妊娠期糖尿病患者外周血Obestatin水平变化及其临床意义
发布时间：2018-08-21 19:36
【摘要】：背景 妊娠期糖尿病(Gestational diabetes mellitus, GDM)是妊娠期首次诊断或发生的糖尿病,为妊娠期常见的并发症之一。发病率约为8%～14%,并有逐年增高的趋势。GDM严重威胁孕妇和胎儿健康,可导致巨大儿、羊水过多、自然流产、胎儿畸形、胎儿窘迫、死胎、死产、新生儿低血糖、产伤等。GDM其病因及发病机制目前尚未阐明,近年来的研究发现某些多肽分子可能参与妊娠期血糖和能量代谢,并与GDM发病有关。肥胖抑制素(Obestatin)是新近发现的一种多肽分子,由已知的Ghrelin基因经过翻译,经不同修饰后产生的不同于Ghrelin的生物活性肽,广泛存在于多种物种机体内,并在不同物种间的氨基酸组成上具有高度保守性。Obestatin广泛分布于大肠、小肠、胃、脾、大脑皮层、胰腺及血浆内,并可能通过内分泌、旁分泌、自分泌、远距分泌、神经内分泌等多种不同途径发挥多种调节作用。最早的研究认为Obestatin具有拮抗Ghrelin的生物效应,即可减缓胃排空,抑制食欲,进而减少进食,降低体重,对抗肥胖的作用,因此Obestatin与肥胖症、糖尿病等多种代谢疾病之间的关系受到学者的重视。现有的一些研究结果表明Obestatin可促进胰岛p细胞增殖、对抗细胞因子介导的胰岛p细胞凋亡,并抑制外周炎症,从而达到保护胰岛β细胞,改善胰岛素抵抗(insulin resistance, IR)的作用,甚至可能直接影响胰岛素的分泌。鉴于Obestatin维持能量代谢、抑制凋亡等方面存在重要作用,有学者推测妊娠期间Obestatin的改变可能涉及妊娠期间能量代谢的紊乱,可能是GDM的重要发病机制之一。已有国内外学者对Obestatin与GDM之间的关系进行了一些探索,但报道尚少,且尚无统一结果。 目的 通过比较GDM孕妇与正常孕妇的外周血Obestatin水平及糖、脂代谢指标,探讨Obestatin与GDM的发生发展之间是否存在相关性。 方法 选取2011年4月到2012年4月在浙江大学医学院附属妇产科医院产科门诊定期产检并住院分娩的孕妇,根据IADPSG标准诊断为GDM的孕妇37例,同期随机选择OGTT正常,且年龄、孕周、孕前体重指数等指标与实验组相匹配的孕妇37例作为正常对照组,两组孕妇均在37周～42周之间住院并抽取空腹静脉血。测定Obestatin、空腹血糖(Fast Plasm Glucose, FPG)、空腹胰岛素(Fast Insulins, Fins)、甘油三酯(Triglyceride, TG)、高密度脂蛋白(High-density lipoprotein, HDL-C)、低密度脂蛋白(Low-density lipoprotein, LDL-C)、胆固醇水平(Total Cholesterole, TC),用HOMA稳态模型=(FPG×Fins/22.5)评估胰岛素抵抗指数(HOMA-IR),比较两组之间Obestatin水平的差异以及Obestatin与糖脂代谢指标、胰岛素抵抗水平之间的关系。结果 (1)GDM组孕妇与正常对照组孕妇的年龄、孕周、产次、孕次、BMI、孕期体重增加方面差异无统计学意义(P0.05)。(2)GDM组患者空腹外周血Obstatin水平显著高于正常对照组(分别为1151619.33μg/L和102.51±19.41μg/LP0.001); GDM组FPG. Fins. HbA1c. HOMA-IR、TG、LDL、TC均高于正常对照组(分别为5.40±0.54mmol/L,14.03±2.98mu/L,6.09±1.86%,1.94±0.38,2.06±0.48mmol/L,3.34±0.93mmol/L,5.92±2.10mmol/L和4.38±0.53mmol/L,7.76±2.80mu/L,5.13±0.87%,1.19±0.35,1.56±0.45mmol/L,2.89±0.51mmol/L,4.74±1.79mmol/L, P均0.05),而HDL水平显著低于正常对照组(分别为1.60±0.39mmol/L和2.10±0.46mmol/L, p0.01).(3)正常对照组Obestatin与FPG (r=-0.455, P0.01)、LDL (r=-0.369, P0.05)呈负相关,与Fins (r=0.394, P0.05)、TG(r=0.427, P0.05)呈正相关,而GDM组Obestatin水平与Fins(r=0.337, P0.05)、HDL(r=0.365, P0.05)成正相关,与HOMA-IR (r=-0.376, P0.05)、TC(r=-0.513, P0.01)呈负相关。结论 (1)Obestatin参与正常妊娠期血糖、血脂代谢调节；(2)Obestatin水平在GDM组升高,而且与血糖、血脂代谢紊乱有关；可能是针对GDM组糖脂代谢异常、胰岛素抵抗情况启动的可逆性自我保护机制之一。
[Abstract]:background
Gestational diabetes mellitus (GDM) is one of the most common complications in pregnancy. The incidence of GDM is about 8%-14% and is increasing year by year. Stillbirths, stillbirths, neonatal hypoglycemia, birth injuries, etc. The etiology and pathogenesis of GDM have not been elucidated. Recent studies have found that some polypeptide molecules may be involved in glucose and energy metabolism during pregnancy and may be related to the pathogenesis of GDM. Obestatin is widely distributed in the large intestine, small intestine, stomach, spleen, cerebral cortex, pancreas and plasma, and may be secreted by endocrine, paracrine, autocrine, and remote secretion. The earliest studies suggest that Obestatin has antagonistic biological effects on Ghrelin, which can slow gastric emptying, inhibit appetite, thereby reducing food intake, weight loss and anti-obesity. Obestatin's relationship with obesity, diabetes and other metabolic diseases has been studied. Existing studies have shown that Obestatin can promote the proliferation of pancreatic P cells, resist the apoptosis of pancreatic P cells mediated by cytokines, and inhibit peripheral inflammation, thereby protecting pancreatic beta cells, improving insulin resistance (IR), and even directly affecting insulin secretion. Some scholars speculate that the change of Obestatin during pregnancy may involve the disorder of energy metabolism during pregnancy and may be one of the important pathogenesis of GDM. Result.
objective
By comparing the levels of Obestatin in peripheral blood and glucose and lipid metabolism between GDM pregnant women and normal pregnant women, the relationship between Obestatin and the occurrence and development of GDM was explored.
Method
From April 2011 to April 2012, 37 pregnant women with GDM diagnosed according to IADPSG criteria were randomly selected as normal control group. 37 pregnant women with normal OGTT, matching age, gestational age, pre-pregnancy body mass index were selected as normal control group. Obestatin, fasting plasma glucose (FPG), fasting insulin (Fast Insulins, Fins), triglyceride (TG), high-density lipoprotein (HDL-C), low-density lipoprotein (LDL-C), cholesterol were measured. Total Cholesterole (TC), HOMA homeostasis model = (FPG *Fins/22.5) was used to evaluate insulin resistance index (HOMA-IR). Obestatin levels were compared between the two groups and the relationship between Obestatin and glucose and lipid metabolism, insulin resistance.
(1) There was no significant difference in age, gestational age, parity, gestational age, BMI and weight gain between GDM group and normal control group (P 0.05). (2) Obstatin level in fasting peripheral blood of GDM group was significantly higher than that of normal control group (1151619.33 ug/L and 102.51 (+19.41 ug/LP0.001), FPG.Fins.HbA1c.HOMA-IR, TG, LDL, TC, etc. They were all higher than those in the normal control group (5.40 (+ 0.54 mmol/L, 14.03 (+ 2.98 mu/L, 14.03 (+ 2.98 mu/L, 6.09 (+ 1.86%, 1.94 (+ 0.38, 2.06 (+ 0.48 mmol/L, 2.06 (+) 0.48 mmol/L, 3.34 (+ 0.93 mmol/L, 5.34 (+ 0.93 mmol/L), 5.92 (+ 2.10 mmol/L) and 4.38 (+ 0.53 mmol/L), 7.76 (+ 2.80 mu/L, 2.80 mu/L, 5.13 (+ 0.87%, 5.87%, 1.19 (+ 0 The level of HDL was significantly lower than that of normal control group. Obestatin was negatively correlated with FPG (r = - 0.455, P 0.01), LDL (r = - 0.369, P 0.05), LDL (r = - 0.369, P 0.05), Fins (r = 0.394, P 0.05), TG (r = 0.427, P 0.05), FinTG (r = 0.427, P 0.05), FinFinFinTG (r = 0 0.427, P 0.05), Obestatin GDM group was positipositipositively correlwith s (r = 0.337, P 0.337, P 0.05), HDL (r = 0.365, HDL (r = 0.365, P 0.365, P 0.365, P 0.365, P 0.05), HOHOand HOMA-IR (r=-0.376, P 0.05), TC (r=-0.513, P0.01) was negatively correlated.
(1) Obestatin participates in the regulation of blood glucose and lipid metabolism in normal pregnancy; (2) Obestatin level is elevated in GDM group, and is related to the disorder of blood glucose and lipid metabolism; it may be one of the reversible self-protection mechanisms against abnormal glucose and lipid metabolism and insulin resistance in GDM group.
【学位授予单位】：浙江大学
【学位级别】：硕士
【学位授予年份】：2014
【分类号】：R714.256
本文编号：2196145
[Abstract]:background
Gestational diabetes mellitus (GDM) is one of the most common complications in pregnancy. The incidence of GDM is about 8%-14% and is increasing year by year. Stillbirths, stillbirths, neonatal hypoglycemia, birth injuries, etc. The etiology and pathogenesis of GDM have not been elucidated. Recent studies have found that some polypeptide molecules may be involved in glucose and energy metabolism during pregnancy and may be related to the pathogenesis of GDM. Obestatin is widely distributed in the large intestine, small intestine, stomach, spleen, cerebral cortex, pancreas and plasma, and may be secreted by endocrine, paracrine, autocrine, and remote secretion. The earliest studies suggest that Obestatin has antagonistic biological effects on Ghrelin, which can slow gastric emptying, inhibit appetite, thereby reducing food intake, weight loss and anti-obesity. Obestatin's relationship with obesity, diabetes and other metabolic diseases has been studied. Existing studies have shown that Obestatin can promote the proliferation of pancreatic P cells, resist the apoptosis of pancreatic P cells mediated by cytokines, and inhibit peripheral inflammation, thereby protecting pancreatic beta cells, improving insulin resistance (IR), and even directly affecting insulin secretion. Some scholars speculate that the change of Obestatin during pregnancy may involve the disorder of energy metabolism during pregnancy and may be one of the important pathogenesis of GDM. Result.
objective
By comparing the levels of Obestatin in peripheral blood and glucose and lipid metabolism between GDM pregnant women and normal pregnant women, the relationship between Obestatin and the occurrence and development of GDM was explored.
Method
From April 2011 to April 2012, 37 pregnant women with GDM diagnosed according to IADPSG criteria were randomly selected as normal control group. 37 pregnant women with normal OGTT, matching age, gestational age, pre-pregnancy body mass index were selected as normal control group. Obestatin, fasting plasma glucose (FPG), fasting insulin (Fast Insulins, Fins), triglyceride (TG), high-density lipoprotein (HDL-C), low-density lipoprotein (LDL-C), cholesterol were measured. Total Cholesterole (TC), HOMA homeostasis model = (FPG *Fins/22.5) was used to evaluate insulin resistance index (HOMA-IR). Obestatin levels were compared between the two groups and the relationship between Obestatin and glucose and lipid metabolism, insulin resistance.
(1) There was no significant difference in age, gestational age, parity, gestational age, BMI and weight gain between GDM group and normal control group (P 0.05). (2) Obstatin level in fasting peripheral blood of GDM group was significantly higher than that of normal control group (1151619.33 ug/L and 102.51 (+19.41 ug/LP0.001), FPG.Fins.HbA1c.HOMA-IR, TG, LDL, TC, etc. They were all higher than those in the normal control group (5.40 (+ 0.54 mmol/L, 14.03 (+ 2.98 mu/L, 14.03 (+ 2.98 mu/L, 6.09 (+ 1.86%, 1.94 (+ 0.38, 2.06 (+ 0.48 mmol/L, 2.06 (+) 0.48 mmol/L, 3.34 (+ 0.93 mmol/L, 5.34 (+ 0.93 mmol/L), 5.92 (+ 2.10 mmol/L) and 4.38 (+ 0.53 mmol/L), 7.76 (+ 2.80 mu/L, 2.80 mu/L, 5.13 (+ 0.87%, 5.87%, 1.19 (+ 0 The level of HDL was significantly lower than that of normal control group. Obestatin was negatively correlated with FPG (r = - 0.455, P 0.01), LDL (r = - 0.369, P 0.05), LDL (r = - 0.369, P 0.05), Fins (r = 0.394, P 0.05), TG (r = 0.427, P 0.05), FinTG (r = 0.427, P 0.05), FinFinFinTG (r = 0 0.427, P 0.05), Obestatin GDM group was positipositipositively correlwith s (r = 0.337, P 0.337, P 0.05), HDL (r = 0.365, HDL (r = 0.365, P 0.365, P 0.365, P 0.365, P 0.05), HOHOand HOMA-IR (r=-0.376, P 0.05), TC (r=-0.513, P0.01) was negatively correlated.
(1) Obestatin participates in the regulation of blood glucose and lipid metabolism in normal pregnancy; (2) Obestatin level is elevated in GDM group, and is related to the disorder of blood glucose and lipid metabolism; it may be one of the reversible self-protection mechanisms against abnormal glucose and lipid metabolism and insulin resistance in GDM group.
【学位授予单位】：浙江大学
【学位级别】：硕士
【学位授予年份】：2014
【分类号】：R714.256
【参考文献】
相关期刊论文 前1条
1 姜殿林;董桂虎;徐霞;;正常妊娠妇女血脂及载脂蛋白水平的变化[J];实用临床医学;2006年04期
，本文编号：2196145
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