妊娠期糖尿病孕妇血清PAPP-A与IR的相关性研究

发布时间：2018-08-10 22:34

【摘要】：目的：妊娠期外周组织的胰岛素抵抗(insulin resistance, IR)和胰岛素敏感性的下降是妊娠期糖尿病的主要发病机制之一。研究表明2型糖尿病中IGF-I与胰岛素抵抗具有负相关性,但关于GDM中胰岛素抵抗与IGF-I相关性研究的报道并不多。而妊娠相关血浆蛋白A作为IGFBPs蛋白水解酶,在游离IGF-I从IGF-I/IGFBPs复合物中分离出来并发挥类胰岛素样作用中起着重要的作用。本研究通过比较正常妊娠孕妇和妊娠期糖尿病孕妇早孕期血清PAPP-A. IGF-I及IGFBP-4含量的变化,探讨其在妊娠期糖尿病发生发展中的作用及其机制。方法：对所有纳入对象孕8到12周的空腹血标本检测PAPP-A, IGF-I和IGFBP-4,孕24-28周测空腹血糖(FPG)及空腹胰岛素(FINS)并计算胰岛素抵抗指数HOMA-IR=ln (FINS FPG/22.5)。根据孕24-28周行糖耐量实验结果将纳入对象分为GDM组和正常组。在进行正态性检验和方差齐性检验后,采用成组t检验进行两组间同一指标的均数比较,采用Pearson相关系数来分析指标间的相关性。结果：与正常组相比,GDM组早孕期血清PAPP-A含量和游离IGF-I含量下降,而IGFBP-4含量及中孕期胰岛素抵抗指数均上升。PAPP-A与IGF-I呈正相关；PAPP-A与IGFBP-4含量呈负相关；PAPP-A与中孕期胰岛素抵抗指数呈负相关。IGF-I与中孕期胰岛素抵抗指数呈负相关。结论：①游离IGF-I与胰岛素抵抗呈负相关,提示早孕期IGF-I的下降与中晚孕期GDM的发生具有相关性。②孕妇外周血中PAPP-A的下降与游离IGF-I的降低密切相关,提示早孕期监测PAPP-A可能对GDM具有预测价值。图10幅,表7个,参考文献52篇
[Abstract]:Objective: the decrease of insulin resistance (insulin resistance, IR) and insulin sensitivity in peripheral tissues of pregnancy is one of the main pathogenesis of gestational diabetes mellitus. There is a negative correlation between IGF-I and insulin resistance in type 2 diabetes mellitus, but there are few reports on the correlation between insulin resistance and IGF-I in GDM. The pregnancy-associated plasma protein A, as a IGFBPs proteolytic enzyme, plays an important role in the isolation of free IGF-I from IGF-I/IGFBPs complex and plays an important role in insulin-like action. The aim of this study was to compare serum PAPP-A between normal pregnant women and pregnant women with gestational diabetes mellitus (GDM). To explore the role and mechanism of IGF-I and IGFBP-4 in the development of gestational diabetes mellitus (GDM). Methods: PAPP-A, IGF-I and IGFBP-4 were measured in fasting blood samples from 8 to 12 weeks of gestation. Fasting blood glucose (FPG) and fasting insulin (FINS) (FINS) were measured at 24-28 weeks of gestation. Insulin resistance index (FINS FPG/22.5) was calculated. Subjects were divided into GDM group and normal group according to 24-28 weeks gestational glucose tolerance test results. After normality test and variance homogeneity test, the group t test was used to compare the mean of the same index between the two groups, and the Pearson correlation coefficient was used to analyze the correlation between the two groups. Results: compared with the normal group, the serum PAPP-A content and free IGF-I content decreased, while the IGFBP-4 content and insulin resistance index increased. PAPP-A was negatively correlated with IGF-I content. There was a negative correlation between PAPP-A and insulin resistance index in middle pregnancy and a negative correlation between IGF-I and insulin resistance index during pregnancy. Conclusion there is a negative correlation between free IGF-I and insulin resistance, suggesting that the decrease of IGF-I in early pregnancy and the occurrence of GDM in middle and late pregnancy are related to the decrease of PAPP-A in peripheral blood of pregnant women and the decrease of free IGF-I in peripheral blood of pregnant women. The results suggest that monitoring PAPP-A in early pregnancy may be of predictive value for GDM. 10 figures, 7 tables, 52 references
【学位授予单位】：中南大学
【学位级别】：硕士
【学位授予年份】：2014
【分类号】：R714.256

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