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目的探讨胰岛素样生长因子(IGFs)系统及瘦素对胎儿生长发育的作用,了解妊娠期糖代谢正常及异常孕妇胎儿内分泌改变与新生儿体重的关系。方法2005年1月至7月在首都医科大学附属北京妇产医院应用酶联免疫吸附试验、化学发光法分别检测614例糖代谢正常妇女和157例糖代谢异常妇女足月计划剖宫产分娩时,胎儿脐动脉血中血糖、胰岛素、瘦素、IGFⅠ-、IGF-Ⅱ、胰岛素样生长因子结合蛋白3(IGF-BP3)水平,记录新生儿出生体重。结果在糖代谢正常妇女中,巨大儿(MS)脐血瘦素、IGF-Ⅰ、IGF-BP3、IGF-Ⅱ、胰岛素水平高于适龄儿(AGA)(P<0.05),且与新生儿体重相关(P<0.05)。在糖代谢异常妇女中MS脐血IGFⅠ-水平高于AGA(P<0.05),且均与新生儿体重相关(P<0.05),IGF-BP3两者间差异无统计学意义,但与新生儿出生体重相关(P<0.05)。两组间脐动脉血血糖、胰岛素、瘦素、IGF-Ⅱ差异无统计学意义(P>0.05)。结论来自胎儿循环中的IGFⅠ-、IGF-Ⅱ、IGF-BP3、瘦素、胰岛素对胎儿的生长发育有重要的调节作用,可能共同参与巨大儿的病理生理过程。
Objective To investigate the effects of insulin-like growth factor (IGFs) system and leptin on the growth and development of the fetus and to understand the relationship between fetal endocrine changes in normal and abnormal pregnant women with neonatal body weight. Methods Enzyme-linked immunosorbent assay was used in Beijing Maternity Hospital Affiliated to Capital Medical University from January to July 2005. Chemiluminescence was used to detect 614 cases of normal glucose metabolism and 157 cases of abnormal glucose metabolism in pregnant women. , Fetal umbilical artery blood glucose, insulin, leptin, IGFⅠ-, IGF-Ⅱ, insulin-like growth factor binding protein 3 (IGF-BP3) levels were recorded neonatal birth weight. Results The levels of cord blood leptin, IGF-Ⅰ, IGF-BP3, IGF-Ⅱ and insulin were significantly higher in MS patients than those in AGA group (P <0.05) Related (P <0.05). The levels of IGF-Ⅰ in cord blood of MS patients with abnormal glucose metabolism were significantly higher than that of AGA (P <0.05), and both of them were related to the body weight of neonates (P <0.05). There was no significant difference between IGF-BP3 and neonate Birth weight related (P <0.05). Umbilical artery blood glucose, insulin, leptin, IGF-Ⅱin the two groups showed no significant difference (P> 0.05). Conclusions IGFⅠ-, IGF-Ⅱ, IGF-BP3, leptin and insulin from the fetal circulation play an important regulatory role in fetal growth and development and may participate in the pathophysiological process of macrosomia.