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目的研究妊娠期糖尿病(gestational diabetes mellitus,GDM)患者晚孕期血脂水平检测的临床意义。方法选择2012年5月至2015年10月在深圳市龙岗区第七人民医院妇产科被确诊为GDM的孕晚期孕妇85例为观察组,同期待产的健康孕晚期孕妇100例为对照组,采集血清并测定血脂指标、血糖及血清胰岛素(insulin,INS)含量、炎性因子含量,计算胰岛素抵抗指数(homeostasis model assessment-insulin resistance index,HOMA-IR)和胰岛β细胞分泌指数(homeostasis model assessment–β,HOMA-β)。结果观察组患者总胆固醇(total cholesterol,TC)、甘油三酯(triglyceride,TG)、低密度胆固醇(low density lipoprotein cholesterol,LDL-C)、载脂蛋白B(apolipoprotein B,Apo B)的含量明显高于对照组,高密度胆固醇(high density lipoprotein cholesterol,HDL-C)、载脂蛋白A(apolipoprotein A,Apo A)的含量明显低于对照组(P<0.05);INS含量、HOMA-IR均明显高于对照组,HOMA-β均明显低于对照组(P<0.05);血清C反应蛋白(C-reaction protein,CRP)、肿瘤坏死因子-α(tumor necrosis factor-α,TNF-α)、白细胞介素-6(interleukin-6,IL-6)、同型半胱氨酸(homocysteine,HCY)含量均明显高于对照组(P<0.05);血清TC、TG、LDL-C、Apo B含量与INS、CRP、TNF-α、IL-6、HCY的含量以及HOMA-IR呈正相关,与HOMA-β呈负相关(P<0.05);血清HDL-C、Apo A1的含量与INS、CRP、TNF-α、IL-6、HCY的含量以及HOMA-IR呈负相关,与HOMA-β呈正相关(P<0.05)。结论 GDM患者晚孕期血脂水平的检测不仅能够评估血脂代谢情况,还与胰岛素敏感性、全身炎症反应具有良好一致性。
Objective To study the clinical significance of serum lipid levels during late pregnancy in patients with gestational diabetes mellitus (GDM). Methods From May 2012 to October 2015, 85 pregnant women of the third trimester in the department of obstetrics and gynecology at the Seventh People’s Hospital, Longgang District, Shenzhen were enrolled as the observation group, and 100 healthy pregnant women were enrolled in the same period. Serum samples were collected for determination of serum lipids, blood glucose, serum insulin (INS), inflammatory cytokines, homeostasis model assessment-insulin resistance index (HOMA-IR) and homeostasis model assessment -β, HOMA-β). Results The levels of total cholesterol (TC), triglyceride (TG), low density lipoprotein cholesterol (LDL-C) and apolipoprotein B (Apo B) Compared with the control group, the levels of high density lipoprotein cholesterol (HDL-C) and apolipoprotein A (Apo A) were significantly lower than those of the control group (P <0.05) (P <0.05). The levels of serum C-reactive protein (CRP), tumor necrosis factor-α (TNF-α) , Interleukin-6 (IL-6) and homocysteine (HCY) were significantly higher than those in the control group (P <0.05). Serum TC, TG, LDL-C and Apo B The levels of INS, CRP, TNF-α, IL-6 and HCY were positively correlated with HOMA-IR and negatively correlated with HOMA-β (P <0.05) , TNF-α, IL-6, HCY and HOMA-IR, and had positive correlation with HOMA-β (P <0.05). Conclusion The detection of serum lipids during late pregnancy in GDM patients can not only assess the lipid metabolism, but also have good consistency with insulin sensitivity and systemic inflammatory response.