發(fā)布時間：2019-05-18 00:14

【摘要】：目的:該課題通過觀察孕期女性在不同糖代謝狀態(tài)下血清骨鈣素及脂聯(lián)素水平的變化,探討妊娠期糖尿病的可能發(fā)病機制,有望為未來防治2型糖尿病提供新的理論依據(jù)。方法:參照2013年ADA糖尿病診療指南,依據(jù)孕期24-28周(PGDM組除外)口服葡萄糖耐量試驗(OGTT)結(jié)果:將28名孕婦納入糖尿病合并妊娠(PGDM)組,42名孕婦納入妊娠糖尿病(GDM)組,30名孕婦納入糖耐量正常(NGT)組。檢測血糖、胰島素、脂聯(lián)素(ADP)、骨鈣素(OC),計算胰島素抵抗指數(shù)(HOMA-IR)及胰島β細胞功能指數(shù)(HOMA-β),統(tǒng)計數(shù)據(jù)后進行相關(guān)性分析。結(jié)果:1.年齡、血脂四項指標(biāo)及孕周差異三組間均無統(tǒng)計學(xué)意義(P0.05),組間妊娠前BMI及孕期BMI增加差值差異均無統(tǒng)計學(xué)意義(P0.05);2.PGDM組、GDM組、NGT組FPG、OGTT 2小時血糖(2 hPG)及HbA1c呈遞減趨勢,組間比較差異均有統(tǒng)計學(xué)意義(均P0.01);3.PGDM組FINS、HOMA-IR顯著高于GDM組及NGT組(P0.01),NGT組FINS、HOMA-IR均低于GDM組,差異有統(tǒng)計學(xué)意義(P0.05);4.PGDM組、GDM組、NGT組HOMA-β呈遞增趨勢,組間比較差異有統(tǒng)計學(xué)意義(P0.01);5.GDM組、NGT組血清OC水平均高于PGDM組(分別P0.01、P0.05),GDM組血清OC水平高于NGT組,差異均有統(tǒng)計學(xué)意義(P0.01);6.血清ADP水平NGT組、GDM組、PGDM組依次降低,組間比較差異均有統(tǒng)計學(xué)意義(均P0.01);7.Pearson相關(guān)分析結(jié)果:GDM及NGT組血清OC與FINS、HOMA-IR顯著正相關(guān),相關(guān)系數(shù)分別為0.709、0.696(P0.01);PGDM組血清OC與FINS,HOMA-IR呈負相關(guān),相關(guān)系數(shù)為-0.707、-0.784(P0.01);三組ADP與HOMA-IR顯著負相關(guān),相關(guān)系數(shù)為-0.473(P0.01);三組ADP與OC無明顯相關(guān)性。結(jié)論:1.PGDM組、GDM組及NGT組FINS、HOMA-IR依次降低,提示妊娠期婦女隨著糖代謝異常的加重,胰島素抵抗更為明顯;2.妊娠期不同糖代謝狀態(tài)下婦女血清ADP與HOMA-IR呈負相關(guān),NGT組、GDM組、PGDM組ADP水平依次降低,提示血清ADP降低可能促發(fā)了胰島素抵抗,進而導(dǎo)致糖代謝異常;3.GDM組、NGT組血清OC水平均高于PGDM組,GDM組血清OC水平高于NGT組,GDM組、NGT組血清OC與HOMA-IR正相關(guān),PGDM組血清OC與HOMA-IR負相關(guān),推測血清OC水平升高可能是對早期胰島素抵抗的一種代償,隨著胰島素抵抗的加重及血糖持續(xù)升高而出現(xiàn)了失代償。
[Abstract]:Objective: to observe the changes of serum osteocalcin and adiponectin levels in pregnant women under different glucose metabolism conditions, and to explore the possible pathogenesis of gestational diabetes mellitus (GDM), which is expected to provide a new theoretical basis for the prevention and treatment of type 2 diabetes mellitus (T2DM) in the future. Methods: according to the guidelines for the diagnosis and treatment of ADA diabetes mellitus in 2013, according to the (OGTT) results of oral glucose tolerance test at 24 weeks of pregnancy (except PGDM group): 28 pregnant women were included in the (PGDM) group of diabetes mellitus complicated with pregnancy. 42 pregnant women were included in gestational diabetes mellitus (GDM) group and 30 pregnant women in normal glucose tolerance (NGT) group. Insulin resistance index (HOMA-IR) and islet 尾 cell function index (HOMA- 尾) were calculated by measuring blood glucose, insulin and adiponectin (ADP), osteocalcin (OC),. Result: 1. There was no significant difference in age, blood lipid and gestational age among the three groups (P 0.05), but there was no significant difference in BMI and BMI before pregnancy between the three groups (P 0.05). FPG,OGTT 2-hour blood glucose (2 hPG) and HbA1c in 2.PGDM group, GDM group and NGT group showed a decreasing trend, and the differences between the two groups were statistically significant (all P 0.01). FINS,HOMA-IR in 3.PGDM group was significantly higher than that in GDM group and NGT group (P 0.01. FINS,HOMA-IR in), NGT group was lower than that in GDM group, the difference was statistically significant (P 0.05). There was an increasing trend of HOMA- 尾 in 4.PGDM group, GDM group and NGT group, and there was significant difference between the two groups (P 0.01). The level of serum OC in 5.GDM group and NGT group was higher than that in PGDM group (P0.01, P 0.05), and the level of serum OC in), GDM group was significantly higher than that in NGT group (P 0.01). The level of serum ADP in NGT group, GDM group and PGDM group decreased in turn, and the difference between the two groups was statistically significant (all P 0.01). The results of 7.Pearson correlation analysis showed that there was a significant positive correlation between serum OC and FINS,HOMA-IR in GDM and NGT groups, and the correlation coefficients were 0.709 and 0.696 (P 0.01), respectively. There was a negative correlation between serum OC and FINS,HOMA-IR in PGDM group, with a correlation coefficient of-0.707, 鈮，

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