發(fā)布時間：2018-07-12 13:14

  本文選題：維生素D + 妊娠糖尿病　； 參考：《廣州醫(yī)科大學(xué)》2014年碩士論文

【摘要】：背景 近些年來，國內(nèi)外大量研究表明維生素D水平與葡萄糖代謝存在相關(guān)性。維生素D通過結(jié)合細(xì)胞膜或細(xì)胞核內(nèi)的維生素D受體（Vitamin D receptors,VDR）發(fā)揮作用。人們已經(jīng)發(fā)現(xiàn)VDR存在于全身多種器官組織，其中在胰島β細(xì)胞表面就發(fā)現(xiàn)了VDR，這提示維生素D可以通過結(jié)合β細(xì)胞表面的VDR，進(jìn)而影響胰島素的生成和分泌；同時在胰島素作用的靶器官及組織，如肝臟、骨骼肌、脂肪細(xì)胞中也存在VDR，表明維生素D也會影響機(jī)體胰島素抵抗（Insulin resistant,IR）程度，即胰島素敏感性。因此國內(nèi)外學(xué)者認(rèn)為維生素D可能通過調(diào)節(jié)胰島素的分泌和胰島素敏感性參與糖代謝。但是，近些年也相繼出現(xiàn)不少研究表明維生素D與胰島素分泌、胰島素敏感性并不存在相關(guān)性。不僅如此，維生素D與妊娠糖尿�。℅estational diabetes mellitus，GDM）的相關(guān)性也是研究熱點(diǎn)之一。 目的 探討妊娠早期血維生素D水平能否預(yù)測GDM的發(fā)生，為妊娠早期預(yù)防婦女GDM的發(fā)生提供理論依據(jù)；并分析妊娠早期血維生素D水平與胰島素分泌、胰島素敏感性是否存在相關(guān)性。 對象與方法 本研究選取孕4-11周710名在廣州醫(yī)科大學(xué)附屬第二醫(yī)院確診早孕的婦女為研究對象，在其確診早孕時留取血標(biāo)本檢測血清25-(OH)D、空腹血糖（Fastingplasma glucose，F(xiàn)PG）、空腹胰島素（Fasting insulin，F(xiàn)Ins），妊娠24-28周163名婦女行75g口服葡萄糖耐量試驗（Oral glucose tolerance test，OGTT）篩查GDM。本實驗采用美國糖尿病學(xué)會（American Diabetes Association，ADA）2011年推薦的GDM診斷標(biāo)準(zhǔn)：妊娠24-28周行75gOGTT試驗，診斷界值如下：空腹、1小時和2小時血糖值分別為5.1mmol/L、10.0mmol/L和8.5mmol/L，任何一項血糖值達(dá)到或超過上述界值，則診斷為妊娠糖尿��；采用穩(wěn)態(tài)模型胰島素分泌指數(shù)（Homeostasis model assessment-β，HOMA-β）和穩(wěn)態(tài)模型胰島素抵抗指數(shù)（Homeostasis model assessment-insulin resistant，HOMA-IR）評估胰島β細(xì)胞分泌功能和胰島素敏感性。HOMA-β=[20×FINS(mU/L)]／[FPG(mmol/L)－3.5]，HOMA-IR=[FPG(mmol/L)×FINS(mU/L)]／22.5。 結(jié)果 （1）710名妊娠婦女進(jìn)入研究，隨訪過程中，因人工流產(chǎn)、藥物流產(chǎn)以及失訪、研究對象排除標(biāo)準(zhǔn)等原因，最終219名孕婦納入研究。其中163名行GDM篩查，發(fā)生GDM20例（GDM組），GDM發(fā)生率為12.3%，BMI為23.4±3.5kg/m2；發(fā)生流產(chǎn)56例（流產(chǎn)組），BMI為24.0±3.9kg/m2；正常組143例，BMI為23.7±5.0kg/m2。三組人群年齡、孕周以及BMI差異無統(tǒng)計學(xué)意義，P＞0.05。 （2）219例總樣本25(OH)D濃度為28.3±9.4ng/mL，其中25(OH)D不足（30ng/mL）占62.6%。GDM組25(OH)D濃度為29.7±10.4ng/mL，正常組25(OH)D濃度為28.0±9.3ng/mL，兩組間差異無統(tǒng)計學(xué)意義，P=0.469。對163例樣本進(jìn)行25(OH)D濃度四分位分組，經(jīng)卡方檢驗，上四分位組（8.6～20.7ng/mL）與下四分位組（33.9～58.7ng/mL）的GDM發(fā)生率差異無統(tǒng)計學(xué)意義（7.5%vs17.1%,P=0.331)。 （3）由于標(biāo)本血清留取有限，檢測不同指標(biāo)消耗，以及考慮檢測試劑的批間差異，最終對128例樣本測定FIns進(jìn)行25(OH)D與胰島素相關(guān)性分析，簡單線性相關(guān)分析結(jié)果表明25(OH)D與FPG、FIns、Ln(HOMA-β)、Ln(HOMA-IR)均不存在相關(guān)性，，P0.05；以HOMA-IR1.586為界分組，比較HOMA-IR1組（HOMA-IR1.586）與HOMA-IR2組（HOMA-IR≥1.586）的維生素D濃度，結(jié)果表明兩組間維生素D濃度差異無統(tǒng)計學(xué)意義（27.8±7.6vs28.1±10.0,P=0.880)。 結(jié)論 1.廣州市妊娠婦女普遍存在維生素D不足。 2.妊娠早期血清25(OH)D水平不能預(yù)測GDM的發(fā)生。 3.妊娠早期血清25(OH)D水平與胰島素分泌和胰島素敏感性不存在相關(guān)性。
[Abstract]:background
In recent years, a large number of studies have shown that vitamin D levels are associated with glucose metabolism. Vitamin D plays a role by combining the Vitamin D receptors (VDR) in cell membrane or nucleus. It has been found that VDR exists in a variety of organ tissues in the whole body, and VDR is found on the surface of islet beta cells. It is shown that vitamin D can affect the formation and secretion of insulin by binding to VDR on the surface of beta cells, and also in the target organs and tissues of insulin action, such as the liver, skeletal muscle, and adipocytes, which also indicate that vitamin D also affects the degree of insulin resistance (Insulin resistant, IR) in the body, that is, insulin sensitivity. Therefore, the state of insulin resistance (VDR) is also sensitive to insulin. Domestic and foreign scholars believe that vitamin D may participate in glycometabolism by regulating insulin secretion and insulin sensitivity. However, in recent years, many studies have shown that vitamin D and insulin secretion are not associated with insulin sensitivity. Not only so, vitamin D and pregnancy induced diabetes mellitus (Gestational diabetes mellitus, GDM). Correlation is also one of the hotspots of research.
objective
To investigate whether the levels of vitamin D in the early pregnancy can predict the occurrence of GDM and provide a theoretical basis for the prevention of GDM in the early pregnancy, and the correlation between the level of vitamin D in the early pregnancy and the insulin secretion and the insulin sensitivity.
Object and method
In this study, 710 women who had been diagnosed with early pregnancy at the Second Affiliated Hospital of Guangzhou Medical University at 4-11 weeks of pregnancy were selected to examine the serum 25- (OH) D, fasting blood glucose (Fastingplasma glucose, FPG), fasting insulin (Fasting insulin, FIns), and 163 women for 24-28 weeks of pregnancy, and 163 women in 24-28 weeks of pregnancy for 75g oral glucose tolerance test. The test (Oral glucose tolerance test, OGTT) screened the GDM. experiment using the GDM diagnostic criteria recommended by the American Diabetes Society (American Diabetes Association, ADA) 2011: 24-28 weeks of pregnancy, a 75gOGTT trial was performed. The diagnostic values were as follows: the fasting, 1 and 2 hours of blood sugar, respectively, any blood sugar The value of Homeostasis model assessment- beta (HOMA- beta) and homeostasis model insulin resistance index (Homeostasis model assessment-insulin resistant, HOMA-IR) were used to evaluate the secretory function of islet beta cells and the.HOMA- beta =[20 of insulin sensitivity. * FINS (mU/L)] / [FPG (mmol/L) - 3. 5], HOMA-IR=[FPG (mmol/L) x FINS (mU/L)] / 22.5.
Result
(1) 710 pregnant women entered the study. In the course of follow-up, 219 pregnant women were included in the study because of abortion, drug abortion and loss of visits. 219 pregnant women were included in the study. Among them, 163 were screened by GDM and had GDM20 (group GDM), the incidence of GDM was 12.3%, BMI was 23.4 + 3.5kg/m2; 56 abortion groups (abortion group) and BMI were 24 + 3.9kg/m2. There were no significant differences in age, gestational age and BMI between the 143 normal group and 23.7 BMI 5.0kg/m2. group, P > 0.05. three.
(2) the total concentration of 25 (OH) D was 28.3 + 9.4ng/mL, of which 25 (OH) D deficiency (30ng/mL) was 25 (OH) D concentration of 29.7 + 10.4ng/mL in 62.6%.GDM group, 25 (OH) in the normal group was 28 +, and there was no statistical difference between two groups. There was no significant difference in the incidence of GDM between the g/mL and the lower four groups (33.9 to 58.7ng/mL) (7.5%vs17.1%, P=0.331).
(3) due to the limited retention of the specimen serum, the consumption of different indexes, and the difference between the test reagents, the correlation analysis between 25 (OH) D and insulin was carried out in 128 samples of FIns. The results of simple linear correlation analysis showed that 25 (OH) D and FPG, FIns, Ln (HOMA- beta), Ln (HOMA-IR) had no correlation, P0.05. The concentration of vitamin D in group HOMA-IR1 (HOMA-IR1.586) and group HOMA-IR2 (HOMA-IR > 1.586) was compared. The results showed that there was no significant difference in the concentration of vitamin D between the two groups (27.8 + 7.6vs28.1 + 10, P=0.880).
conclusion
1. vitamin D deficiency is prevalent among pregnant women in Guangzhou.
2. serum level of 25 (OH) D in early pregnancy can not predict the occurrence of GDM.
3. there was no correlation between serum 25 (OH) D level and insulin secretion and insulin sensitivity in early pregnancy.
【學(xué)位授予單位】：廣州醫(yī)科大學(xué)
【學(xué)位級別】：碩士
【學(xué)位授予年份】：2014
【分類號】：R714.256

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