α2-HS糖蛋白与妊娠期糖尿病关系的研究

目的观察不同程度糖代谢异常孕妇血清α2-HS糖蛋白(AHSG)浓度的变化并探讨其与血糖、血脂代谢及胰岛素抵抗的关系。方法根据75 g口服葡萄糖耐量(OGTT)结果将135名孕周为36～41周的孕妇分为3组:妊娠期糖尿病(GDM)组(45例)、糖耐量异常(GIGT)组(45例)、正常糖耐量(NGT)组(45例)。检测各组血清AHSG、空腹血糖(FPG)、空腹胰岛素(FINS)、空腹血脂(总胆固醇(TC)、甘油三酯(TG)、高密度脂蛋白胆固醇(HDL-C)、低密度脂蛋白胆固醇(LDL-C)]水平并计算体重指数(BMI)、胰岛素抵抗指数(HOMA-IR)、胰岛β细胞功能指数(HOMA-β)。结果 GDM组、GIGT组、NGT组的AHSG浓度分别为150.2±20.0、131.9±16.0(、124.0±15.0)μg/L,3组之间差异均有统计学意义(P<0.05)。GDM组FPG、TG、LDL-C、FINS水平均高于NGT组(P<0.05、P<0.01),HDL-C水平低于NGT组(P<0.05);GDM组TG、FINS水平高于GIGT组(P均<0.05、P<0.01);GIGT组TG、LDL-C、FINS高于NGT组(P<0.05、P<0.01);3组之间TC水平差异无统计学意义(P>0.05)。NGT组、GIGT组、GDM组HOMA-IR逐渐升高、HOMA-β逐渐下降3,组之间差异均有统计学意义(P<0.05)。AHSG浓度与BMI、TG、FINS、HOMA-IR呈正相关相关系数(r)分别为0.406、0.503、0.533、0.612,P均<0.05],与HDL-C、HOMA-β呈负相关(r分别为-0.321、-0.589,P均<0.05),与FPG、TC无相关性(r分别为0.0580、.095,P均>0.05)。结论 AHSG在GDM患者的血糖、血脂代谢中发挥重要作用。AHSG参与了胰岛素抵抗、加重了β细胞损害,与GDM的发病关系密切。

Research on correlation between serum AHSG and gestational diabetes mellitus

Objective To observe the variations of serum levels of alpha 2-HS-glycoprotein(AHSG) in pregnant women with different types of glucose intolerance and the correlation with plasma glucose,blood lipid metabolism and insulin resistance.Methods Totally,135 pregnant women with 36-41 weeks of gestation were classified into 3 groups according to the results of 75 g oral glucose tolerance test(OGTT):gestational diabetes mellitus(GDM)group: 45cases,gestational impaired glucose tolerance(GIGT)group: 45 cases and normal glucose tolerance(NGT)group:45 cases.The levels of fasting AHSG,fasting plasma glucose(FPG),fasting insulin(FINS) and fasting blood lipid total cholesterol(TC),trigly ceride(TG),high-density lipoprotein cholesterol(HDL-C) and low-density lipoprotein cholesterol(LDL-C)] were measured,and the values of body mass index(BMI),homeostasis model assessment insulin resistance(HOMA-IR) index and hemeostasis model assessment beta(HOMA-β) index were calculated.Results The serum levels of AHSG in GDM group,GIGT group and NGT group were 150.2±20.0,131.9 ±16.0 and(124.0±15.0) μg/mL,respectively.There was a statistical significance among the 3 groups(P<0.05).The levels of FPG,TG,LDL-C and FINS were significantly higher in GDM group than those in NGT group(P<0.05,P<0.01),and the levels of HDL-C were significantly lower in GDM group than those in NGT group(P<0.05).The levels of TG and FINS were significantly higher in GDM group than those in GIGT group(P<0.05,P<0.01),and the levels of TG,LDL-C and FINS were significantly higher in GIGT group than those in NGT group(P<0.05,P<0.01).The levels of TC had no significant difference among the 3 groups(P>0.05).The HOMA-IR indices increased gradually,and the HOMA-β indices decreased gradually among the 3 groups with statistical significance(P<0.05).Furthermore,serum AHSG levels had positive relationship with BMI,TG,FINS and HOMA-IR the coefficients of correlation(r) were 0.406,0.503,0.533 and 0.612,P<0.05],negative relationship with HDL-C and HOMA-β(r=-0.321 and-0.589,P<0.05),and no relationship with FPG and TC(r=0.058,0.095,P>0.05).Conclusions AHSG plays an important role in the metabolism of plasma glucose and blood lipid in GDM women,and AHSG is involved in insulin resistance and aggravates the suffering of beta cells.AHSG is closely related with the cause of GDM.