妊娠期糖尿病患者脂肪细胞因子和氧化应激的相互作用

摘要

目的 探讨孕妇体内脂肪细胞因子和氧化应激的相互关系及其与胰岛素抵抗之间的关系.方法 测定56例妊娠期糖尿病(GDM)组患者和55例糖耐量正常的对照组孕妇血浆、胎盘和脐血中脂肪细胞因子(脂联素、瘦素和抵抗素)和丙二醛、8-异前列腺素和黄嘌呤氧化酶这三种氧化应激标记物的水平,用稳态胰岛素评价指数(HOMA-IR)评价胰岛素抵抗情况.观察孕妇母血、胎盘及脐血中脂肪细胞因子及氧化应激标记物表达情况,比较巨大儿与正常体重儿的母血、脐血和胎盘分泌的脂肪细胞因子和氧化应激标记物水平,分析孕妇血浆、脐血和胎盘中各氧化应激标记物和脂肪细胞因子间的相关关系、孕妇血、脐血和胎盘中瘦素、抵抗素及所有的氧化应激标记物与HOMA-IR的相关性.结果 除脂联素在胎盘中无表达外,其他各标记物在母亲、胎盘和脐血中均有表达.母血、脐血和胎盘中瘦素、抵抗素及相应组织中所有的氧化应激标记物均呈正相关,而母血脂联素水平与母血中的氧化应激标记物呈负相关(P<0.05).巨大儿的胎盘和脐血瘦素、脐血抵抗素高于正常体重儿.母血、脐血和胎盘中瘦素、抵抗素及所有的氧化应激标记物均与HOMA-IR呈正相关,而母血脂联素水平与HOMA-IR呈负相关(P<0.05).结论 脂肪细胞因子与氧化应激相互作用,共同导致胰岛素抵抗及GDM的发生,但还需要进一步的实验室研究和大规模临床研究加以证实.%Objectives To explore the relationship between adipokines and oxidative stress and their potential effect in pregnant women.Methods The levels of malondialdehyde (MDA), 8-isoprostane (8ISO), xanthine oxidize (XO), leptin, and resistin in maternal plasma, cord and placenta blood in 111 pregnant women were determined and had been analyzed.Homeostatic model assessment of insulin resistance (HOMA-IR) was used to assess the extent of insulin resistance.The possible difference in expression of above markers and adipokines between macrosomia and newborn with normal birth weight had also been analyzed.The relationship between markers of oxidative stress and adipokines and their correlation with HOMA-IR was analyzed.Results The levels of adiponectin were only examined in maternal and cord plasma samples.Among all these women, 56 were diagnosed with gestational diabetes mellitus (GDM) while other 55 were controls.Leptin, resistin, MDA, XO and 8ISO in maternal plasma, cord plasma and placenta were significantly higher while maternal adiponectin was significantly lower in women with GDM (P<0.05).Placental/cord leptin and cord resistin were higher in macrosomatia while maternal adiponectin level was lower (P<0.05) than that of newborn with normal birth weight.Leptin, resistin, MDA, XO and 8ISO in maternal plasma, cord plasma and placenta were positively correlated while maternal adiponectin was inversely correlated with HOMA-IR (P<0.05).Leptin and resistin in maternal plasma, cord plasma and placenta were positively correlated while maternal adiponectin was negatively correlated with markers of oxidative stress (P<0.05).Conclusion Adipokines interact with markers of oxidative stress, both of them lead to insulin resistance and GDM-associated macrosomia.