妊娠期糖尿病与胰岛素抵抗关系的临床研究  

Correlation between gestational diabetes mellitus and insulin resistance

作　　者：赵建峰 张华新 宋玉林 

机构地区：[1]河北省沧州市人民医院妇产科,沧州061000 [2]河北省沧州市人民医院手术室,沧州061000 [3]河北省沧州市人民医院超声科,沧州061000

出　　处：《生殖医学杂志》2015年第2期120-124,共5页Journal of Reproductive Medicine

摘　　要：目的通过观察胰岛素受体底物-1(IRS-1)和葡萄糖转运体-4(GLUT4)在妊娠期糖尿病(GDM)患者和健康孕妇胎盘组织中的表达情况,分析其与胰岛素抵抗指数(HOMA-IR)、胰岛素敏感指数(HOMA-ISI)的相关性,探讨GDM与胰岛素抵抗的关系。方法采用1:1随机对照病例研究,选择30例妊娠期糖尿病(GDM)患者和30例同孕龄正常健康孕妇为研究对象。分娩时采集胎盘组织,采用逆转录-聚合酶链式反应(RT-PCR)检测IRS-1和GLUT4的mRNA表达水平,采用SPSS17.0软件分析IRS-1和GLUT4与HOMA-IR和HOMA-ISI的相关性。结果正常孕妇胎盘组织中IRS-1在mRNA水平表达量显著高于GDM患者(P<0.05)。正常孕妇胎盘组织中上GLUT4在mRNA水平表达量亦显著高于GDM患者(P<0.05)。GDM组比正常对照组HOMA-IR显著增加[(4.42±1.12)vs.(1.76±0.96)],HOMA-ISI则显著降低[(-1.45±0.25)vs.(-0.27±0.34)](P均<0.01)。相关性分析结果显示,IRS-1表达与HOMA-IR呈负相关(r=-0.473,P<0.01),与HOMA-ISI呈正相关(r=0.342,P<0.05);而GLUT4的表达与HOMA-IR呈负相关(r=-0.520,P<0.01),与HOMA-ISI无相关性(r=0.187,P>0.05)。结论 GDM患者中IRS-1和GLUT4在mRNA水平表达明显下降,且与HOMA-IR和HOMA-ISI有相关性,提示HOMA-IR的增加和HOMA-ISI的降低可能涉及GDM的发病机制。Objective. To explore the expression of IRS-1 and GLUT4 in the placenta tissues of patients with gestational diabetes mellitus（GDM）and healthy pregnant women, and analyze the correlations between IRS-1,GLUT4 and HOMA-IR, HOMA-ISI to find the relationship between GDM and insulin resistance. Methods. 30 GDM patients and 30 normal pregnant women with the same gestational age were randomly recruited in the prospective randomized controlled clinical study. The subjects of the study were free of other pathological obstetric factors. The placentas were collected during childbirth to detect mRNA of IRS-1 and GLUT4 by RT-PCR. The correlations between IRS-1,GLUT4 and HOMA-IR, HOMA-ISI were analyzed with SPSS 17.0. Results： The mRNA levels of IRS-1 and GLUT4 in the placenta tissues were significantly decreased in GDM group compared with the normal group（P〈0.05）. HOMA-IR was significantly increased[（4.42± 1.12） vs. （1.76±0.96）]andHOMA-ISIE（-1.45±0.25） vs. （-0. 27±0. 34）]was significantly decreased in GDM group compared with the normal group（P〈0.01）. The correlations analysis revealed that there was a negative correlation between the expression of IRS-] and HOMA-IR（r=-0. 473,P〈0.01）and a positive correlation between the expression of IRS-1 and HOMA-ISI （r = 0. 342, P〈 0.05 ）. In the other hand,there was a negative correlation between the expression of GLUT4 and HOMA-IR（r=-0. 520, P〈 0.01）. However,there was no correlation between the expression of GLUT4 and HOMA-ISI（r=0. 187,P〉0. 05）. Conclusions： The mRNA levels of IRS-1 in the placenta tissues are decreased in GDM group compared with the normal group,and there are correlations between IRS-1 ,GLUT4 and HOMA-IR, HOMA-ISI. The decrease of HOMA-ISI and the increase of HOMA-IR may be involved in GDM.

关 键 词：妊娠期糖尿病 胰岛素受体底物-1 葡萄糖转运体-4 胰岛素抵抗指数 胰岛素敏感指数 相关性分析 

分 类 号：Q492.6[生物学—生理学]