【摘要】：目的：妊娠期外周組織的胰島素抵抗(insulin resistance, IR)和胰島素敏感性的下降是妊娠期糖尿病的主要發(fā)病機制之一。研究表明2型糖尿病中IGF-I與胰島素抵抗具有負相關性,但關于GDM中胰島素抵抗與IGF-I相關性研究的報道并不多。而妊娠相關血漿蛋白A作為IGFBPs蛋白水解酶,在游離IGF-I從IGF-I/IGFBPs復合物中分離出來并發(fā)揮類胰島素樣作用中起著重要的作用。本研究通過比較正常妊娠孕婦和妊娠期糖尿病孕婦早孕期血清PAPP-A. IGF-I及IGFBP-4含量的變化,探討其在妊娠期糖尿病發(fā)生發(fā)展中的作用及其機制。 方法：對所有納入對象孕8到12周的空腹血標本檢測PAPP-A, IGF-I和IGFBP-4,孕24-28周測空腹血糖(FPG)及空腹胰島素(FINS)并計算胰島素抵抗指數(shù)HOMA-IR=ln (FINS FPG/22.5)。根據(jù)孕24-28周行糖耐量實驗結果將納入對象分為GDM組和正常組。在進行正態(tài)性檢驗和方差齊性檢驗后,采用成組t檢驗進行兩組間同一指標的均數(shù)比較,采用Pearson相關系數(shù)來分析指標間的相關性。 結果：與正常組相比,GDM組早孕期血清PAPP-A含量和游離IGF-I含量下降,而IGFBP-4含量及中孕期胰島素抵抗指數(shù)均上升。PAPP-A與IGF-I呈正相關；PAPP-A與IGFBP-4含量呈負相關；PAPP-A與中孕期胰島素抵抗指數(shù)呈負相關。IGF-I與中孕期胰島素抵抗指數(shù)呈負相關。 結論：①游離IGF-I與胰島素抵抗呈負相關,提示早孕期IGF-I的下降與中晚孕期GDM的發(fā)生具有相關性。②孕婦外周血中PAPP-A的下降與游離IGF-I的降低密切相關,提示早孕期監(jiān)測PAPP-A可能對GDM具有預測價值。圖10幅,表7個,參考文獻52篇
[Abstract]:Objective: the decrease of insulin resistance (insulin resistance, IR) and insulin sensitivity in peripheral tissues of pregnancy is one of the main pathogenesis of gestational diabetes mellitus. There is a negative correlation between IGF-I and insulin resistance in type 2 diabetes mellitus, but there are few reports on the correlation between insulin resistance and IGF-I in GDM. The pregnancy-associated plasma protein A, as a IGFBPs proteolytic enzyme, plays an important role in the isolation of free IGF-I from IGF-I/IGFBPs complex and plays an important role in insulin-like action. The aim of this study was to compare serum PAPP-A between normal pregnant women and pregnant women with gestational diabetes mellitus (GDM). To explore the role and mechanism of IGF-I and IGFBP-4 in the development of gestational diabetes mellitus (GDM). Methods: PAPP-A, IGF-I and IGFBP-4 were measured in fasting blood samples from 8 to 12 weeks of gestation. Fasting blood glucose (FPG) and fasting insulin (FINS) (FINS) were measured at 24-28 weeks of gestation. Insulin resistance index (FINS FPG/22.5) was calculated. Subjects were divided into GDM group and normal group according to 24-28 weeks gestational glucose tolerance test results. After normality test and variance homogeneity test, the group t test was used to compare the mean of the same index between the two groups, and the Pearson correlation coefficient was used to analyze the correlation between the two groups. Results: compared with the normal group, the serum PAPP-A content and free IGF-I content decreased, while the IGFBP-4 content and insulin resistance index increased. PAPP-A was negatively correlated with IGF-I content. There was a negative correlation between PAPP-A and insulin resistance index in middle pregnancy and a negative correlation between IGF-I and insulin resistance index during pregnancy. Conclusion there is a negative correlation between free IGF-I and insulin resistance, suggesting that the decrease of IGF-I in early pregnancy and the occurrence of GDM in middle and late pregnancy are related to the decrease of PAPP-A in peripheral blood of pregnant women and the decrease of free IGF-I in peripheral blood of pregnant women. The results suggest that monitoring PAPP-A in early pregnancy may be of predictive value for GDM. 10 figures, 7 tables, 52 references
【學位授予單位】：中南大學
【學位級別】：碩士
【學位授予年份】：2014
【分類號】：R714.256

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相關期刊論文 前2條

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