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目的探讨成纤维细胞生长因子21(FGF-21)与妊娠糖尿病及2型糖尿病(T2DM)发生和发展之间的关系。方法通过对孕单胎24~28 w的妊娠妇女440例进行5年的随访,记录参与者一般临床资料,测定空腹及服糖后1 h、2 h胰高血糖素(PG)及胰岛素(INS)、C肽水平,并计算稳态模型胰岛素抵抗指数(HOMA-IR)、胰岛β细胞功能指数(HOMA-β)。采用酶联免疫吸附法(ELISA)测定基线及随访5年后血清FGF-21浓度水平。对比分析T2DM组与非T2DM组间FGF-21浓度水平差异。结果妊娠糖尿病的发生率10.2%,5年后妊娠糖尿病患者转变为T2DM的发生率44.4%。妊娠糖尿病组的空腹血糖(FPG)、1 h PG、2 h PG、空腹胰岛素(FINS)、HOMAIR,FGF-21水平均明显高于正常对照组,HOMA-β低于正常对照组,差异有统计学意义(P<0.05)。随访5年后,T2DM组的FPG、2h PG、FINS、FGF-21水平均明显高于非T2DM组,而HOMA-β均明显低于非T2DM组,差异均有统计学意义(均P<0.05)。T2DM组血清FGF-21浓度水平明显高于基线血清FGF-21浓度水平,差异有统计学意义(P<0.05);非T2DM组血清FGF-21浓度水平与基线血清FGF-21浓度水平接近,差异无统计学意义(P>0.05)。结论妊娠糖尿病及T2DM患者随着空腹血糖水平的升高,胰岛素抵抗进行性加重,胰岛β细胞功能下降,FGF-21水平逐渐升高。FGF-21的升高在妊娠糖尿病及T2DM的发生发展中起着重要作用。FGF-21未来可能成为妊娠糖尿病及T2DM早期诊断和评估的分子标记物。
Objective To investigate the relationship between fibroblast growth factor 21 (FGF-21) and the occurrence and development of gestational diabetes and type 2 diabetes mellitus (T2DM). METHODS: Four hundred and forty-four pregnant women with gestational unwifed pregnancies from 24 to 28 w were followed up for 5 years. The clinical data of participants were recorded. The levels of fasting glucagon (PG) and insulin ), C-peptide levels, and calculate the homeostasis model insulin resistance index (HOMA-IR), pancreatic β-cell function index (HOMA-β). Serum FGF-21 levels at baseline and at follow-up were measured by enzyme-linked immunosorbent assay (ELISA). The differences of FGF-21 levels between T2DM group and non-T2DM group were analyzed. Results The incidence of gestational diabetes was 10.2%. The incidence of T2DM after gestational diabetes mellitus was 44.4% after 5 years. The levels of fasting blood glucose (FPG), 1 h PG, 2 h PG, FINS, HOMAIR and FGF-21 in gestational diabetes mellitus group were significantly higher than those in normal control group, and HOMA-β was lower than that in normal control group Significance (P <0.05). After 5 years of follow-up, the levels of FPG, 2h PG, FINS and FGF-21 in T2DM group were significantly higher than those in non-T2DM group and HOMA-β were significantly lower than those in non-T2DM group (all P <0.05 ). The level of serum FGF-21 in T2DM group was significantly higher than that of baseline serum FGF-21 level (P <0.05), while the level of serum FGF-21 in non-T2DM group was similar to that of baseline serum FGF-21 level No statistical significance (P> 0.05). Conclusions With the increase of fasting blood glucose level, the progress of insulin resistance and the function of islet β cell in gestational diabetes mellitus and T2DM patients gradually increase, and the level of FGF-21 gradually increases. Elevated FGF-21 plays an important role in the development of gestational diabetes mellitus and T2DM. The future of FGF-21 may become a molecular marker for early diagnosis and assessment of gestational diabetes mellitus and T2DM.