Caruso A, Ferrazzani S, De Carolis S, Lucchese A, Lanzone A, De Santis L, Paradisi G
Department of Obstetrics and Gynecology, Catholic University, Rome, Italy.
Hum Reprod. 1999 Jan;14(1):219-23. doi: 10.1093/humrep/14.1.219.
The aim of this study was to assess whether the metabolic characteristics of insulin resistance syndrome are present in pre-eclamptic (PE), gestational (GH) and chronic hypertensive (CH) pregnancies. Glucose and insulin serum concentrations, both fasting and after oral administration of a glucose tolerance test, were evaluated in 26 hypertensive pregnant women (10 PE, 10 GH and six CH patients) and in 10 healthy controls during the third trimester of gestation. Insulin sensitivity was assessed using the hyperinsulinaemic-euglycaemic clamp technique. The plasma concentrations of triglyceride (TG), high density (HDL), low density (LDL), and very low density (VLDL) lipoprotein cholesterol, apolipoproteins AI and B, and non-esterified fatty acid (NEFA) were also measured. Women with GH exhibited approximately 40% lower steady-state insulin sensitivity index (ISI) compared to controls (3.75 versus 6.34, P < 0.03), as well as approximately 33% higher mean plasma TG (3.57 versus 2.68 mmol/l, P < 0.01), and approximately 69% higher mean NEFA (0.59 versus 0.35 mmol/l, P < 0.01). Women with PE showed similar ISI but reduced insulin and glucose areas under curve compared to controls (P < 0.006, P < 0.0005 respectively). Women with PE also had higher HDL-cholesterol and apo-AI than controls. Patients with CH had similar lipid and carbohydrate metabolism to control subjects. In conclusion, women with GH exhibit metabolic features similar to those of patients with insulin resistance syndrome, suggesting that similar abnormalities could be involved in the pathogenesis of these disorders. In contrast, our data do not support an association between insulin resistance syndrome and hypertension in pregnant women with PE and chronic hypertension.
本研究旨在评估子痫前期（PE）、妊娠期高血压（GH）和慢性高血压（CH）孕妇是否存在胰岛素抵抗综合征的代谢特征。在妊娠晚期，对26例高血压孕妇（10例PE、10例GH和6例CH患者）及10例健康对照者进行了空腹及口服葡萄糖耐量试验后血糖和胰岛素血清浓度的评估。采用高胰岛素-正常血糖钳夹技术评估胰岛素敏感性。同时测定了血浆甘油三酯（TG）、高密度脂蛋白（HDL）、低密度脂蛋白（LDL）和极低密度脂蛋白（VLDL）胆固醇、载脂蛋白AI和B以及非酯化脂肪酸（NEFA）的浓度。与对照组相比，GH孕妇的稳态胰岛素敏感性指数（ISI）降低约40%（分别为3.75和6.34，P<0.03），平均血浆TG升高约33%（分别为3.57和2.68 mmol/L，P<0.01），平均NEFA升高约69%（分别为0.59和0.35 mmol/L，P<0.01）。PE孕妇的ISI与对照组相似，但胰岛素和葡萄糖曲线下面积低于对照组（分别为P<0.006，P<0.0005）。PE孕妇的HDL胆固醇和载脂蛋白AI也高于对照组。CH患者的脂质和碳水化合物代谢与对照受试者相似。总之，GH孕妇表现出与胰岛素抵抗综合征患者相似的代谢特征，提示这些疾病的发病机制可能涉及相似的异常。相反，我们的数据不支持胰岛素抵抗综合征与PE和慢性高血压孕妇高血压之间存在关联。
