C-反应蛋白、肿瘤坏死因子与妊娠期糖尿病的胰岛素抵抗、血脂相关性研究  

Study on the relationship between C-reactive protein,tumor necrosis factor-α and insulin resistance,hyperlipemia in gestational diabetes mellitus

作　　者：严小艳[1] 丛林[1] 袁静[1] 陈珊珊[1] 

机构地区：[1]安徽医科大学第一附属医院妇产科,安徽合肥230022

出　　处：《中国妇幼保健》2009年第4期530-532,共3页Maternal and Child Health Care of China

基　　金：安徽省自然科学基金课题(070413092)

摘　　要：目的:探讨妊娠期糖尿病患者血清中C-反应蛋白(CRP)、肿瘤坏死因子(TNF-α)水平变化及其与胰岛素抵抗、血脂的关系。方法:采用双抗体夹心酶联法于妊娠24～28周测定无孕前肥胖的30例妊娠期糖尿病孕妇(GDM组)和30例正常妊娠晚期孕妇(正常妊娠组)的空腹血清TNF-α水平;同时测定两组孕妇血清CRP、空腹血糖(FBS)、胰岛素(FINS)、C肽、总胆固醇(TG)和甘油三酯(TC)水平,并根据公式计算孕前体重指数(BMI),胰岛素抵抗指数(HOMA-IRI)以评价胰岛素抵抗程度。结果:①GDM组孕妇空腹血清CRP、TNF-α、FBS、FINS、C肽、HOMA-IRI、TG水平及孕前BMI分别为(3.9±0.7)mg/L、(38.8±5.6)ng/L、(4.7±0.8)mmol/L、(18.1±3.4)IU/L、(5.8±0.9)mmol/L、(3.9±1.2)、(6.3±0.7)mmol/L、(23.5±3.7)kg/m2,正常妊娠组孕妇分别为(2.5±0.6)mg/L、(25.7±2.4)ng/L、4.2±0.8mmol/L、13.5±2.6IU/L、4.1±0.6mmol/l、2.5±0.7、5.6±0.7mmol/l、21.7±3.3kg/m2;两组比较,差异有显著性(P<0.01或P<0.05)。两组孕妇血清TC水平比较无明显差异性(P>0.05)。②将孕前BMI(协变量)控制后,对上述各项指标进行协方差分析,结果显示GDM组孕妇空腹血清CRP、TNF-α、FBS、FINS、C肽、HOMA-IRI、TG水平与正常妊娠组比较,差异仍有显著性(P<0.01或P<0.05);两组孕妇血清TC水平比较无明显差异(P>0.05)。③GDM组孕妇血清CRP和TNF-α与HOMA-IRI、TG、TC多元线性相关性分析结果显示,CRP和TNF-α的水平分别与HOMA-IRI、TG呈正相关性(r=0.891、0.782,P(0.05和r=0.662、0.714,P<0.05);CRP和TNF-α的水平分别与TC无相关性(P(0.05)。④将孕前BMI作为协变量,CRP和TNF-α与HOMA-IRI、TG、TC相关性分析采用偏相关分析法,结果显示GDM组孕妇血清CRP和TNF-α的水平分别与HOMA-IRI、TG呈正相关(r=0.727、0.539,P(0.05和r=0.385、0.515,P(0.05);与TC无相关性。结论:在无孕前肥胖状况下,妊娠期糖尿病患者血清中CRP、TNF-α水平升高与胰岛素抵抗、血脂指标异常有关。Objective： To investigate serum concentration of C - reactive protein （ CRP）, tumor necrosis factor - a （ TNF- α） and their correlation with insulin resistance, hyperlipemia in pregnant women with gestational diabetes mellitus （GDM） . Methods ： Enzyme - linked immunosorbent assay was used to measure the level of fasting serum TNF-αin 30 GDM women and 30 normal pregnant women, whose pre - pregnancy body mass index （BMI） was less than 25 during 24 - 28 gestational weeks. At the same time, CRP, fasting plasma glucose, insulin and C - peptide were measured. Pre - pregnancy BMI and insulin resistance index （HOMA - IRI ） were also calculated. Results： ①Significantly increased serum CRP, TNF-α, fasting plasma glucose, insulin, C-peptide, HOMA-IRI, TG and pre - pregnancy BMI were found in GDM women （3.9 ± 0. 7 mg/l, 38.8±5.6ng/l, 4. 7 ± 0. 8 mmol/l, 18. 1 ± 3.4 IU/l, 5.8 ± 0. 9mmol/l, 3.9 ± 1.2, 6. 3± 0. 7 mmol/l, 23.5 ± 3.7 kg/m^2） compared with those in healthy pregnant women （2.5 ± 0. 6 mg/l, 25.7±2.4 ng/l, 4. 2 ± 0. 8mmol/l,13.5±2. 6 IU/l, 4. 1 ±0. 6mmol/l, 2. 5 ± 0. 7, 5. 6± 0. 7 mmol/l, 21.7 ± 3.3 kg/m^2 ） （P 〈 0. 01 or P 〈 0. 05 ） , respectively. However, there was no difference in TC between two groups.②After the controlling of pre - pregnancy BMI, cova-riable regression analysis of the above data still showed that the fasting serum CRP, TNF- α, fasting plasma glucose, insulin, C - peptide, HOMA -IRI and TG in GDM patients had significant difference between normal pregnant women and GDM women （P〈0. 01 or P 〈0. 05） . No difference was found in TC level between two groups （ P 〉 0. 05 ）.③Significant positive linear correlation was revealed between CRP, TNF- αand HOMA - IRI, TG （y = 0. 891, 0. 782 , P 〈 0. 05 ） （ y = 0. 662, 0. 714, P〈0.05）, but no significant linear correlation was found between CRP , TNF- αand TC （ P 〉 0. 05 ） .④With pre - pregnancy BMI as a variance, partial correlation analysis was used to an-a

关 键 词：C反应蛋白 肿瘤坏死因子 胆固醇 甘油三酯 糖尿病 妊娠 胰岛素抗药性 

分 类 号：R714.256[医药卫生—妇产科学]