肥胖型妊娠期糖尿病患者血清视黄醇结合蛋白-4表达变化及临床意义探讨
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摘要
目的探讨肥胖型妊娠期糖尿病(gestational diabetes mellitus,GDM)患者血清视黄醇结合蛋白-4(retinol binding protein 4,RBP-4)表达变化及临床意义。方法选取2016年6月至2017年12月于河北省保定市妇幼保健院正规建卡产检且孕前体质量指数(body mass index,BMI)>25 kg/m~2,孕期体质量增加低于20 kg的40例肥胖型GDM患者为观察组,同时选择同期产检且孕前BMI为18.5～25.0 kg/m~2,孕期体质量增加低于20 kg的40例非肥胖型GDM患者为对照组。观察两组患者孕24～28周的糖脂生化指标,使用酶联免疫吸附法检测患者血清RBP-4表达情况,比较两组患者空腹胰岛素(fasting insulin,FINS)、胰岛素抵抗指数(homeostasis model assessment for insulin resistance,HOMA-IR)、肿瘤坏死因子-α(tumor necrosis factor-α,TNF-α)、血清脂联素(adiponectin,APN)水平。结果观察组患者空腹血糖(fasting blood glucose,FBG)水平明显高于对照组(P<0.05);两组患者餐后2 h血糖、糖化血红蛋白比较,差异无统计学意义(P>0.05);观察组患者甘油三酯(triglyceride,TG)水平高于对照组(P<0.05);两组患者血清总胆固醇(total cholesterol,TC)、高密度脂蛋白胆固醇(HDL-cholesterol,HDL-Ch)、低密度脂蛋白胆固醇(LDL-cholesterol,LDL-C)比较,差异无统计学意义(P>0.05);观察组患者RBP-4、FINS、HOMA-IR、TNF-α水平高于对照组,APN水平低于对照组(P<0.05);血清RBP-4与患者孕前BMI、FBG、TG、FINS、HOMA-IR、TNF-α呈正相关(r=0.274、0.317、0.501、0.668、0.503、0.527,P<0.05),与APN呈负相关(r=-0.385,P<0.05);经多元线性回归分析显示,孕前BMI是影响GDM患者血清RBP-4的独立相关因素(r=-0.361,P<0.05)。结论肥胖型GDM患者血清RBP-4明显高于非肥胖型GDM患者,其水平与肥胖程度、FINS、HOMA-IR、TNF-α呈正相关,与ANP呈负相关,提示血清RBP-4参与了GDM和肥胖的发生、发展,高水平RBP-4易引起GDM和肥胖,可作为肥胖型GDM的诊断指标应用。
Objective To investigate the expression and clinical significance of serum retinol binding protein 4(RBP-4) in obese gestational diabetes mellitus(GDM) patients. Methods 80 cases with the formal card establishment of Baoding Maternal and Child Health Hospital from June 2016 to December 2017 was selected, 40 patients with obesity GDM and the body mass index(BMI) was >25 kg/m~2, and the body weight increased less than 20 kg during pregnancy were included in the observation group, and 40 patients with non-obese GDM who underwent concurrent physical examination and had a pre-pregnancy mass index of 18.5～25.0 kg/m~2 and a body mass increase of less than 20 kg during pregnancy were selected as the control group. The biochemical parameters of glycolipids in the two groups were observed from 24 to 28 weeks after pregnancy. The expression of RBP-4 in serum was detected by enzyme-linked immunosorbent assay(ELISA). The fasting insulin(FINS), islet resistance index,tumor necrosis factor-α(TNF-α) and serum adiponectin(APN) levels were compared between the two groups. Results The fasting plasma glucose(FPG) level of the patients was significantly higher than that of the control group(P<0.05). There was no significant difference in the 2 h PG and HbA1 C between the two groups(P>0.05). The levels of triglyceride(TG) in patients were significantly higher than those in the control group(P<0.05). Total cholesterol(TC) and high-density lipoprotein cholesterol(HDL-Ch) were used in the two groups. There was no significant difference in low-density lipoprotein cholesterol(LDL-C)(P>0.05). The levels of RBP-4, FINS, insulin resistance index(HOMA-IR) and TNF-α in the observation group were significantly higher than those in the control group, and the APN level was significantly lower than that in the control group(P<0.05). Serum RBP-4 was positively correlated with pre-pregnancy BMI, FPG, TG, FINS, HOMA-IR, TNF-α(r=0.274, 0.317, 0.501, 0.668, 0.503, 0.527,P<0.05), and negatively correlated with APN(r=-0.385, P<0.05); Multiple linear regression analysis showed that pre-pregnancy BMI was an independent factor affecting serum RBP-4 in patients with GDM(r=-0.361, P<0.05).Conclusion Serum RBP-4 was significantly higher in obese GDM patients than in non-obese GDM patients. The level was positively correlated with obesity, FINS, HOMA-IR, TNF-α, and negatively correlated with ANP, suggesting that serum RBP-4 is involved in GDM and the occurrence and development of obesity, high level of RBP-4 easily cause GDM and obesity, and can be used as a diagnostic indicator for obese GDM.
Objective To investigate the expression and clinical significance of serum retinol binding protein 4(RBP-4) in obese gestational diabetes mellitus(GDM) patients. Methods 80 cases with the formal card establishment of Baoding Maternal and Child Health Hospital from June 2016 to December 2017 was selected, 40 patients with obesity GDM and the body mass index(BMI) was >25 kg/m~2, and the body weight increased less than 20 kg during pregnancy were included in the observation group, and 40 patients with non-obese GDM who underwent concurrent physical examination and had a pre-pregnancy mass index of 18.5～25.0 kg/m~2 and a body mass increase of less than 20 kg during pregnancy were selected as the control group. The biochemical parameters of glycolipids in the two groups were observed from 24 to 28 weeks after pregnancy. The expression of RBP-4 in serum was detected by enzyme-linked immunosorbent assay(ELISA). The fasting insulin(FINS), islet resistance index,tumor necrosis factor-α(TNF-α) and serum adiponectin(APN) levels were compared between the two groups. Results The fasting plasma glucose(FPG) level of the patients was significantly higher than that of the control group(P<0.05). There was no significant difference in the 2 h PG and HbA1 C between the two groups(P>0.05). The levels of triglyceride(TG) in patients were significantly higher than those in the control group(P<0.05). Total cholesterol(TC) and high-density lipoprotein cholesterol(HDL-Ch) were used in the two groups. There was no significant difference in low-density lipoprotein cholesterol(LDL-C)(P>0.05). The levels of RBP-4, FINS, insulin resistance index(HOMA-IR) and TNF-α in the observation group were significantly higher than those in the control group, and the APN level was significantly lower than that in the control group(P<0.05). Serum RBP-4 was positively correlated with pre-pregnancy BMI, FPG, TG, FINS, HOMA-IR, TNF-α(r=0.274, 0.317, 0.501, 0.668, 0.503, 0.527,P<0.05), and negatively correlated with APN(r=-0.385, P<0.05); Multiple linear regression analysis showed that pre-pregnancy BMI was an independent factor affecting serum RBP-4 in patients with GDM(r=-0.361, P<0.05).Conclusion Serum RBP-4 was significantly higher in obese GDM patients than in non-obese GDM patients. The level was positively correlated with obesity, FINS, HOMA-IR, TNF-α, and negatively correlated with ANP, suggesting that serum RBP-4 is involved in GDM and the occurrence and development of obesity, high level of RBP-4 easily cause GDM and obesity, and can be used as a diagnostic indicator for obese GDM.
引文
[1] 周婉,叶山东.视黄醇结合蛋白4,25羟维生素D水平与2型糖尿病下肢血管病变的相关性研究 [J].中国糖尿病杂志,2018,26(4):280-284.
[2] KOIVUSALO S B,R?N? K,STACH-LEMPINEN B,et al.Response to comment on koivusalo et al.gestational diabetes mellitus can be prevented by lifestyle intervention:the finnish gestational diabetes prevention study (RADIEL):A randomized controlled trial [J].Diabetes Care,2016,39 (8):e126-e127.
[3] WOLF M,SAUK J,SHAH A,et al.Inflammation and glucose intolerance:a prospective study of gestational diabetes mellitus [J].Diabetes Care,2004,27 (1):21-27.
[4] KOIVUSALO B O.Gestational diabetes mellitus can be prevented by lifestyle intervention:the finnish gestational diabetes prevention study (RADIEL):A randomized controlled trial[J].Diabetes Care,2016,39 (8):e125.
[5] 卜和美,马向华,孙婧,等.十二指肠空肠旁路术与十二指肠空肠吻合术对2型糖尿病大鼠视黄醇结合蛋白4的作用及意义 [J].南京医科大学学报(自然科学版),2017,37(9):1148-1153.
[6] 叶青跃,谢军,杨杨,等.视黄醇结合蛋白4和葡萄糖-6-磷酸异构酶与糖尿病分型、并发症的相关性 [J].中国老年学杂志,2016,36(9):2124-2126.
[7] PIRJANI R,SHIRZAD N,QORBANI M A,et al.Gestational diabetes mellitus its association with obesity:a prospective cohort study [J].Eating and Weight Disorders-Studies on Anorexia Bulimia and Obesity,2017,22 (3):445-450.
[8] 马钧,黄翠兰,徐卫东,等.2型糖尿病大血管病变患者血清视黄醇结合蛋白水平变化及意义 [J].山东医药,2016,56(37):1-4.
[9] DUGAS C,PERRON J,KEARNEY M,et al.Postnatal prevention of childhood obesity in offspring prenatally exposed to gestational diabetes mellitus:where are we now?[J].Obesity Facts,2017,10 (4):396-406.
[10] Shoar Z,Zivot A T,Nasiri S,et al.Maternal obesity,maternal gestational diabetes mellitus,and maternal and neonatal outcomes [J].Journal of Obesity & Weight Loss Therapy,2016.
[11] OZLER S,OZTAS E,EREL O,et al.Impact of gestational diabetes mellitus and maternal obesity on cord blood dynamic thiol/disulfide homeostasis [J].Fetal and Pediatric Pathology,2017,36 (1):8-15.
[12] DAMM P,HOUSHMAND-OEREGAARD A,KELSTRUP L A,et al.Gestational diabetes mellitus and long-term consequences for mother and offspring:a view from Denmark [J].Diabetologia,2016,59 (7):1396-1399.
[13] 钟慧,李熠,肖扬,等.新诊2型糖尿病患者血浆视黄醇结合蛋白4与亚临床动脉粥样硬化的关系 [J].中国动脉硬化杂志,2016,24(4):381-385.
[14] 孙伟,王飞,朱江,等.血清视黄醇结合蛋白4与2型糖尿病合并脑梗死的关系 [J].广东医学,2016,37(17):2595-2597.
[15] 牛美兰,王辉,何雄文.non-HDL,RBP,SF在非酒精性脂肪肝合并2型糖尿病患者体内表达及相关性 [J].中国老年学杂志,2018,38(6):1299-1301.
[16] 袁小松,张一鸣,蒋健,等.血清视黄醇结合蛋白联合脂联素对妊娠期糖尿病的早期预测价值 [J].重庆医学,2016,45(27):3788-3789,3792.
[17] 高静媛,杨雨旸,邢磊,等.DHPLC法分析视黄醇结合蛋白4基因rs 17484721及rs 36035572多态性与老年人超重肥胖的关系 [J].中国老年学杂志,2017,37(5):1115-1116.
[18] HERNANDEZ T L,VAN PELT R E,ANDERSON M A,et al.Women with gestational diabetes mellitus randomized to a higher-complex carbohydrate/low-fat diet manifest lower adipose tissue insulin resistance,inflammation,glucose,and free fatty acids:a pilot study [J].Diabetes Care,2016,39 (1):39-42.
[19] SCHOENAKER D A,MISHRA G D,CALLAWAY L K,et al.The role of energy,nutrients,foods,and dietary patterns in the development of gestational diabetes mellitus:a systematic review of observational studies [J].Diabetes Care,2016,39 (1):16-23.
[20] 邢辙,栾新红.视黄醇结合蛋白4的生物学作用研究进展 [J].中国家禽,2017,39 (8):45-47.
[21] 赵亮,赵建山,王广霞,等.糖尿病足溃疡患者血清视黄醇结合蛋白4的水平变化及其临床意义 [J].中国糖尿病杂志,2016,24(7):626-629.
[22] SKORZYNSKA-DZIDUSZKO K E,KIMBER-TROJNAR Z A,OLSZEWSKA A,et al.An interplay between obesity and inflammation in gestational diabetes mellitus [J].Current Pharmaceutical Biotechnology,2016,17 (7):603-613.
[23] KAWADA T.Regulatory T cells,natural killer cells,and obesity in patients with gestational diabetes mellitus [J].American Journal of Reproductive Immunology,2018,79 (4):e12831.
[24] DARYASARI S F,RAZAVINIA F,TATARI F T,et al.The role of adiponectin in gestational diabetes mellitus,preeclampsia and obesity during pregnancy:A systematic review [J].Iranian Journal of Endocrinology&Metabolism,2018,19 (5):370-383.
[25] 崔嘉琴,柏友萍,吴琳,等.运动与白藜芦醇对老年肥胖大鼠视黄醇结合蛋白4、血糖和胰岛素敏感性的影响 [J].卫生研究,2017,46(4):602-609.
[2] KOIVUSALO S B,R?N? K,STACH-LEMPINEN B,et al.Response to comment on koivusalo et al.gestational diabetes mellitus can be prevented by lifestyle intervention:the finnish gestational diabetes prevention study (RADIEL):A randomized controlled trial [J].Diabetes Care,2016,39 (8):e126-e127.
[3] WOLF M,SAUK J,SHAH A,et al.Inflammation and glucose intolerance:a prospective study of gestational diabetes mellitus [J].Diabetes Care,2004,27 (1):21-27.
[4] KOIVUSALO B O.Gestational diabetes mellitus can be prevented by lifestyle intervention:the finnish gestational diabetes prevention study (RADIEL):A randomized controlled trial[J].Diabetes Care,2016,39 (8):e125.
[5] 卜和美,马向华,孙婧,等.十二指肠空肠旁路术与十二指肠空肠吻合术对2型糖尿病大鼠视黄醇结合蛋白4的作用及意义 [J].南京医科大学学报(自然科学版),2017,37(9):1148-1153.
[6] 叶青跃,谢军,杨杨,等.视黄醇结合蛋白4和葡萄糖-6-磷酸异构酶与糖尿病分型、并发症的相关性 [J].中国老年学杂志,2016,36(9):2124-2126.
[7] PIRJANI R,SHIRZAD N,QORBANI M A,et al.Gestational diabetes mellitus its association with obesity:a prospective cohort study [J].Eating and Weight Disorders-Studies on Anorexia Bulimia and Obesity,2017,22 (3):445-450.
[8] 马钧,黄翠兰,徐卫东,等.2型糖尿病大血管病变患者血清视黄醇结合蛋白水平变化及意义 [J].山东医药,2016,56(37):1-4.
[9] DUGAS C,PERRON J,KEARNEY M,et al.Postnatal prevention of childhood obesity in offspring prenatally exposed to gestational diabetes mellitus:where are we now?[J].Obesity Facts,2017,10 (4):396-406.
[10] Shoar Z,Zivot A T,Nasiri S,et al.Maternal obesity,maternal gestational diabetes mellitus,and maternal and neonatal outcomes [J].Journal of Obesity & Weight Loss Therapy,2016.
[11] OZLER S,OZTAS E,EREL O,et al.Impact of gestational diabetes mellitus and maternal obesity on cord blood dynamic thiol/disulfide homeostasis [J].Fetal and Pediatric Pathology,2017,36 (1):8-15.
[12] DAMM P,HOUSHMAND-OEREGAARD A,KELSTRUP L A,et al.Gestational diabetes mellitus and long-term consequences for mother and offspring:a view from Denmark [J].Diabetologia,2016,59 (7):1396-1399.
[13] 钟慧,李熠,肖扬,等.新诊2型糖尿病患者血浆视黄醇结合蛋白4与亚临床动脉粥样硬化的关系 [J].中国动脉硬化杂志,2016,24(4):381-385.
[14] 孙伟,王飞,朱江,等.血清视黄醇结合蛋白4与2型糖尿病合并脑梗死的关系 [J].广东医学,2016,37(17):2595-2597.
[15] 牛美兰,王辉,何雄文.non-HDL,RBP,SF在非酒精性脂肪肝合并2型糖尿病患者体内表达及相关性 [J].中国老年学杂志,2018,38(6):1299-1301.
[16] 袁小松,张一鸣,蒋健,等.血清视黄醇结合蛋白联合脂联素对妊娠期糖尿病的早期预测价值 [J].重庆医学,2016,45(27):3788-3789,3792.
[17] 高静媛,杨雨旸,邢磊,等.DHPLC法分析视黄醇结合蛋白4基因rs 17484721及rs 36035572多态性与老年人超重肥胖的关系 [J].中国老年学杂志,2017,37(5):1115-1116.
[18] HERNANDEZ T L,VAN PELT R E,ANDERSON M A,et al.Women with gestational diabetes mellitus randomized to a higher-complex carbohydrate/low-fat diet manifest lower adipose tissue insulin resistance,inflammation,glucose,and free fatty acids:a pilot study [J].Diabetes Care,2016,39 (1):39-42.
[19] SCHOENAKER D A,MISHRA G D,CALLAWAY L K,et al.The role of energy,nutrients,foods,and dietary patterns in the development of gestational diabetes mellitus:a systematic review of observational studies [J].Diabetes Care,2016,39 (1):16-23.
[20] 邢辙,栾新红.视黄醇结合蛋白4的生物学作用研究进展 [J].中国家禽,2017,39 (8):45-47.
[21] 赵亮,赵建山,王广霞,等.糖尿病足溃疡患者血清视黄醇结合蛋白4的水平变化及其临床意义 [J].中国糖尿病杂志,2016,24(7):626-629.
[22] SKORZYNSKA-DZIDUSZKO K E,KIMBER-TROJNAR Z A,OLSZEWSKA A,et al.An interplay between obesity and inflammation in gestational diabetes mellitus [J].Current Pharmaceutical Biotechnology,2016,17 (7):603-613.
[23] KAWADA T.Regulatory T cells,natural killer cells,and obesity in patients with gestational diabetes mellitus [J].American Journal of Reproductive Immunology,2018,79 (4):e12831.
[24] DARYASARI S F,RAZAVINIA F,TATARI F T,et al.The role of adiponectin in gestational diabetes mellitus,preeclampsia and obesity during pregnancy:A systematic review [J].Iranian Journal of Endocrinology&Metabolism,2018,19 (5):370-383.
[25] 崔嘉琴,柏友萍,吴琳,等.运动与白藜芦醇对老年肥胖大鼠视黄醇结合蛋白4、血糖和胰岛素敏感性的影响 [J].卫生研究,2017,46(4):602-609.