Gao Xue-lian, Yang Hui-xia, Zhao Yi
Department of Obstetrics & Gynecology, Peking University First Hospital, Beijing 100034, China.
Chin Med J (Engl). 2008 Apr 20;121(8):701-5.
Many cytokines have been found to increase the insulin resistance during pregnancy complicated by glucose metabolism disorder. This study aimed to investigate which comes first, the changes of some cytokines or the abnormal glucose metabolism.
This nested case-control study was undertaken from January 2004 to March 2005. Twenty-two women with gestational diabetes mellitus (GDM), 10 with gestational impaired glucose tolerance (GIGT), and 20 healthy pregnant women were chosen from the women who had visited the antenatal clinics and had blood samples prospectively taken and kept during their visit. The levels of tumor necrosis factor-alpha (TNF-alpha), leptin and adiponectin were determined. One-way ANOVA analysis and bivariate correlation analysis were used to assess the laboratory results and their relationship with body mass index (BMI).
Women with GDM have the highest values of TNF-alpha and leptin and the lowest value of adiponectin compared with those with GIGT and the healthy controls (P < 0.01) at 14-20 weeks of gestation. This was also found when these women progressed to 24-32 weeks. The significantly increased levels of TNF-alpha and leptin and the decreased level of adiponectin were found at the different periods of gestation within the same group. Positive correlation was shown between the levels of TNF-alpha and leptin at the two periods of gestation with the BMI at 14-20 weeks, while adiponectin was negatively correlated (P < 0.05).
The concentrations of TNF-alpha, leptin and adiponectin may change before the appearance of the abnormal glucose level during pregnancy. Further studies are required to verify the mechanism of this alteration and whether the three cytokines can be predictors for GDM at an early stage of pregnancy.
许多细胞因子已被发现会在并发糖代谢紊乱的孕期增加胰岛素抵抗。本研究旨在探究是某些细胞因子的变化先出现，还是糖代谢异常先出现。
本巢式病例对照研究于2004年1月至2005年3月进行。从前来产前门诊就诊且在就诊时前瞻性采集并保存血样的女性中，选取22例妊娠期糖尿病（GDM）女性、10例妊娠期糖耐量受损（GIGT）女性和20例健康孕妇。测定肿瘤坏死因子-α（TNF-α）、瘦素和脂联素水平。采用单因素方差分析和双变量相关分析来评估实验室结果及其与体重指数（BMI）的关系。
与GIGT女性和健康对照组相比，GDM女性在妊娠14 - 20周时TNF-α和瘦素水平最高，脂联素水平最低（P < 0.01）。当这些女性进入妊娠24 - 32周时也发现了同样情况。在同一组内不同妊娠时期，均发现TNF-α和瘦素水平显著升高，脂联素水平降低。在妊娠的两个时期，TNF-α和瘦素水平与14 - 20周时的BMI呈正相关，而脂联素呈负相关（P < 0.05）。
在孕期血糖水平异常出现之前，TNF-α、瘦素和脂联素的浓度可能就已发生变化。需要进一步研究来证实这种变化的机制，以及这三种细胞因子是否可作为孕期早期GDM的预测指标。
