付丹

[摘要] 目的 探讨25-羟基维生素D（25OHD）与妊娠期糖尿病孕妇胰岛素抵抗的关系及意义。 方法 选择2015年4月～2017年8月于抚顺矿务局总医院进行产检并明确诊断为妊娠期糖尿病的孕妇98例作为研究组，选择同期产检的正常妊娠孕妇98名为健康对照组。检测两组孕妇血脂[总胆固醇（TC）、三酰甘油（TG）、高密度脂蛋白胆固醇（HDL-C）、低密度脂蛋白胆固醇（LDL-C）]、空腹血糖（FBG）、空腹胰島素（FINS）及25OHD水平，并测定胰岛素敏感性脂肪因子视黄醇结合蛋白4（RBP4）和内脂素（Visfatin）水平，计算胰岛素抵抗指数（HOMA-IR），分析25OHD与HOMA-IR、RBP4及Visfatin的相关性。 结果 研究组TG水平明显高于对照组（P < 0.05），而两组TC、HDL-C及LDL-C水平差异无统计学意义（P > 0.05）；研究组FBG、FINS及糖化血红蛋白水平明显高于对照组（P < 0.05）；研究组25OHD水平明显低于对照组，HOMA-IR、RBP4及Visfatin水平明显高于对照组，差异有统计学意义（P < 0.05）。相关性分析显示，25OHD水平与HOMA-IR、RBP4及Visfatin水平呈负相关（r = -0.916、-0.526、-0.153，均P < 0.05）。 结论 妊娠期糖尿病孕妇胰岛素抵抗与血清25OHD水平有密切关系，因此补充维生素D可能对缓解孕妇胰岛素抵抗、降低相关脂肪因子、预防妊娠期糖尿病有积极作用，值得进一步研究。

[关键词] 妊娠期糖尿病；25-羟基维生素D；胰岛素抵抗；脂肪因子

[中图分类号] R714.256 [文献标识码] A [文章编号] 1673-7210（2018）07（b）-0079-04

Relationship between 25-hydroxy vitamin D and insulin resistance in pregnant women with gestational diabetes mellitus and its significant

FU Dan

Department of Obstetrics and Gynecology， General Hospital of Fushun Mining Bureau， Liaoning Province， Fushun 113008， China

[Abstract] Objective To investigate the relationship between 25-hydroxy vitamin D （25OHD） and insulin resistance in pregnant women with gestational diabetes mellitus （GDM） and its significance. Methods From April 2015 to August 2017， 98 cases of pregnant women diagnosed with GDM in General Hospital of Fushun Mining Bureau were selected as study group， 98 cases of normal pregnant women in the same period were selected as healthy control group. The serum levels of lipids， fasting blood glucose （FBG）， fasting insulin （FINS）， and 25OHD were detected， the insulin sensitivity adipokines retinol binding protein 4 （RBP4） and Visfatin level of pregnant women in two groups were measured， insulin resistance index （HOMA-IR） was counted， the relationship between 25OHD and HOMA-IR， RBP4， Visfatin were analyzed. Results Level of TG in the study group was significantly higher than that of the control group， the difference was not statistically significant （P < 0.05）， while the levels of TC， HDL-C and LDL-C between two groups were not significantly different （P > 0.05）； levels of FBG， FINS and HbA1c in the study group were significantly higher than those in the control group， the differences were statistically significant （P < 0.05）； level of 25OHD in the study group was significantly lower than that in the control group， levels of HOMA-IR， RBP4 and Visfatin in the study group were significantly higher than those in the control group， the differences were statistically significant （P < 0.05）. Correlation analysis showed that， 25OHD level was negatively correlated with levels of HOMA-IR， RBP4， Visfatin （r = -0.916， -0.526， -0.153， all P < 0.05）. Conclusion Insulin resistance of pregnant women with GDM is closely related with serum 25OHD level， and therefore vitamin D supplementation for pregnant women may have a positive effect in alleviating insulin resistance， reducing related adipokines， and preventing gestational diabetes， it is worthy of further research.

[Key words] Gestational diabetes mellitus； 25-hydroxy vitamin D； Insulin resistance； Adipokines

维生素D是调节机体钙磷代谢的主要物质，但近年来随着研究的深入进展，国外学者发现糖尿病、代谢综合征患者体内也存在不同程度的维生素D缺乏，提示维生素D可能与其发病有关[1-4]。目前研究发现维生素D及其活性代谢产物在胰岛素抵抗和胰岛素抵抗的表达中发挥作用，而胰岛素抵抗又是妊娠期糖尿病发生的基础，因此维生素D已成为研究妊娠期糖尿病的重要线索[5-6]。而血清25-羟基维生素D（25OHD）是衡量机体维生素D营养状况的最佳指标，因此本文笔者收集抚顺矿务局总医院（以下简称“我院”）妊娠期糖尿病患者，分析25OHD在妊娠期糖尿病患者中的变化情况及其与胰岛素抵抗的关系，报道如下：

1 资料与方法

1.1 一般资料