【作者】 雷晨；

【导师】 张如意； 周旭；

【作者基本信息】 宁夏医科大学 ， 内分泌， 2009， 硕士

【摘要】 目的通过对不同糖耐量状态妊娠个体中脂联素(ADPN)和内脂素的测定和相关因素研究,探讨在不同糖耐量状态妊娠个体的ADPN和内脂素水平变化以及ADPN与内脂素在妊娠糖尿病(GDM)中对于胰岛β细胞分泌功能的影响和在GDM发病中的可能机制。方法根据GDM的诊断标准和不同糖耐量进行分组:分为GDM组(33例)、妊娠糖耐量异常(GIGT)组(33例)和正常妊娠(NGT)组(30例)。检测血清ADPN(ELISA法)、内脂素(ELISA法),同时测定空腹和餐后血糖、HbAlc、血脂水平、空腹和餐后胰岛素、空腹和餐后C肽、内分泌激素(甲状腺激素、孕酮、雌二醇、血PRL)等指标,比较各组间的差异并进行相关性分析。结果1)不同糖耐量状态妊娠个体的总体脂和股部皮下脂肪面积(FA)无差异;随着糖耐量损伤程度的加重,腹部内脏脂肪面积(VA)和腹部皮下脂肪面积(SA)明显增加,P<0.05。2)GDM、GIGT组的空腹和餐后胰岛素、C肽明显增高,且GDM餐后胰岛素和C肽明显高于GIGT,P<0.05。3)糖耐量异常妊娠个体孕激素和泌乳素分泌量明显增加,而游离甲状腺素无明显升高。GDM游离三碘甲状原氨酸高于GIGT患者。4)与NGT组相比,GDM、GIGT组血清ADPN明显下降,P<0.05;GDM组血清ADPN高于GIGT组,P<0.05。5)GDM的空腹和餐后血清内脂素明显高于GIGT和NGT,而GIGT与NGT无差异;各组的空腹与餐后血清内脂素无统计学差异。6)ADPN随孕周的进展无变化,而血清内脂素在孕中期无变化,但在孕晚期明显增高。7)多元逐步回归分析显示:BMI、VA、SA、2hPG、FINS、餐后2小时胰岛素、空腹C肽、餐后C肽、HOMA-IR等与ADPN水平密切相关;而BMI、FPG、1hPG、2hPG、3hPG、FINS、空腹C肽、VA、SA等与血清内脂素密切相关。8)ADPN与HbA1c、FPG、1hPG、2hPG、3hPG呈正相关,与BMI、年龄、HDL、VA呈负相关;血清内脂素与FPG、1hPG、2hPG、3hPG、FINS、空腹C肽、HOMA-IR、VA、SA呈现正相关,与ISI呈负相关。结论糖耐量损伤的妊娠个体不仅存在由于胰岛素抵抗所致的胰岛素大量释放,还存在胰岛素释放延迟。血清内脂素在妊娠进展的过程中可以随着孕周的变化而变化。ADPN的分泌增加可以促进胰岛β细胞分泌胰岛素,而血清内脂素受到血糖的刺激,可以增加分泌,发挥其类胰岛素的作用,同时内脂素也可以影响胰岛素的分泌,共同起到降低血糖的作用。更多还原

【Abstract】 Objective: To investigate the serum adiponectin; visfatin and related factors in pregnancy patients with different glucose tolerance, discussion on the changes of adiponectin and visfatin levels in pregnancy patients with different glucose tolerance and the effect the secretary function of Beta cell, analysis possible mechanisms in GDM.Methods: According to the diagnostic criteria of GDM and impaired glucose tolerance, the patients were divided into three groups: gestational diabetes mellitus(GDM) group: (33 cases), gestational impaired glucose tolerance (GIGT) group: (33 cases) and normal pregnancy (NGT) group: (30 cases). Serum adiponectin and visfatin was measured by ELISA. At the same time, measured fasting blood glucose and postprandial, HbAlc, blood lipid levels, fasting and postprandial insulin, fasting and postprandial C-peptide, endocrine hormones and so on, compare the differences between the groups and correlation analysis.Results: (1) The overall fat and femoral subcutaneous fat area (FA) were no differences in three groups; with the tolerance level of injury increased abdominal visceral fat area (VA) and abdominal subcutaneous fat area (SA) increased significantly. (2) The fasting and postprandial insulin and C peptide increased significantly in GDM and GIGT groups, the postprandial insulin and C peptide in GDM group were significantly higher than GIGT group. (3) Progesterone and prolactin secretion increased, and free thyroxine had no significant rise in Pregnancy patients with impaired glucose tolerance, free Triiodothyronine in GDM group was higher than GIGT group. (4) The level of serum adiponectin was lower in GDM and GIGT groups than NGT group, the serum adiponectin in GDM was higher than GIGT group. (5) The level of serum fasting and postprandial visfatin in GDM were higher than GIGT and NGT. The fasting and postprandial visfatin have no significant differences in every group. (6) With the progress of gestational age, there is no change in the level of serum ADPN; Serum visfatin has no change in the second trimester, but increased significantly in the third trimester of pregnancy. (7) Multiple regression analysis showed that: BMI, VA, SA, 2hPG, Fasting and postprandial insulin and C-peptide, HOMA-IR are closely related to the level of ADPN; and BMI, FPG, 1hPG, 2hPG, 3hPG, FINS, fasting C-peptide, VA, SA are closely related to the level of visfatin. (8) Correlation analysis indicated serum adiponectin was positively associated with HbA1c, FPG, 1hPG, 2hPG and 3hPG,negatively associated with BMI, age, HDL and VA; serum visfatin was positively associated with FPG, 1hPG, 2hPG, 3hPG, FINS, fasting C-peptide, HOMA-IR, VA and SA, negatively associated with ISI.Conclusions: Damage in pregnancy patients with impaired glucose tolerance is not only due to presence of the large number of insulin release caused by insulin resistance, there are still delays in the release of insulin. With the change of gestational age, serum visfatin and ADPN levels are also changing, and their secretion are increasing by the stimulation of high blood sugar.ADPN and visfatin may play an important role in Insulin-like effect and the promotion of insulin-secreting isletβcells.更多还原