Chen You-Peng, Li Jian, Wang Zi-Neng, Reichetzeder Christoph, Xu Hao, Gong Jian, Chen Guang-Ji, Pfab Thiemo, Xiao Xiao-Min, Hocher Berthold
Department of Infectious Diseases, First Affiliated Hospital of Jinan University, Guangzhou 510630, China.
Clin Lab. 2012;58(5-6):527-33.
The renin-angiotensin-aldosterone system (RAAS) is involved in the pathogenesis of insulin resistance and type 2 diabetes in the general population. The RAAS is activated during pregnancy. However, it is unknown whether the RAAS contributes to glycemia in pregnant women.
Plasma renin activity (PRA) and plasma aldosterone levels were quantified at delivery in 689 Chinese mothers. An oral glucose tolerance test in fasted women was performed in the second trimester of pregnancy. The diagnosis of gestational diabetes mellitus (GDM) and impaired glucose tolerance during pregnancy were made according to the guidelines of the Chinese Society of Obstetrics.
Plasma aldosterone was significantly higher in pregnant women with GDM as compared to those without impairment of glycemic control (normal pregnancies: 0.27 +/- 0.21 ng/mL, GDM: 0.36 +/- 0.30 ng/mL; p < 0.05). Regression analyses revealed that PRA was negatively correlated with fasting blood glucose (FBG) (R2 = 0.03, p = 0.007), whereas plasma aldosterone and aldosterone/PRA ratio were positively correlated with FBG (R2 = 0.05, p < 0.001 and R = 0.03, p = 0.007, respectively). Multivariable regression analysis models considering relevant confounding factors confirmed these findings.
This study demonstrated that fasting blood glucose in pregnant women is inversely correlated with the PRA, whereas plasma aldosterone showed a highly significant positive correlation with fasting blood glucose during pregnancy. Moreover, plasma aldosterone is significantly higher in pregnant women with GDM as compared to those women with normal glucose tolerance during pregnancy. Although causality cannot be proven in association studies, these data may indicate that the RAAS during pregnancy contributes to the pathogenesis of insulin resistance/new onset of diabetes during pregnancy.
肾素 - 血管紧张素 - 醛固酮系统（RAAS）参与一般人群胰岛素抵抗和2型糖尿病的发病机制。RAAS在孕期被激活。然而，RAAS是否与孕妇血糖有关尚不清楚。
对689名中国产妇分娩时的血浆肾素活性（PRA）和血浆醛固酮水平进行定量分析。在妊娠中期对空腹女性进行口服葡萄糖耐量试验。根据中华医学会妇产科学分会的指南诊断妊娠期糖尿病（GDM）和孕期糖耐量受损。
与血糖控制未受损的孕妇相比，患有GDM的孕妇血浆醛固酮水平显著更高（正常妊娠：0.27±0.21 ng/mL，GDM：0.36±0.30 ng/mL；p<0.05）。回归分析显示，PRA与空腹血糖（FBG）呈负相关（R2 = 0.03，p = 0.007），而血浆醛固酮和醛固酮/PRA比值与FBG呈正相关（R2 = 0.05，p<0.001和R = 0.03，p = 0.007）。考虑相关混杂因素的多变量回归分析模型证实了这些发现。
本研究表明，孕妇空腹血糖与PRA呈负相关，而孕期血浆醛固酮与空腹血糖呈高度显著正相关。此外，与孕期糖耐量正常的女性相比，患有GDM的孕妇血浆醛固酮水平显著更高。尽管在关联研究中无法证明因果关系，但这些数据可能表明孕期RAAS参与了孕期胰岛素抵抗/新发糖尿病的发病机制。
