【摘要】 目的 探讨妊娠糖尿病（gestational diabetes mellitus,GDM）患者血清、脐血及胎盘组织中的内脏脂肪组织（Visfatin）、脂肪因子趋化素（Chemerin）的表达变化及与患者发生胰岛素抵抗的关系。方法 选取阜阳市人民医院2018年12月～2020年4月妊娠分娩的GDM孕妇100例作为GDM组、糖耐量正常孕妇100例作为NGT组。统计分析两组的一般资料、血糖指标、血脂指标，检测两组研究对象血清、脐血、胎盘组织中的Visfatin,Chemerin表达水平，分析Visfatin,Chemerin表达与胰岛素抵抗指数（HOMA-IR）的相关性；通过重组慢病毒载体构建Visfatin,Chemerin过表达的3T3-L1脂肪细胞，分析Visfatin,Chemerin过表达对3T3-L1脂肪细胞增殖、葡萄糖消耗量、Akt及pAkt蛋白表达的影响。结果 GDM组的FPG(5.84±0.52mmol/L),Fins(18.96±3.75μU/ml),HbA1c(6.42%±0.89%),HOMA-IR(2.48±0.66),TC(5.22±0.57mmol/L)和TG(2.41±0.43mmol/L)测定值均高于NGT组(4.61±0.40mmol/L,12.53±2.20μU/ml,5.31%±0.70%,1.51±0.42,4.86±0.49mmol/L和2.18±0.34mmol/L)，差异具有统计学意义（t=18.749,14.789, 9.803, 12.399, 4.789, 4.196，均P <0.05）;GDM组和NGT组的HDL-C(1.64±0.22mmol/L vs 1.70±0.24mmol/L),LDL-C(3.23±0.67 mmol/L vs 3.10±0.54 mmol/L)和ALB(37.84±3.02g/L vs 38.44±3.30 g/L)测定值比较，差异均无统计学意义（t=-1.843, 1.511,-1.341，均P> 0.05）;GDM组的血清、脐血、胎盘组织中的Visfatin(10.55±2.41pg/ml,9.87±2.26 pg/ml, 0.421±0.093/βactin)和Chemerin(233.0±47.6 ng/ml,438.1±95.0 ng/ml,1.338±0.207/βactin)测定值均高于NGT组(6.39±1.05pg/ml,6.11±0.94pg/ml,0.235±0.074/βactin;155.7±30.6ng/ml,218.7±76.8ng/ml,0.905±0.152/βactin)，差异具有统计学意义（t=13.660～17.960，均P <0.05）;GDM组的血清、脐血和胎盘组织中的Visfatin和Chemerin水平与HOMA-IR测定值均呈显著的正相关关系（r=0.357～0.583，均P <0.05）；在细胞实验中，Chemerin过表达组与Visfatin过表达组的3T3-L1脂肪细胞葡萄糖消耗量均低于Chemerin空载组、Visfatin空载组（t=-12.175,5.319，均P <0.05）;Chemerin过表达组和Visfatin过表达组的3T3-L1脂肪细胞增值A值高于Chemerin空载组与Visfatin空载组（t=-13.765,6.034，均P <0.05）;Chemerin过表达组和Visfatin过表达组Akt与pAkt蛋白相对表达强度低于Chemerin空载组和Visfatin空载组（t=-15.938～-10.352，均P <0.05）。结论 GDM患者血清、脐血和胎盘组织中的Visfatin和Chemerin表达水平显著升高，并且与胰岛素抵抗有正相关性，其作用机制可能与下调Akt和pAkt蛋白表达有关。更多还原

【Abstract】 Objective To explore the expression changes of visceral adipose tissue(Visfatin) and adipokines(Chemerin) in serum, cord blood and placental tissue of patients with gestational diabetes mellitus mellitus(GDM) and their relationship with insulin resistance. Methods 100 pregnant women with GDM in Fuyang People’s Hospital from December 2018 to April 2020 were selected as GDM group and 100 pregnant women with normal glucose tolerance(NGT group). The general data, blood glucose indexes, and blood lipid indexes of the two groups were statistically analyzed. Detected the expression levels of Visfatin and Chemerin in the serum, cord blood, and placental tissues of the two groups of study subjects, and analyzed the correlation between Visfatin and Chemerin expression and insulin resistance index(HOMA-IR). Constructed Visfatin by recombinant lentiviral vector, Chemerin overexpression 3 T3-L1 adipocytes,and analyzed the effect of Visfatin and Chemerin overexpression on 3 T3-L1 adipocyte proliferation, glucose consumption, Akt and pAkt protein expression. Results The measured values of GDM group FPG(5.84±0.52 mmol/L), Fins(18.96±3.75μU/ml), HbA1 c(6.42%±0.89%), HOMA-IR(2.48±0.66), TC(5.22±0.57 mmol/L), TG(2.41±0.43 mmol/L) were higher than those of NGT group(4.61±0.40 mmol/L,12.53±2.20μU/ml,5.31%±0.70%,1.51±0.42,4.86±0.49 mmol/L 和 2.18±0.34 mmol/L),the differences were statistically significant(t=18.749, 14.789, 9.803, 12.399, 4.789, 4.196,all P < 0.05). There was no statistically significant difference between the measured values of HDL-C(1.64±0.22 mmol/L vs 1.70±0.24 mmol/L),LDL-C(3.23±0.67 mmol/L vs 3.10±0.54 mmol/L)and ALB(37.84±3.02 g/L vs 38.44±3.30 g/L)in the GDM group and the NGT group(t=-1.843, 1.511,-1.341,all P > 0.05).The Visfatin(10.55±2.41 pg/ml,9.87±2.26 pg/ml, 0.421±0.093/βactin) and Chemerin(233.0±47.6 ng/ml,438.1±95.0 ng/ml,1.338±0.207/βactin) measured values in serum, cord blood, and placenta tissue of the GDM group were higher than those of the NGT group(6.39±1.05 pg/ml,6.11±0.94 pg/ml,0.235±0.074/βactin;155.7±30.6 ng/ml,218.7±76.8 ng/ml,0.905±0.152/βactin),the difference was statistically significant(t=13.660～17.960, all P < 0.05).The levels of Visfatin and Chemerin in serum, cord blood, and placental tissues of the GDM group were significantly positively correlated with the measured values of HOMA-IR(r= 0.357～0.583, all P < 0.05). In cell experiments, the levels of Chemerin overexpression group and Visfatin overexpression group Glucose consumption of 3 T3-L1 adipocytes was lower than Chemerin no-load group and Visfatin no-load group(t=-12.175, 5.319, all P < 0.05); 3 T3-L1 adipocytes proliferation A value of Chemerin overexpression group and Visfatin overexpression group were higher than Chemerin no-load group, Visfatin no-load group(t=-13.765, 6.034,all P < 0.05); Chemerin overexpression group, Visfatin overexpression group Akt, the relative expression intensity of pAkt protein was lower than Chemerin no-load group,and Visfatin no-load group(t=-15.938～-10.352, all P < 0.05). Conclusion The expression levels of Visfatin and Chemerin in serum, cord blood, and placental tissues of GDM patients were significantly increased, and were positively correlated with insulin resistance. The mechanism of action may be related to down-regulation of Akt and pAkt protein expression.更多还原