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目的探讨妊娠期糖尿病(GDM)患者血清中apelin水平改变及其临床意义。方法 2012年6月至2012年12月北京军区总医院产科门诊妊娠24~28周孕妇232人,进行口服75 g葡萄糖耐量试验。诊断GDM的57例孕妇为GDM组,正常妊娠孕妇175例作为对照组。采用使用酶联免疫吸附法(ELISA)检测血清apelin水平,检测总胆固醇(TC)、甘油三酯(TG)、载脂蛋白A(apoA)、低密度脂蛋白胆固醇(LDL-C)、高密度脂蛋白胆固醇(HDL-C)、载脂蛋白A(apoA)、空腹血糖(FPG)、餐后1 h血糖(1 h PG)、餐后2 h血糖(2 h PG)、空腹胰岛素(FINS)水平,计算胰岛素抵抗指数(HOMA-IR),比较两组的差异、分析血清apelin与胰岛素抵抗相关性。结果 GDM组血清apelin[(361.62±28.19)ng/L]、TG[(2.78±0.33)mmol/L]、LDL-C[(2.86±0.44)mmol/L]、apoA[(1.66±0.10)g/L]、FPG[(5.85±0.75)mmol/L]、2 h PG[(8.52±1.07)mmol/L]、FINS[(17.63±1.49)mU/L]和HOMA-IR(4.59±0.74)均明显高于正常妊娠组apelin[(319.45±24.28)ng/L,P<0.01]、TG[(2.67±0.26)mmol/L,P<0.05]、LDL-C[(2.66±0.38)mmol/L,P<0.01]、apoA[(0.79±0.06)g/L,P<0.01]、FPG[(4.28±0.37)mmol/L,P<0.01]、2 h PG[(6.87±0.69)mmol/L,P<0.01]、FINS[(12.37±0.98)mU/L,P<0.01]和HOMA-IR(2.35±0.27,P<0.01)。相关性分析显示,GDM孕妇血清apelin与LDL-C、FPG、FINS及HOMA-IR呈正相关(r=0.345,P<0.01;r=0.526,P<0.01;r=0.425,P<0.01;r=0.344,P<0.01)。结论 GDM孕妇血清apelin水平增高;血清apelin升高与胰岛素抵抗密切相关,可能是妊娠期糖尿病发病的重要机制。
Objective To investigate the changes of serum apelin levels in patients with gestational diabetes mellitus (GDM) and its clinical significance. Methods From June 2012 to December 2012, 232 pregnant women with obstetrical outpatients from 24 to 28 weeks of pregnancy in Beijing Military Region General Hospital were enrolled in oral glucose tolerance test of 75 g. 57 pregnant women diagnosed with GDM were GDM group and 175 pregnant women with normal pregnancy as control group. Serum apelin levels were measured by enzyme-linked immunosorbent assay (ELISA). The levels of total cholesterol (TC), triglyceride (TG), apoA, LDL- HDL-C, apoA, FPG, 1 h postprandial blood glucose (1 h PG), 2 h postprandial blood glucose (2 h PG), fasting insulin (FINS) (HOMA-IR) were calculated. The differences between two groups were compared. The correlation between serum apelin and insulin resistance was analyzed. Results The levels of serum apelin (361.62 ± 28.19) ng / L, TG [(2.78 ± 0.33) mmol / L] and LDL-C L, FPG [(5.8 ± 0.75) mmol / L], 2 h PG [(8.52 ± 1.07) mmol / L], FINS [(17.63 ± 1.49) mU / L] and HOMA-IR (P <0.01), TG [(2.67 ± 0.26) mmol / L, P <0.05], LDL-C [(2.66 ± 0.38) mmol / L, P <0.01], apoA [(0.79 ± 0.06) g / L, P <0.01] and FPG (4.28 ± 0.37) mmol / L, L, P <0.01], FINS [(12.37 ± 0.98) mU / L, P <0.01] and HOMA-IR (2.35 ± 0.27, P <0.01). Correlation analysis showed that serum apelin was positively correlated with LDL-C, FPG, FINS and HOMA-IR (r = 0.344, P <0.01). Conclusions Serum apelin levels are elevated in pregnant women with GDM. Elevated serum apelin is closely related to insulin resistance, which may be an important mechanism of gestational diabetes mellitus.