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目的:探讨妊娠晚期妇女脂肪组织中11β-羟类固醇脱氢酶Ⅰ型(11β-HSD1)及脂联素mRNA表达水平的变化及其临床意义。方法:取剖宫产妇女33例(正常妊娠22例,妊娠糖尿病11例)以及14例开腹手术的育龄期非妊娠妇女(非妊娠组)的皮下和网膜脂肪组织,应用实时定量PCR方法测定脂肪组织11β-HSD1和脂联素mRNA水平。结果:与非妊娠妇女比较,孕晚期正常妊娠和妊娠糖尿病妇女皮下和网膜组织11β-HSD1基因mRNA表达水平均明显增加(P<0.001),而脂联素基因mRNA表达水平均明显下降(P<0.01)。皮下和网膜配对比较显示,孕晚期正常妊娠和GDM妇女网膜脂肪组织11β-HSD1基因表达水平均明显高于皮下(P<0.05),而脂联素表达水平无显著部位差异(P=0.08)。相关分析显示,妊娠糖尿病妇女皮下脂联素表达与母血胆固醇(r=-0.779,P=0.003)、低密度脂蛋白(r=-0.664,P=0.029)负相关,而网膜11β-HSD1与孕期增加的BMI(r=0.323,P=0.043)及新生儿胰岛素抵抗指数呈正相关(r=0.618,P=0.032)。结论:妊娠晚期脂肪组织11β-HSD1mRNA表达增加和脂联素mRNA表达水平的下降,这可能是妊娠期间脂肪组织积聚,能量代谢增加产生的一种适应性分子变化,其在妊娠糖尿病的发生发展中的作用值得关注和进一步研究。
Objective: To investigate the changes of 11β-hydroxysteroid dehydrogenase type 1 (11β-HSD1) and adiponectin mRNA expression in adipose tissue of late pregnancy and its clinical significance. Methods: 33 cases of cesarean section women (22 cases of normal pregnancy, 11 cases of gestational diabetes mellitus) and 14 cases of non-pregnant women of childbearing age of non-pregnant women (non-pregnant group) subcutaneous and omental adipose tissue, real-time quantitative PCR Adipose tissue 11β-HSD1 and adiponectin mRNA levels were measured. Results: Compared with non-pregnant women, the expression levels of 11β-HSD1 mRNA in subcutaneous and omental tissues of normal pregnancy and gestational diabetes mellitus were significantly increased in the third trimester of pregnancy (P <0.001), while the expression of adiponectin gene mRNA was significantly decreased (P <0.01). The subcutaneous and omental pairing comparison showed that the level of 11β-HSD1 gene expression in normal pregnant women and omental adipose tissue in third trimester was significantly higher than that in subcutaneous (P <0.05), while adiponectin expression was not significantly different (P = 0.08 ). Correlation analysis showed that the expression of subcutaneous adiponectin in gestational diabetes mellitus patients was negatively correlated with that of mother’s blood cholesterol (r = -0.779, P = 0.003) and low density lipoprotein (r = -0.664, P = 0.029) It was positively correlated with increased BMI (r = 0.323, P = 0.043) and neonatal insulin resistance index during pregnancy (r = 0.618, P = 0.032). Conclusion: The increase of 11β-HSD1mRNA and the decrease of adiponectin mRNA expression in the third trimester of pregnancy may be an adaptive molecular change of the accumulation of adipose tissue during pregnancy and the increase of energy metabolism, which may play an important role in the development of gestational diabetes mellitus The role of worthy of attention and further research.