Lappas Martha, Mundra Piyushkumar A, Wong Gerard, Huynh Kevin, Jinks Debra, Georgiou Harry M, Permezel Michael, Meikle Peter J
Obstetrics, Nutrition and Endocrinology Group, Department of Obstetrics and Gynaecology, University of Melbourne, Mercy Hospital for Women, Level 4/163 Studley Road, Heidelberg, 3084, VIC, Australia,
Diabetologia. 2015 Jul;58(7):1436-42. doi: 10.1007/s00125-015-3587-7. Epub 2015 Apr 17.
AIMS/HYPOTHESIS: The risk of developing diabetes is greater for women with previous gestational diabetes mellitus (GDM). In the general population, plasma lipidomic analysis can identify individuals at risk of developing type 2 diabetes. The aim of this study was to determine whether circulating lipid levels 12 weeks following a GDM pregnancy were associated with an increased risk of developing type 2 diabetes.
Plasma lipid profiles containing >300 lipids were measured in 104 normal glucose-tolerant women 12 weeks following an index GDM pregnancy using electrospray-ionisation tandem mass spectrometry. Women were assessed for 10 years for development of overt type 2 diabetes.
Among the 104 women with previous GDM, 21 (20%) developed diabetes during the median follow-up period of 8.5 years. Three lipid species, the cholesteryl ester species CE 20:4, the alkenylphosphatidylethanolamine species PE(P-36:2) and the phosphatidylserine species PS 38:4, were independently and positively associated with the development of type 2 diabetes. In a clinical model of prediction of type 2 diabetes that included age, BMI, and levels of pregnancy fasting glucose, postnatal fasting glucose, triacylglycerol and total cholesterol, the addition of these three lipid species resulted in an improvement in the net reclassification index of 22.3%.
CONCLUSIONS/INTERPRETATION: The lipid species CE 20:4, PE(P-36:2) and PS 38:4 were significant risk factors for the development of type 2 diabetes in women with a previous history of GDM. This report is the first to use plasma lipidomic analysis to identify individual lipids as potential biomarkers for the prediction of type 2 diabetes in women with a history of GDM.
目的/假设：既往有妊娠期糖尿病（GDM）的女性患糖尿病的风险更高。在一般人群中，血浆脂质组学分析可识别有患2型糖尿病风险的个体。本研究的目的是确定GDM妊娠后12周时的循环脂质水平是否与患2型糖尿病风险增加相关。
采用电喷雾电离串联质谱法，对104例糖耐量正常的女性在其首次GDM妊娠后12周时测量了包含300多种脂质的血浆脂质谱。对这些女性进行了10年的随访，以评估显性2型糖尿病的发生情况。
在104例既往有GDM的女性中，21例（20%）在中位随访期8.5年期间患糖尿病。三种脂质种类，即胆固醇酯种类CE 20:4、烯基磷脂酰乙醇胺种类PE(P-36:2)和磷脂酰丝氨酸种类PS 38:4，与2型糖尿病的发生独立且呈正相关。在一个包括年龄、BMI以及妊娠空腹血糖、产后空腹血糖、甘油三酯和总胆固醇水平的2型糖尿病临床预测模型中，加入这三种脂质种类后，净重新分类指数提高了22.3%。
结论/解读：脂质种类CE 20:4、PE(P-36:2)和PS 38:4是既往有GDM病史女性患2型糖尿病的重要危险因素。本报告首次使用血浆脂质组学分析来识别个体脂质作为既往有GDM病史女性预测2型糖尿病的潜在生物标志物。
