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妊娠期糖尿病(gestational diabetes mellitus,GDM)是严重危害母婴健康的妊娠期特有代谢性疾病,胰岛素抵抗是GDM发病的主要机制之一,与胎儿生长发育受限、早产、流产等不良妊娠结局有关[1]。人吻素-1(Kisspeptin)是多肽类激素,具有调控生殖系统功能,在妊娠代谢调节中发挥重要作用,现有研究发现血清Kisspeptin水平在GDM病人中明显升高,高水平Kisspeptin可能促使了GDM的发生和进展[2]。促代谢因子(Betatrophin)表达于人体肝脏组织,其过表达可抑制肝糖异生,促进糖原合成,现代研究证实Betatrophin参与GDM和代谢综合征的发生和进展[3]。目前Kisspeptin、Betatrophin与GDM胰岛素抵抗的研究较为少见,其关系尚不明确,本研究设计对照研究,观察GDM病人和正常孕育孕妇血清Kisspeptin、Betatrophin水平差异,并分析其与胰岛素抵抗的关系,旨在为临床诊断和治疗提供参考。
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GDM组PFG、FINS、HOMA-IR、HbA1c、TC、TG均高于NGT组(P < 0.01),HDL-C、LDL-C与NGT组比较差异均无统计学意义(P>0.05)(见表 1)。
分组 n FPG/(mmol/L) FINS/(mmol/L) HOMA-IR HbAlc/% TC/(mmol/L) TG/(mmol/L) HDL-C/(mmol/L) LDL-C/(mmol/L) GDM组 86 6.52±2.65 10.24±3.26 3.95±0.63 9.89±3.28 5.71±0.85 2.85±0.33 2.13±0.29 2.52±0.52 NGT组 60 3.62±0.51 7.21±1.09 2.02±0.35 5.13±1.02 4.26±0.24 2.11±0.26 2.21±0.31 2.41±0.31 t — 8.36 6.93 21.51 10.87 12.85 14.51 1.59 1.45 P — < 0.01 < 0.01 < 0.01 < 0.01 < 0.01 < 0.01 >0.05 >0.05 表 1 2组糖脂代谢指标水平比较(x±s)
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GDM组血清Kisspeptin、Betatrophin水平均高于NGT组(P < 0.01)(见表 2)。
分组 n Kisspeptin/(ng/mL) Betatrophin/(pg/mL) GDM组 86 66.75±12.35 313.25±61.25 NGT组 60 32.15±6.49 241.25±35.26 t — 19.86 8.20 P — < 0.01 < 0.01 表 2 2组血清Kisspeptin、Betatrophin水平比较(x±s)
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Pearson相关性分析血清Kisspeptin、Betatrophin水平与TC、TG、PFG、FINS、HOMA-IR呈正相关关系(P < 0.01),与BMI、HDL-C、LDL-C、HbAlc无相关性(P>0.05)(见表 3)。Kisspeptin与Betatrophin之间呈正相关关系(r=0.326,P < 0.05)。
指标 Kisspeptin Betatrophin r P r P BMI 0.169 >0.05 0.134 >0.05 TC 0.435 < 0.01 0.471 < 0.01 TG 0.464 < 0.01 0.502 < 0.01 HDL-C 0.106 >0.05 0.056 >0.05 LDL-C 0.012 >0.05 0.035 >0.05 PFG 0.367 < 0.01 0.391 < 0.01 FINS 0.485 < 0.01 0.499 < 0.01 HOMA-IR 0.542 < 0.01 0.576 < 0.01 HbAlc 0.192 >0.05 0.183 >0.05 表 3 血清Kisspeptin、Betatrophin水平与临床指标相关系数
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以HOMA-IR为因变量,年龄、孕周、孕前BMI、孕次、产次、TC、TG、LDL-C、HDL-C为自变量,建立多重线性回归方程,逐步法排除无关变量,最终TC、TG、Kisspeptin、Betatrophin均与GDM病人HOMA-IR独立相关(P < 0.05~ P < 0.01)(见表 4)。
变量 B SE B′ t P TC 0.492 0.116 0.564 4.24 < 0.01 TG 0.503 0.137 0.426 3.67 < 0.05 Kisspeptin 0.671 0.182 0.626 3.69 < 0.05 Betatrophin 0.886 0.167 0.813 5.31 < 0.01 表 4 各变量与GDM病人胰岛素抵抗相关性
血清Kisspeptin、Betatrophin水平与妊娠期糖尿病病人胰岛素抵抗的相关性分析
Correlation between serum Kisspeptin, Betatrophin levels and insulin resistance in gestational diabetes mellitus patients
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摘要:
目的探讨血清人吻素-1(Kisspeptin)、促代谢因子(Betatrophin)水平与妊娠期糖尿病(GDM)病人胰岛素抵抗的相关性。 方法选择86例GDM病人(GDM组)和60例正常妊娠孕妇(NGT组),均检测血清Kisspeptin、Betatrophin水平,分析其与GDM发生胰岛素抵抗的相关性。 结果GDM组空腹血糖(FPG)、空腹胰岛素(FINS)、胰岛素抵抗指数(HOMA-IR)、糖化血红蛋白(HbAlc)、总胆固醇(TC)、三酰甘油(TG)、Kisspeptin、Betatrophin水平高于NGT组(P < 0.01),Pearson相关性分析血清Kisspeptin、Betatrophin水平与TC、TG、PFG、FINS、HOMA-IR呈正相关关系(r=0.367~0.576,P < 0.01),Kisspeptin与Betatrophin之间呈正相关关系(r=0.326,P < 0.05)。多重线性回归分析Kisspeptin(B=0.671)、Betatrophin(B=0.886)均与GDM病人HOMA-IR独立相关(P < 0.05~P < 0.01)。 结论GDM病人血清Kisspeptin、Betatrophin水平明显升高,Kisspeptin、Betatrophin水平均与GDM病人胰岛素抵抗存在正线性相关关系。 Abstract:ObjectiveTo investigate the correlation between serum Kisspeptin, Betatrophin levels, insulin resistance in patients with gestational diabetes mellitus (GDM). MethodsA total of 86 GDM patients (GDM group) and 60 normal pregnant women (NGT group) were selected.Serum Kisspeptin and Betatrophin levels were detected.The correlation between serum Kisspeptin, Betatrophin levels and insulin resistance in GDM was analyzed. ResultsThe levels of fasting plasma glucose (FPG), fasting insulin (FINS), homeostasis model assessment-insulin resistance (HOMA-IR), hemoglobin A1c (HbA1c), total cholesterol (TC), triglycerides (TG), Kisspeptin and Betatrophin in the GDM group were higher than those in the NGT group (P < 0.01).Pearson correlation analysis showed that serum Kisspeptin and Betatrophin levels were positively correlated with TC, TG, PFG, FINS and HOMA-IR (r=0.367-0.576, P < 0.01), and Kisspeptin was positively correlated with Betatrophin (r=0.326, P < 0.05).Multiple linear regression analysis results showed that Kisspeptin (B=0.671) and Betatrophin (B=0.886) were independently correlated with HOMA-IR in patients with GDM (P < 0.05 to P < 0.01). ConclusionsSerum Kisspeptin and Betatrophin levels are significantly increased in GDM patients, and there is a positive linear correlation between Kisspeptin, Betatrophin levels and insulin resistance in GDM patients. -
表 1 2组糖脂代谢指标水平比较(x±s)
分组 n FPG/(mmol/L) FINS/(mmol/L) HOMA-IR HbAlc/% TC/(mmol/L) TG/(mmol/L) HDL-C/(mmol/L) LDL-C/(mmol/L) GDM组 86 6.52±2.65 10.24±3.26 3.95±0.63 9.89±3.28 5.71±0.85 2.85±0.33 2.13±0.29 2.52±0.52 NGT组 60 3.62±0.51 7.21±1.09 2.02±0.35 5.13±1.02 4.26±0.24 2.11±0.26 2.21±0.31 2.41±0.31 t — 8.36 6.93 21.51 10.87 12.85 14.51 1.59 1.45 P — < 0.01 < 0.01 < 0.01 < 0.01 < 0.01 < 0.01 >0.05 >0.05 表 2 2组血清Kisspeptin、Betatrophin水平比较(x±s)
分组 n Kisspeptin/(ng/mL) Betatrophin/(pg/mL) GDM组 86 66.75±12.35 313.25±61.25 NGT组 60 32.15±6.49 241.25±35.26 t — 19.86 8.20 P — < 0.01 < 0.01 表 3 血清Kisspeptin、Betatrophin水平与临床指标相关系数
指标 Kisspeptin Betatrophin r P r P BMI 0.169 >0.05 0.134 >0.05 TC 0.435 < 0.01 0.471 < 0.01 TG 0.464 < 0.01 0.502 < 0.01 HDL-C 0.106 >0.05 0.056 >0.05 LDL-C 0.012 >0.05 0.035 >0.05 PFG 0.367 < 0.01 0.391 < 0.01 FINS 0.485 < 0.01 0.499 < 0.01 HOMA-IR 0.542 < 0.01 0.576 < 0.01 HbAlc 0.192 >0.05 0.183 >0.05 表 4 各变量与GDM病人胰岛素抵抗相关性
变量 B SE B′ t P TC 0.492 0.116 0.564 4.24 < 0.01 TG 0.503 0.137 0.426 3.67 < 0.05 Kisspeptin 0.671 0.182 0.626 3.69 < 0.05 Betatrophin 0.886 0.167 0.813 5.31 < 0.01 -
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