目的 检测妊娠期糖尿病(GDM)患者胎盘组织内胰岛素受体底物1(IRS-1)的表达水平及其与胰岛素抵抗的相关性.方法 纳入2013年1月至2014年1月于石家庄市第四医院产检并分娩的产妇99例,分为GDM组(49例)和正常组(50例).采用免疫组织化学方法检测胎盘组织中IRS-1的表达,分析产妇空腹血糖、空腹胰岛素(FINS)、胰岛素抵抗指数(HOMA-IR)、胰岛β细胞功能(HOMA-β)、胰岛素敏感指数(HOMA-ISI)与IRS-1表达的相关性.结果 GDM组空腹血糖、FINS、HOMA-IR明显高于正常组[(7.1±0.9) mmol/L比(4.5 ±0.9)mmol/L,(15.1±1.7)mU/L比(8.0±2.0)mU/L,(4.3±1.2)比(1.6±0.5)];HOMA-β和HOMA-ISI低于正常组[(169±99)比(296±168),(-1.39±0.16)比(-0.29±0.48)],差异均有统计学意义(均P＜0.01).GDM组胎盘组织中IRS-1阳性表达率为63.3％(31/49),明显低于正常组[100.0％ (50/50)],差异有统计学意义(x2=22.86,P＜0.01).GDM组IRS-1表达与HOMA-IR呈负相关(r=-0.55,P＜0.01).结论 GDM产妇胎盘中IRS-1表达明显降低,IRS-1表达与HOMA-IR呈负相关.%Objective To assess the expression of the insulin receptor substrate 1 (IRS-1) in placental tissues and the correlation between IRS-1 expression and insulin resistance in gestational diabetes mellitus (GDM) patients.Methods Totally 99 delivery women from January 2013 to January 2014 were enrolled and divided into GDM group (49 cases) and normal group (50 cases).Immunohistochemical method was used to detect the expression of IRS-1 in the placenta.The correlations of IRS-1 expression and fasting blood glucose (FBG),fasting insulin (FINS),insulin resistance index (HOMA-IR),islet beta cell function (HOMA-β) and insulin sensitivity index (HOMA-ISI) were analyzed.Results Compared with those in normal group,the FBG,FINS and HOMA-IR were all significantly higher,HOMA-β and HOMA-ISI were significantly lower in GDM group [(7.1 ± 0.9) mmol/Lvs (4.5±0.9) mmol/L,(15.1 ±1.7) mU/Lvs (8.0±2.0) mU/L,(4.3±1.2) vs (1.6± 0.5),(169 ±99) vs (296±168),(-1.39 ±0.16) vs (-0.29 ±0.48)] (P＜0.01).The positive expression rate of IRS-1 placenta tissue in GDM group was 63.3％ (31/49),significantly lower than that in normal group [100.0％ (50/50)] (x2 =22.86,P ＜0.01).The expression of IRS-1 in the placenta tissue was negatively correlated with HOMA-IR (r =-0.55,P ＜ 0.01).Conclusion In GDM patients,IRS-1 levels are significantly decreased and they are negatively correlated with HOMA-IR
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