既往有妊娠期糖尿病的女性的血浆脂联素、胰岛素敏感性及亚临床炎症

Plasma adiponectin, insulin sensitivity, and subclinical inflammation in women with prior gestational diabetes mellitus.

作者信息

Winzer Christine, Wagner Oswald, Festa Andreas, Schneider Barbara, Roden Michael, Bancher-Todesca Dagmar, Pacini Giovanni, Funahashi Tohru, Kautzky-Willer Alexandra

机构信息

Department of Medicine III, Vienna University Hospital, Vienna, Austria.

出版信息

Diabetes Care. 2004 Jul;27(7):1721-7. doi: 10.2337/diacare.27.7.1721.

DOI:10.2337/diacare.27.7.1721

PMID:15220253

Abstract

OBJECTIVE

Women with prior gestational diabetes mellitus (pGDM) are at increased risk of developing type 2 diabetes and associated vasculopathy. Because increased fat mass and inflammatory processes are angiopathic risk factors, the relationship between insulin sensitivity, parameters of subclinical inflammation, and plasma concentrations of adipocytokines was investigated in pGDM both at 3 months and 12 months after delivery.

RESEARCH DESIGN AND METHODS

Insulin sensitivity (through a frequently sampled intravenous glucose tolerance test) and plasma concentrations of ultrasensitive C-reactive protein (CRP), adiponectin, plasminogen activator inhibitor (PAI)-1, tumor necrosis factor-alpha, leptin, and interleukin-6 were measured in 89 pGDM (BMI 26.9 +/- 0.5 kg/m(2), age 32 +/- 0.5 years) and in 19 women with normal glucose tolerance during pregnancy (NGT) (23.7 +/- 0.9 kg/m(2), 31 +/- 1.3 years).

RESULTS

pGDM showed lower (P < 0.0001) plasma adiponectin (6.7 +/- 0.2 microg/ml) than NGT (9.8 +/- 0.6 microg/ml) and a decreased (P < 0.003) insulin sensitivity index (S(i)) and disposition index (P < 0.03), but increased plasma leptin (P < 0.003), PAI-1 (P < 0.002), and CRP (P < 0.03). After adjustment for body fat mass, plasma adiponectin remained lower in pGDM (P < 0.004) and correlated positively with S(i) (P < 0.003) and HDL cholesterol (P < 0.0001) but negatively with plasma glucose (2-h oral glucose tolerance test [OGTT]) (P < 0.0001), leptin (P < 0.01), CRP (P < 0.007), and PAI-1 (P < 0.0001). On regression analysis, only HDL cholesterol, postload (2-h OGTT) plasma glucose, and S(i) remained significant predictors of plasma adiponectin, explaining 42% of its variability. Of note, adiponectin further decreased (P < 0.05) only in insulin-resistant pGDM despite unchanged body fat content and distribution after a 1-year follow-up.

CONCLUSIONS

Lower plasma adiponectin concentrations characterize women with previous GDM independently of the prevailing insulin sensitivity or the degree of obesity and are associated with subclinical inflammation and atherogenic parameters.

摘要

目的

既往有妊娠期糖尿病（pGDM）的女性患2型糖尿病及相关血管病变的风险增加。由于脂肪量增加和炎症过程是血管病变的危险因素，因此对pGDM患者在分娩后3个月和12个月时胰岛素敏感性、亚临床炎症参数与脂肪细胞因子血浆浓度之间的关系进行了研究。

研究设计与方法

对89例pGDM患者（体重指数[BMI]26.9±0.5kg/m²，年龄32±0.5岁）和19例孕期糖耐量正常（NGT）的女性（23.7±0.9kg/m²，31±1.3岁）测量胰岛素敏感性（通过频繁采样静脉葡萄糖耐量试验）以及超敏C反应蛋白（CRP）、脂联素、纤溶酶原激活物抑制剂（PAI）-1、肿瘤坏死因子-α、瘦素和白细胞介素-6的血浆浓度。

结果

pGDM患者的血浆脂联素（6.7±0.2μg/ml）低于NGT患者（9.8±0.6μg/ml）（P<0.0001），胰岛素敏感性指数（S(i)）和处置指数降低（P<0.003和P<0.03），但血浆瘦素（P<0.003）、PAI-1（P<0.002）和CRP（P<0.03）升高。在调整体脂量后，pGDM患者的血浆脂联素仍较低（P<0.004），且与S(i)（P<0.003）和高密度脂蛋白胆固醇（HDL-C）（P<0.0001）呈正相关，与血浆葡萄糖（2小时口服葡萄糖耐量试验[OGTT]）（P<0.0001）、瘦素（P<0.01）、CRP（P<0.007）和PAI-1（P<0.0001）呈负相关。回归分析显示，只有HDL-C、负荷后（2小时OGTT）血浆葡萄糖和S(i)仍是血浆脂联素的显著预测因素，并解释了其42%的变异性。值得注意的是，尽管1年随访后体脂含量和分布未变，但脂联素仅在胰岛素抵抗的pGDM患者中进一步降低（P<0.05）。