【作者】 王娜；

【导师】 石芳鑫；

【作者基本信息】 大连医科大学 ， 妇产科学， 2013， 硕士

【摘要】 目的:探讨妊娠中期孕妇血清铁蛋白水平在妊娠期糖尿病发病中的作用。方法：选取2012年8月至2012年12月间在大连医科大学附属第一医院产科门诊及大连市中山区妇幼保健院产科门诊行常规产前检查，并记录有完整资料的妊娠24-28周的单胎初产孕妇，总计90名为研究对象。按照2011年美国糖尿病协会(American Diabetes Association，ADA)发布的妊娠期糖尿病诊断标准，选取GDM孕妇44例作为GDM组，同期糖耐量正常的孕妇46例作为对照，即正常糖耐量组（Normal Glucose Tolerance，NGT）。详细记录研究对象的年龄、孕龄、孕次、身高、孕前体重及行葡萄糖耐量试验(Oral Glucose Tolerance Test，OGTT)抽血前的体重等相关的个人信息。并排除急性炎症、感染等应激因素和其他妊娠合并症等相关性疾病；近期无外伤、手术及输血史；否认家族遗传病史。通过竞争性放射免疫及离子交换高效液相色谱法等分别测定血清铁蛋白（Serum Ferritin，SF）、空腹胰岛素（Fasting Insulin，FINS）、空腹血糖（Fasting Plasma Glucose，FPG）和糖化血红蛋白（Glycosylated Hemoglobin Alc，HbAlc）等；通过对孕妇孕中、晚期常规产检化验结果收集并记录血红蛋白（Hemoglobin，HB）的数值。通过测量孕妇的身高、孕前体重及抽血前体重，分别计算出孕前及抽血前体重指数(Body MassIndex，BMI)。计算胰岛素抵抗指数（HOMA-IR）、胰岛分泌细胞功能（HBCI），比较两组间孕妇SF水平变化、胰岛素抵抗和胰岛分泌细胞功能的差异，并分析其相互之间的关系及在GDM发病中的作用。结果：(1) SF水平在GDM组中高于NGT组，差异有统计学意义（P<0.05）；(2)GDM组中孕妇血清HOMA-IR较NGT组增高，HBCI较NGT组降低，均有显著差异（P<0.05）；(3)孕妇HbAlc、HB、抽血前BMI在GDM组中均高于NGT组，差异有统计学意义（P<0.05）；(4)相关性分析：GDM组孕妇中，SF与HOMA-IR呈正相关性，r=0.334，P<0.05；SF与FPG、FINS、HB和HbAlc呈正相关性，r值分别为=0.350、0.336、0.369、0.364，P值均<0.05。结论：(1)GDM孕妇体内存在较为严重的胰岛素抵抗和胰岛功能细胞损伤，而两者为GDM发病的重要因素。(2)GDM孕妇体内的高水平SF与胰岛素抵抗之间具有相关性，SF可能参与GDM的发病。(3)SF能更为敏感、准确地反应体内储存铁情况，妊娠期间应监测SF、HB等相关指标以合理指导临床铁剂的补充。更多还原

【Abstract】 Objective: To investigate the role of Serum Ferritin in the etiopathology ofGestational Diabetes Mellitus.Methods: The singleton pregnancy of primiparous women at24to28weeks ofgestation who accepted antenatal examination in the obstetrics clinic of the firstaffiliated hospital of dalian medical university and Maternal and Child Health hospitalof Zhongshan District from August2012to December2012were selected，total of90cases were divided into two groups according to the clinical diagnostic criteria ofgestational diabetes which was released by the American Diabetes Association in2011.44cases of GDM pregnant women as GDM group，46cases of pregnant women withnormal glucose tolerance at the same time as the control, normal glucose tolerance(NGT) group. Height、age、gestational age、pregnant times、prepregnancy weight andweight of OGTT test before hemospasia and other related personal information wererecored in detail. Acute inflammation、infection、stress factors、other pregnancycomplications and related diseases was excluded. No history of trauma, surgery, bloodtransfusion and family genetic factors. The serum specimens were collected from twogroups: Serum Ferritin (SF)、Fasting Insulin (FINS) Glycosylated Hemoglobin Alc(HbAlc) were measured by the radio-immunity assay and the ionic exchange highperformance liquid chromatography. Hemoglobin (HB) and Fasting Plasma Glucose(FPG) were obtained from the routine examinations. Body mass index (BMI) wascalculated by measuring the height、 weight and weight before hemospasia of thepregnant women. Insulin secretion was assessed by the homeostasisβ-cell functionindex(HBCI)，and Insulin resistance by the homeostasis model insulin resistance index(HOMA-IR). SF level changes, the differences in insulin resistance and insulinsecretion cell function were compared between two groups, the relationship between them and their effect on the pathogenesis of GDM were analyzed.Results:(1) SF levels in GDM group was significantly higher than NGT group(P<0.05);(2) HOMA-IR in GDM group was higher than NGT group，HBCI in GDMgroup was lower than NGT group，there were significant difference (P<0.05);(3)HbAlc、HB and BMI before hemospasia in GDM group were higher than NGT group，there was significant difference (P<0.05);(4) Correlation analysis: SF of GDM groupcompared with HOMA-IR was positively correlation (r=0.334，P<0.05)，and SF ofGDM group compared with FPG、FINS、HB and HbAlc was positively correlation(r=0.350、0.336、0.369、0.364，P<0.05).Conclusions:(1) There are serious insulin resistance and insulin secretiondecrease in GDM pregnant women, both of them play an important role in thepathogenesis of GDM.(2) There are correlationship between high level SF in GDMpregnant women and insulin resistance,SF may participate in the pathogenesis of GDM.(3) SF can response iron storage in the body more sensitive and more accurate. SF、HBand related indicators should be monitored during pregnancy to guide the complementof iron agent in clinical.更多还原