炎性及脂肪细胞因子与妊娠期糖尿病发病的相关性及在产褥期的变化  

Correlation between the inflammatory factors and adipocytokines with gestational diabetes mellitus and their change in puerperium

作　　者：刘陶[1] 房臻[1] 杨冬[1] 刘晴[1] 

机构地区：[1]首都医科大学附属北京安贞医院妇产科,100029

出　　处：《中华妇产科杂志》2012年第6期436-439,共4页Chinese Journal of Obstetrics and Gynecology

基　　金：首都医学发展科研基金（2007-3091）

摘　　要：目的探讨炎性细胞因子——肿瘤坏死因子α（TNF-α）、C反应蛋白（CRP）及脂肪细胞因子——脂联素、瘦素水平与妊娠期糖尿病（GDM）发病的相关性及4种细胞因子水平在产褥期的变化。方法2008年6月至2010年5月，选择在北京安贞医院妇产科进行产前检查并分娩的孕妇80例，其中GDM孕妇40例（GDM组）、同期正常妊娠分娩孕妇40例（对照组），于孕早期（10-12周）、孕晚期（36—38周）、产后第3天及产后第42天分别抽取两组妇女空腹静脉血，用ELISA法测定其血清脂联素、瘦素和TNF-α水平；用颗粒增强免疫透射比浊法测定CRP水平；比较两组孕妇孕期4种细胞因子水平及其与稳态模型胰岛素抵抗指数（HOMA-IR）的相关性，以及4种细胞因子在产褥期的变化；通过受试者工作特征（ROC）曲线计算TNF—α曲线下面积，确定预测GDM的阈值。结果（1）孕期细胞因子水平及其与HOMA-IR的相关性：孕早期GDM组脂联素水平为（5．7±1．8）mg／L，明显低于对照组的（8．1±2．7）mg／L，且脂联素水平与HOMA-L呈负相关（r=-0．333，P〈0．05）；而孕早期GDM组瘦素水平为（28±10）“g／L、TNF-α【水平为（10．0±3．4）ng／L、CRP水平为（4．7±1．1）mg／L，均明显高于对照组的（20±8）μg／L、（4．6±2．7）ng／L和（2．4±1．2）mg／L，且均与HOMA-IR呈正相关（r=0．411、0．529、0．308，P均〈0．05）。孕晚期GDM组脂联素水平为（3．9±2．2）mg／L，明显低于对照组的（6．6±2．7）mg／L，且脂联素水平与HOMA—IR呈负相关（r=-0．344，P〈0．05）；而孕晚期GDM组瘦素水平为（37±13）ng/L、TNF-α水平为（12．7±2．6）ng／L、CRP水平为（6．7±3．6）mg／L，均明显高于对照组的（30±13）μg／L、（5．8±2．1）ng／L和（4．4±3．1）mg／L，且均与HOMA．IR呈正相关（r=0．414、0．487、0．285，P均〈0．05）。多元线性回�Objeαive To investigate the relationship between inflammatory faαors, includingC-reaαive protein（ CRP）, tumor necrosis faαor alpha （TNF-α）, adiponeαin, leptin and gestational diabetes mellitus （GDM） and their changes in puerperium. Methods From June 2008 to May 2010, 40 cases with gestational diabetes mellitus, 40 cases of normal pregnancy were enrolled in this study. Fasting venous blood were obtained at early pregnancy （10 - 12 weeks）, late pregnancy （36 -38 weeks） and day 3 and 42 of postpartum. Serumal adiponeαin, leptin and TNF-α were measured by ELISA, and serumal CRP were measured by particle enhanced immunoturbidimetric method. The levels of those 4 cytokines and homeostasis model assessment insulin resistance （HOMA-IR） index were compared between two groups. And the changes of 4 cytokines were calculated in puerperium. The receiver operating charaαeristic （ROC） for TNF-α prediαing GDM was designed. Results （ 1 ） The relationship between cytokines and HOMA-IR ： the levels of adiponeαin of （5.7 ± 1.8） mg/L in the GDM group were significantly lower than （ 8.1 ± 2. 7） mg/L in control group in early pregnancy, and the level of adiponeαin was negatively correlated with HOMA-IR （r= -0.333,P〈0.05）. The levels of （28 ± 10） μg/L of leptin, （10.0 ±3.4） ng/L of TNF-α and （4. 7 ± 1.1 ） mg/L of CRP in GDM group were significantly higher than （ 20 -± 8 ） μg/L of leptin, （ 4. 6 ± 2. 7 ） ng/L of TNF-α, （ 2.4 ± 1.2 ） mg/L of CRP in control group, which were positively correlated with HOMA-IR （ r = 0. 411,0. 529,0. 308, all P 〈 0.05 ）. In late pregnancy, the level of adiponeαin （ 3.9 ± 2. 2） mg/L in the GDM group was significantly lower than （ 6. 6 ± 2. 7 ） mg/L in control group, and the level of adiponeαin was negatively correlated with HOMA-IR （r = -0. 344 ,P 〈 0. 05 ）. The levels of （37 ± 13） μgL of leptin, （ 12.7 ±2. 6） ng/L of TNF-α and （6. 7 ±3.6） mg/L of CRP in the GDM group were

关 键 词：糖尿病 妊娠 脂联素 瘦素 肿瘤坏死因子Α C反应蛋白质 产后期 

分 类 号：R714.25[医药卫生—妇产科学]