。 (2 )GDM组孕妇空腹血糖、胰岛素、C肽水平分别为 (5 5± 0 7)mmol/L、(13 4± 3 8)mU/L、(1 6± 0 4 )nmol/L ,正常妊娠组孕妇空腹血糖、胰岛素、C肽水平分别为(4 9± 0 4 )mmol/L、(9 3± 2 5 )mU/L、(1 2± 0 3)nmol,两组比较 ,差异有极显著性 (P <0 0 1) ;GDM组孕妇HbA1c为 (5 6± 0 5 ) % ,正常妊娠组孕妇为 (5 3± 0 5 ) % ,两组比较 ,差异有显著性(P <0 0 5 )。 (3)GDM组孕妇空腹血清TNF α水平与ISI呈显著负相关 (r=- 0 70 3,P <0 0 1) ,分别与空腹血糖、C肽、HbA1c呈显著正相关Objective To investigate se rum concentration of tumor necrosis factor(TNF)-α and its correlation with insulin resistance in pregnant women with gestational diabetes mellitus (GDM). Methods Enzyme-linked immunosorbent assay was used to measure th e fasting serum TNF-α levels of 42 women with GDM (28～39 gestational weeks), a n d 40 cases of normal pregnant women in the third trimester. Fasting plasma gluc ose, insulin, C-peptide and glycosylated hemoglobin (HbA1c) were also measured at the same time. Insulin sensitive index (ISI) was calculated. Res u lts (1)Significantly elevated serum TNF-α was found in the women w i th GDM(5.2±1.6) ng/L as compared with the healthy pregnant women in third t rimester (4.5±0.5)ng/L(P<0.01); ISI between the two groups was signifi cantly different, (-4.3±0.5) and (-3.8±0.3) (P<0.01). (2)fasting plasma glucose, insulin, C-peptide, HbA1c in GDM group were (5.5±0.7)mmol/ L,(13.4±3.8) mU/L, (1.6±0.4)nmol/L, (5.6±0.5)%, being significantly hig her than those in the normal pregnant women(P<0.01 or P<0.05). (3) Significant negative linear correlation was revealed between TNF-α and ISI ( r=-0.703, P<0.01), and positive linear correlations between TNF-α an d plasma glucose, C-peptide, and HbA1c were found (r=0.512, 0.629, 0.386 ); but no correlation between TNF-α and insulin was found in GDM group. In no rmal group the correlation between ISI and TNF-α was also found (r=-0.3 90, P<0.05), but less significant than that in the GDM group. C o nclusions Fasting plasma TNF-α levels in pregnant women with GDM i s significantly higher than in normal pregnant women.A negative relationship bet ween TNF-α and insulin sensitivity index is found in GDM, suggesting increased TNF-α may contribute to insulin resistance in pregnant women with gestational diabetes.

关 键 词：GDM 孕妇 空腹 C肽 胰岛素抵抗 HBA1C 血清TNF-Α 负相关 水平 显著性 

分 类 号：R714.2[医药卫生—妇产科学]