妊娠早期血清维生素D水平预测妊娠糖尿病发生的研究

发布时间：2018-07-12 13:14

本文选题：维生素D + 妊娠糖尿病　；参考：《广州医科大学》2014年硕士论文

【摘要】：背景近些年来，国内外大量研究表明维生素D水平与葡萄糖代谢存在相关性。维生素D通过结合细胞膜或细胞核内的维生素D受体（Vitamin D receptors,VDR）发挥作用。人们已经发现VDR存在于全身多种器官组织，其中在胰岛β细胞表面就发现了VDR，这提示维生素D可以通过结合β细胞表面的VDR，进而影响胰岛素的生成和分泌；同时在胰岛素作用的靶器官及组织，如肝脏、骨骼肌、脂肪细胞中也存在VDR，表明维生素D也会影响机体胰岛素抵抗（Insulin resistant,IR）程度，即胰岛素敏感性。因此国内外学者认为维生素D可能通过调节胰岛素的分泌和胰岛素敏感性参与糖代谢。但是，近些年也相继出现不少研究表明维生素D与胰岛素分泌、胰岛素敏感性并不存在相关性。不仅如此，维生素D与妊娠糖尿病（Gestational diabetes mellitus，GDM）的相关性也是研究热点之一。目的探讨妊娠早期血维生素D水平能否预测GDM的发生，为妊娠早期预防妇女GDM的发生提供理论依据；并分析妊娠早期血维生素D水平与胰岛素分泌、胰岛素敏感性是否存在相关性。对象与方法本研究选取孕4-11周710名在广州医科大学附属第二医院确诊早孕的妇女为研究对象，在其确诊早孕时留取血标本检测血清25-(OH)D、空腹血糖（Fastingplasma glucose，FPG）、空腹胰岛素（Fasting insulin，FIns），妊娠24-28周163名妇女行75g口服葡萄糖耐量试验（Oral glucose tolerance test，OGTT）筛查GDM。本实验采用美国糖尿病学会（American Diabetes Association，ADA）2011年推荐的GDM诊断标准：妊娠24-28周行75gOGTT试验，诊断界值如下：空腹、1小时和2小时血糖值分别为5.1mmol/L、10.0mmol/L和8.5mmol/L，任何一项血糖值达到或超过上述界值，则诊断为妊娠糖尿病；采用稳态模型胰岛素分泌指数（Homeostasis model assessment-β，HOMA-β）和稳态模型胰岛素抵抗指数（Homeostasis model assessment-insulin resistant，HOMA-IR）评估胰岛β细胞分泌功能和胰岛素敏感性。HOMA-β=[20×FINS(mU/L)]／[FPG(mmol/L)－3.5]，HOMA-IR=[FPG(mmol/L)×FINS(mU/L)]／22.5。结果（1）710名妊娠妇女进入研究，随访过程中，因人工流产、药物流产以及失访、研究对象排除标准等原因，最终219名孕妇纳入研究。其中163名行GDM筛查，发生GDM20例（GDM组），GDM发生率为12.3%，BMI为23.4±3.5kg/m2；发生流产56例（流产组），BMI为24.0±3.9kg/m2；正常组143例，BMI为23.7±5.0kg/m2。三组人群年龄、孕周以及BMI差异无统计学意义，P＞0.05。（2）219例总样本25(OH)D浓度为28.3±9.4ng/mL，其中25(OH)D不足（30ng/mL）占62.6%。GDM组25(OH)D浓度为29.7±10.4ng/mL，正常组25(OH)D浓度为28.0±9.3ng/mL，两组间差异无统计学意义，P=0.469。对163例样本进行25(OH)D浓度四分位分组，经卡方检验，上四分位组（8.6～20.7ng/mL）与下四分位组（33.9～58.7ng/mL）的GDM发生率差异无统计学意义（7.5%vs17.1%,P=0.331)。（3）由于标本血清留取有限，检测不同指标消耗，以及考虑检测试剂的批间差异，最终对128例样本测定FIns进行25(OH)D与胰岛素相关性分析，简单线性相关分析结果表明25(OH)D与FPG、FIns、Ln(HOMA-β)、Ln(HOMA-IR)均不存在相关性，，P0.05；以HOMA-IR1.586为界分组，比较HOMA-IR1组（HOMA-IR1.586）与HOMA-IR2组（HOMA-IR≥1.586）的维生素D浓度，结果表明两组间维生素D浓度差异无统计学意义（27.8±7.6vs28.1±10.0,P=0.880)。结论 1.广州市妊娠妇女普遍存在维生素D不足。 2.妊娠早期血清25(OH)D水平不能预测GDM的发生。 3.妊娠早期血清25(OH)D水平与胰岛素分泌和胰岛素敏感性不存在相关性。
[Abstract]:background
In recent years, a large number of studies have shown that vitamin D levels are associated with glucose metabolism. Vitamin D plays a role by combining the Vitamin D receptors (VDR) in cell membrane or nucleus. It has been found that VDR exists in a variety of organ tissues in the whole body, and VDR is found on the surface of islet beta cells. It is shown that vitamin D can affect the formation and secretion of insulin by binding to VDR on the surface of beta cells, and also in the target organs and tissues of insulin action, such as the liver, skeletal muscle, and adipocytes, which also indicate that vitamin D also affects the degree of insulin resistance (Insulin resistant, IR) in the body, that is, insulin sensitivity. Therefore, the state of insulin resistance (VDR) is also sensitive to insulin. Domestic and foreign scholars believe that vitamin D may participate in glycometabolism by regulating insulin secretion and insulin sensitivity. However, in recent years, many studies have shown that vitamin D and insulin secretion are not associated with insulin sensitivity. Not only so, vitamin D and pregnancy induced diabetes mellitus (Gestational diabetes mellitus, GDM). Correlation is also one of the hotspots of research.
objective
To investigate whether the levels of vitamin D in the early pregnancy can predict the occurrence of GDM and provide a theoretical basis for the prevention of GDM in the early pregnancy, and the correlation between the level of vitamin D in the early pregnancy and the insulin secretion and the insulin sensitivity.
Object and method
In this study, 710 women who had been diagnosed with early pregnancy at the Second Affiliated Hospital of Guangzhou Medical University at 4-11 weeks of pregnancy were selected to examine the serum 25- (OH) D, fasting blood glucose (Fastingplasma glucose, FPG), fasting insulin (Fasting insulin, FIns), and 163 women for 24-28 weeks of pregnancy, and 163 women in 24-28 weeks of pregnancy for 75g oral glucose tolerance test. The test (Oral glucose tolerance test, OGTT) screened the GDM. experiment using the GDM diagnostic criteria recommended by the American Diabetes Society (American Diabetes Association, ADA) 2011: 24-28 weeks of pregnancy, a 75gOGTT trial was performed. The diagnostic values were as follows: the fasting, 1 and 2 hours of blood sugar, respectively, any blood sugar The value of Homeostasis model assessment- beta (HOMA- beta) and homeostasis model insulin resistance index (Homeostasis model assessment-insulin resistant, HOMA-IR) were used to evaluate the secretory function of islet beta cells and the.HOMA- beta =[20 of insulin sensitivity. * FINS (mU/L)] / [FPG (mmol/L) - 3. 5], HOMA-IR=[FPG (mmol/L) x FINS (mU/L)] / 22.5.
Result
(1) 710 pregnant women entered the study. In the course of follow-up, 219 pregnant women were included in the study because of abortion, drug abortion and loss of visits. 219 pregnant women were included in the study. Among them, 163 were screened by GDM and had GDM20 (group GDM), the incidence of GDM was 12.3%, BMI was 23.4 + 3.5kg/m2; 56 abortion groups (abortion group) and BMI were 24 + 3.9kg/m2. There were no significant differences in age, gestational age and BMI between the 143 normal group and 23.7 BMI 5.0kg/m2. group, P > 0.05. three.
(2) the total concentration of 25 (OH) D was 28.3 + 9.4ng/mL, of which 25 (OH) D deficiency (30ng/mL) was 25 (OH) D concentration of 29.7 + 10.4ng/mL in 62.6%.GDM group, 25 (OH) in the normal group was 28 +, and there was no statistical difference between two groups. There was no significant difference in the incidence of GDM between the g/mL and the lower four groups (33.9 to 58.7ng/mL) (7.5%vs17.1%, P=0.331).
(3) due to the limited retention of the specimen serum, the consumption of different indexes, and the difference between the test reagents, the correlation analysis between 25 (OH) D and insulin was carried out in 128 samples of FIns. The results of simple linear correlation analysis showed that 25 (OH) D and FPG, FIns, Ln (HOMA- beta), Ln (HOMA-IR) had no correlation, P0.05. The concentration of vitamin D in group HOMA-IR1 (HOMA-IR1.586) and group HOMA-IR2 (HOMA-IR > 1.586) was compared. The results showed that there was no significant difference in the concentration of vitamin D between the two groups (27.8 + 7.6vs28.1 + 10, P=0.880).
conclusion
1. vitamin D deficiency is prevalent among pregnant women in Guangzhou.
2. serum level of 25 (OH) D in early pregnancy can not predict the occurrence of GDM.
3. there was no correlation between serum 25 (OH) D level and insulin secretion and insulin sensitivity in early pregnancy.
【学位授予单位】：广州医科大学
【学位级别】：硕士
【学位授予年份】：2014
【分类号】：R714.256

【参考文献】