孕晚期妊娠糖尿病脂联素、瘦素与胰岛素抵抗的相关性

目的探讨孕晚期妊娠糖尿病（GDM）患者脂联素（ADP）、瘦素（LEP）与胰岛素抵抗（IR）的关系。方法选取166例28～32周孕妇,其中84例GDM患者（GDM组）、82例糖耐量正常（NGT组）,检测血清胰岛素、ADP和LEP水平,同时计算HOMA胰岛素抵抗指数（HOMA-IR）及胰岛素敏感指数（ISOGTT）以评价胰岛素敏感性,计算β细胞功能指数（HBCI）和30 min净增胰岛素/30 min净增血糖比值（ΔI30/ΔG30）以评价胰岛素分泌功能。结果 （1）GDM组空腹胰岛素（FIns）明显高于NGT组（P〈0.01）,HOMA-IR也明显高于NGT组（P〈0.05）;GDM组ISOGTT低于NGT组（P〈0.01）;GDM组HBCI低于NGT组（P〈0.01）,ΔI30/ΔG30也低于NGT组（P〈0.05）。（2）GDM组ADP水平低于NGT组（P〈0.01）,而LEP水平高于NGT组（P〈0.01）。（3）GDM组多元线性逐步回归分析结果显示ADP、LEP是影响孕晚期GDM患者IR的独立危险因素。结论孕晚期GDM患者ADP减少、LEP升高与IR密切相关。

Correlation Between Serum Adiponectin, Leptin and Insulin Resistance in Gestational Diabetes Mellitus During Late Pregnancy

Objective To investigate the correlation between serum adiponectin(ADP),leptin(LEP) and insulin resistance(IR) in pregnant women with gestational diabetes mellitus(GDM) during late pregnancy.Methods A total of 166 pregnant women of 28-32 pregnant weeks were enrolled in the study.Serum insulin,ADP and LEP were determined in 84 patients with GDM(GDM group) and 82 pregnant women with normal glucose tolerance(NGT group).Homeostasis model assessment insulin resistance index,HOMA-IR,and insulin sensitivity index,ISOGTT,were calculated to assess the insulin resistance.Homeostasis β-cell function index(HBCI) and 30min net increment of insulin/30min net increment of glucose(ΔI30/ΔG30) were applied to evaluate the secretion function of islet β cells.Results The fasting insulin(FIns) level and HOMA-IR in the GDM group were markedly higher than those in the NGT group(P<0.01 and P<0.05 respectively),while ISOGTT,HBCI and ΔI30/ΔG30 in the GDM group were statistically lower than those in the NGT group(P<0.01 or P<0.05).The serum ADP level was significantly lower in the GDM group(P<0.01),while the serum LEP level was higher(P<0.01).A multiple linear stepwise regression analysis indicated that ADP and LEP were independent risk factors affecting GDM patients during late pregnancy.Conclusions Decreased serum adiponectin and increased serum leptin are closely correlated with insulin resistance in pregnant women with gestational diabetes mellitus(GDM) during late pregnancy.