孕妇孕前体重是妊娠期间血清瘦素及其代谢相关性的主要决定因素，而与妊娠期葡萄糖耐量状态无关。

Maternal pregravid weight is the primary determinant of serum leptin and its metabolic associations in pregnancy, irrespective of gestational glucose tolerance status.

机构信息

Leadership Sinai Centre for Diabetes, 60 Murray Street, Suite L5-025, Mailbox 21, Toronto, Ontario, Canada M5T 3L9.

出版信息

J Clin Endocrinol Metab. 2012 Nov;97(11):4148-55. doi: 10.1210/jc.2012-2290. Epub 2012 Sep 4.

DOI:10.1210/jc.2012-2290

PMID:22948759

Abstract

CONTEXT

Several previous studies have investigated circulating levels of the adipokine leptin in relation to gestational diabetes mellitus (GDM). However, these studies have yielded markedly conflicting results, including increased, decreased, and unchanged leptin levels in women with GDM as compared with their peers.

OBJECTIVE

We sought to evaluate the metabolic determinants of serum leptin in a well-characterized cohort reflecting the full spectrum of glucose intolerance in pregnancy.

DESIGN, SETTING, AND PARTICIPANTS: Metabolic characterization, including oral glucose tolerance test (OGTT) and measurement of serum leptin, insulin, lipids, adiponectin, and C-reactive protein, was performed in 817 pregnant women. The OGTT identified 198 women with GDM, 142 with gestational impaired glucose tolerance, and 477 with normal glucose tolerance.

RESULTS

Median leptin (ng/ml) did not differ between the normal glucose tolerance (33.7), gestational impaired glucose tolerance (36.3), and GDM (36.4) groups (P = 0.085). On univariate correlation analysis, leptin was most strongly associated with prepregnancy body mass index (BMI) (r = 0.54, P < 0.0001), fasting insulin (r = 0.60, P < 0.0001), and C-reactive protein (r = 0.38, P < 0.0001) but only weakly associated with area under the glucose curve (AUC(glucose)) on the OGTT (r = 0.10, P = 0.0066). On multiple linear regression analysis, the strongest independent determinant of leptin was prepregnancy BMI (t = 11.55, P < 0.0001), whereas AUC(glucose) was not a significant predictor (t = -0.95, P = 0.34). Furthermore, although its respective associations with fasting insulin, triglycerides, and adiponectin varied across tertiles of prepregnancy BMI, leptin was not significantly associated with AUC(glucose) in any BMI tertile.

CONCLUSIONS

Pregravid BMI, rather than gestational glucose tolerance, is the primary determinant of serum leptin concentration in pregnancy.

摘要

背景

几项先前的研究已经调查了脂肪细胞因子瘦素在与妊娠糖尿病（GDM）的关系中的循环水平。然而，这些研究的结果明显存在冲突，包括 GDM 女性与同龄人相比，瘦素水平增加、减少和不变。

目的

我们试图在一个反映妊娠期间葡萄糖耐量全貌的特征明确的队列中评估血清瘦素的代谢决定因素。

设计、设置和参与者：对 817 名孕妇进行代谢特征分析，包括口服葡萄糖耐量试验（OGTT）和血清瘦素、胰岛素、脂质、脂联素和 C 反应蛋白的测量。OGTT 确定了 198 名 GDM 患者、142 名妊娠糖耐量受损患者和 477 名糖耐量正常患者。

结果

正常糖耐量（33.7）、妊娠糖耐量受损（36.3）和 GDM（36.4）组之间的中位瘦素（ng/ml）无差异（P=0.085）。在单变量相关分析中，瘦素与孕前体重指数（BMI）（r=0.54，P<0.0001）、空腹胰岛素（r=0.60，P<0.0001）和 C 反应蛋白（r=0.38，P<0.0001）最密切相关，但与 OGTT 下葡萄糖曲线下面积（AUC（葡萄糖））的相关性较弱（r=0.10，P=0.0066）。在多元线性回归分析中，瘦素的最强独立决定因素是孕前 BMI（t=11.55，P<0.0001），而 AUC（葡萄糖）不是一个显著的预测因子（t=-0.95，P=0.34）。此外，尽管其与空腹胰岛素、甘油三酯和脂联素的相关性因孕前 BMI 的三分位数而异，但在任何 BMI 三分位数中，瘦素与 AUC（葡萄糖）均无显著相关性。