维生素D对妊娠糖尿病胰岛素敏感性脂肪因子及肿瘤坏死因子-α的影响  

Effects of Vitaimin D on Insulin Sensitivity and the Adipokine Factors,TNF-α in Patients with Gestational Diabetes Mellitus

作　　者：张黎明[1] 高凌[1] 帅红霞[1] 润袁敏[1] 邓晨盺 田源[1] 马计[1] 肖婧[1] 

机构地区：[1]湖北文理学院附属医院内分泌科,襄阳441021

出　　处：《医药导报》2014年第5期593-597,共5页Herald of Medicine

摘　　要：目的探讨血清维生素D水平对妊娠糖尿病(GDM)胰岛素敏感性、脂肪因子脂联素(APN)、视黄醇结合蛋白4(RBP4)、内脂素(visfatin)及肿瘤坏死因子(TNF-α)的影响及作用机制。方法选择妊娠糖尿病患者101例(GDM组)和血糖正常孕妇50例(正常组),检测两组相关生化指标、APN、RBP4、visfatin、TNF-α及25羟化维生素D3(25OHD3)水平。在GDM组中将诊断为维生素D缺乏患者24例随机分为治疗组及对照组各12例,治疗组口服1,25二羟维生素D3[1,25(OH)2D3]0.25μg·d-11个月,再行相关生化指标检查。结果 GDM组患者25OHD3及APN水平明显低于正常组(P<0.05),而RBP4、visfatin、TNF-α水平高于正常组(均P<0.05);治疗组经补充维生素D,胰岛素分泌指数上升,胰岛素抵抗指数下降,而APN水平升高,与25OHD3呈正相关(r=0.526);RBP4、visfatin、TNF-α降低,与25OHD3呈负相关(r分别为-0.272,-0.153,-0.072)。结论维生素D可降低相关脂肪因子RBP4、visfatin和TNF-α,升高APN,从而对妊娠糖尿病起到防治作用。Objective To investigate the relationship and mechanism of the serum vitamin D levels with insulin sensitivity and adipokines APN, RBP4, visfatin and TNF-α in patients with gestational diabetes mellitus （GDM）. Methods A total of 101 patients with gestational diabetes（GDM group） and 50 pregnant women with normal blood sugar（control group） were recruited to detect the serum levels of correlative biochemical indexes, APN, RBP4, visfatin, TNF-α and 25OHD3 using an HPLC method. Twenty-four patients in the GDM group diagnosed with vitamin D deficiency（ 〈25 nmol · L^-1 ） were randomized to receive either 1,25（OH） 2D3（0.25 μg · d^-1） orally or no treatment. Serum levels of correlative biochemical indexes were detected after 1 month. Results GDM patients had 25OHD3 levels significantly lower than the control group （P〈0.05） , APN levels lower than the control group, and RBP4, visfatin ,TNF-ct levels significantly higher than the control group（ all P〈0.05 ）. After 1 month of 1,25 （OH） 2 D3 treatment, HOMA-IR increased, while HOMA-β decreased. APN levels was positively correlated （r = 0. 526 ） with 25OHD3 ; RBP4,visfatin,TNF-et decreased and were negatively correlated with 25OHD3（ r values were -0. 272,-0. 153, -0. 072）. Conclusion Vitamin D can reduce the adipokines RBP4, visfatin, TNF-α,increase APN, and thus play a protective role for gestational diabetes.

关 键 词：维生素D 糖尿病 妊娠 胰岛素敏感性 脂联素 内脂素 视黄醇结合蛋白 肿瘤坏死因子 

分 类 号：R977.24[医药卫生—药品] R587.1[医药卫生—药学]