妊娠期糖尿病患者血清SHBG含量测定及其与胰岛素抵抗、糖脂质代谢的相关性  

Serum SHBG content in patients with gestational diabetes mellitus and its correlation with insulin resistance,glucose and lipid metabolism

作　　者：卢春梅 张雪莲[2] 吴维宇[2] LU Chun-mei;ZHANG Xue-lian;WU Wei-yu(Department of Obstetrics and Gynecology,Maternal and Child Health Hospital of Pidu District,Chengdu Sichuan 611730,China;Department of Gastroenterology,The First Affiliated Hospital of Chengdu Medical College,Chengdu Sichuan 610500,China)

机构地区：[1]成都市郫都区妇幼保健院妇产科,四川成都611730 [2]成都医学院第一附属医院消化内科,四川成都610500

出　　处：《临床和实验医学杂志》2020年第24期2650-2654,共5页Journal of Clinical and Experimental Medicine

基　　金：四川省卫计委项目(编号:17PJ013)。

摘　　要：目的探讨妊娠期糖尿病(GDM)患者血清性激素结合球蛋白(SHBG)含量测定及其与胰岛素抵抗、糖脂质代谢的相关性。方法回顾性选取2017年6月至2019年11月间在成都市郫都区妇幼保健院规律产检并入院分娩的初产妇308例,将其分为血糖正常组262例、GDM组46例。检测2组产妇的孕中期SHBG含量及胰岛素抵抗指数(HOMA-IR)、糖代谢指标[空腹血糖(FBG)、餐后2h血糖(2hPBG)、糖化血红蛋白(HbA1c)]、脂质代谢指标[总胆固醇(TC)、甘油三酯(TG)、低密度脂蛋白胆固醇(LDL-C)、高密度脂蛋白胆固醇(HDL-C)]水平。进一步根据GDM组SHBG含量中位数将其分为高SHBG组、低SHBG组各23例,对比其HOMA-IR及糖脂代谢指标水平差异。分析GDM患者血清SHBG水平与上述病情指标的相关性,采用受试者工作曲线(ROC)分析GDM患者孕中期SHBG水平对后续疾病严重的预测价值。结果GDM组患者SHBG、HDL-C水平为(349.27±48.10)nmol/L、(1.81±0.19)mmol/L,低于血糖正常组[(481.55±53.91)nmol/L、(1.96±0.22)mmol/L],HOMA-IR、FBG、2 hPBG、HbA1c、TC、TG、LDL-C水平分别为(3.31±0.42)、(6.47±0.82)mmol/L、(10.35±1.35)mmol/L、(6.23±0.71)%、(5.57±0.62)mmol/L、(6.10±0.67)mmol/L、(3.02±0.37)mmol/L,高于正常对照组[(2.29±0.34)、(4.78±0.69)mmol/L、(6.28±0.91)mmol/L、(5.59±0.48)%、(4.78±0.51)mmol/L、(5.53±0.58)mmol/L、(2.41±0.30)mmol/L],差异均有统计学意义(P<0.05)。低SHBG组患者HDL-C水平(1.56±0.17)mmol/L低于高SHBG组[(1.88±0.22)mmol/L],HOMA-IR、FBG、2 hPBG、HbA1c、TC、TG、LDL-C水平分别为(373.88±41.96)、(8.06±0.93)mmol/L、(12.11±1.45)mmol/L、(6.51±0.73)%、(5.87±0.66)mmol/L、(6.35±0.65)mmol/L、(3.31±0.42)mmol/L,高于高SHBG组[(310.64±35.82)、(7.18±0.67)mmol/L、(9.949±1.09)mmol/L、(5.98±0.62)%、(5.21±0.57)mmol/L、(5.72±0.58)mmol/L、(2.88±0.37)mmol/L],差异均有统计学意义(P<0.05)。GDM产妇血清SHBG水平与HOMA-IR、FBG、2 hPBG、HbA1c、TC、TG、LDL-C的水平呈负相�Objective To investigate the correlation between serum SHBG and insulin resistance,glucose and lipid metabolism in patients with gestational diabetes mellitus(GDM).Methods 308 first-time parturient women who underwent regular prenatal examinations in Maternal and Child Health Hospital of Pidu District during the period from June 2017 to November 2019 and were admitted to hospital for delivery were divided into normal blood glucose group(n=262)and GDM group(n=46).SHBG level,insulin resistance index(HOMA-IR),glucose metabolism indexes[fasting blood glucose(FBG),2-hour postprandial blood glucose(2 hPBG),glycosylated hemoglobin(HbA1c)],lipid metabolism indexes[total cholesterol(TC),triglyceride(TG),low density lipoprotein cholesterol(LDL-C),high density lipoprotein cholesterol(HDL-C)]levels were compared between two groups.Further according to the median SHBG level in GDM group,they were further divided into high SHBG group,low SHBG group,each with 23 cases,HOMA-IR and glucolipid metabolism index levels were compared.Correlation of GDM patients between serum SHBG level and the disease indexes were analyzed.ROC was used to analyze the predictive value of second-trimester SHBG level in GDM patients for subsequent disease severity.Results The levels of SHBG and HDL-C in the GDM group were(349.27±48.10)nmol/L and(1.81±0.19)mmol/L,which were lower than the normal blood glucose group[(481.55±53.91)nmol/L,(1.96±0.22)mmol/L],levels of HOMA-IR,FBG,2 hPBG,HbA1c,TC,TG,LDL-C were(3.31±0.42),(6.47±0.82)mmol/L,(10.35±1.35)mmol/L,(6.23±0.71)%,(5.57±0.62)mmol/L,(6.10±0.67)mmol/L,(3.02±0.37)mmol/L,which were higher than the normal control group[(2.29±0.34),(4.78±0.69)mmol/L,(6.28±0.91)mmol/L,(5.59±0.48)%,(4.78±0.51)mmol/L,(5.53±0.58)mmol/L,(2.41±0.30)mmol/L],the differences were all statistically significant(P<0.05).The level of HDL-C in the low SHBG group(1.56±0.17)mmol/L was lower than that in the high SHBG group[(1.88±0.22)mmol/L],levels of HOMA-IR,FBG,2 hPBG,HbA1c,TC,TG,LDL-C were(373.88±41.96),(8.06±0.93)mm

关 键 词：妊娠期糖尿病 性激素结合球蛋白 胰岛素抵抗 糖代谢 脂质代谢 

分 类 号：R714.256[医药卫生—妇产科学]