D'Anna R, Baviera G, Corrado F, Giordano D, De Vivo A, Nicocia G, Di Benedetto A
Department of Obstetrics and Gynecology, University of Messina, Messina, Italy.
BJOG. 2006 Nov;113(11):1264-9. doi: 10.1111/j.1471-0528.2006.01078.x. Epub 2006 Sep 27.
To evaluate the importance of adiponectin and insulin resistance in early- and late-onset pre-eclampsia.
A nested case-control study in 72 pregnant women who participated in the first-trimester Down-syndrome-screening programme and who delivered at our hospital.
University Hospital, Department of Obstetrics and Gynecology.
Pregnant women: 36 women with pre-eclampsia of which 20 late onset and 16 early onset were compared with 36 uncomplicated pregnancies who delivered at term.
In all the women, insulin resistance was calculated by the homeostasis model assessment ratio (HOMA-IR) and plasma adiponectin was determined using an enzyme-linked immunosorbent assay.
Insulin resistance and adiponectin concentration.
First-trimester plasma adiponectin mean levels in the whole pre-eclampsia group were significantly lower than that in the control group (8.4 +/- 3.3 versus 14.8 +/- 4.6 microgram/ml; P < 0.001), whereas first-trimester mean HOMA-IR values were significantly higher in the pre-eclampsia group than that in the control group (2.0 +/- 1.1 versus 1.0 +/- 0.4; P= 0.01). Plasma adiponectin concentrations at delivery in the pre-eclampsia group were significantly higher than that in the control group (9.2 +/- 3.7 versus 7.8 +/- 2.6 microgram/ml; P= 0.04). First-trimester plasma adiponectin mean concentrations in the late-onset subgroup were significantly lower compared with the concentrations in early-onset subgroup (6.2 +/- 1.4 microgram/ml versus 11.1 +/- 3.2 microgram/ml; P < 0.001), and there was a significant difference in adiponectin plasma values only between women in the late-onset pre-eclampsia group versus those in the control group (P < 0.001). First-trimester mean HOMA-IR values were significantly higher in the late-onset subgroup compared with that of the early-onset subgroup (2.5 +/- 1.3 versus 1.3 +/- 0.3; P= 0.02), and there was a significant difference only between the control group versus the late-onset subgroup (P= 0.001).
First-trimester adiponectin and HOMA-IR values seem to select two completely different populations: early- and late-onset pre-eclampsia, which might suggest a different pathogenesis.
评估脂联素和胰岛素抵抗在早发型和晚发型子痫前期中的重要性。
对72名参与孕早期唐氏综合征筛查项目并在我院分娩的孕妇进行巢式病例对照研究。
大学医院妇产科。
孕妇：36名单纯性子痫前期孕妇，其中20例为晚发型，16例为早发型，与36例足月分娩的正常孕妇进行比较。
所有孕妇均采用稳态模型评估比率（HOMA-IR）计算胰岛素抵抗，并采用酶联免疫吸附测定法测定血浆脂联素。
胰岛素抵抗和脂联素浓度。
子痫前期组孕早期血浆脂联素平均水平显著低于对照组（8.4±3.3对14.8±4.6微克/毫升；P<0.001），而子痫前期组孕早期平均HOMA-IR值显著高于对照组（2.0±1.1对1.0±0.4；P=0.01）。子痫前期组分娩时血浆脂联素浓度显著高于对照组（9.2±3.7对7.8±2.6微克/毫升；P=0.04）。晚发型亚组孕早期血浆脂联素平均浓度显著低于早发型亚组（6.2±1.4微克/毫升对11.1±3.2微克/毫升；P<0.001），且仅晚发型子痫前期组与对照组孕妇的脂联素血浆值存在显著差异（P<0.001）。晚发型亚组孕早期平均HOMA-IR值显著高于早发型亚组（2.5±1.3对1.3±0.3；P=0.02），且仅对照组与晚发型亚组之间存在显著差异（P=0.001）。
孕早期脂联素和HOMA-IR值似乎筛选出了两个完全不同的人群：早发型和晚发型子痫前期，这可能提示了不同的发病机制。
