目的:探讨孕前不同体型孕妇的脂肪因子Chemerin及脂质代谢情况与妊娠糖尿病相关关系。方法:选取2018年10月—2019年10月在内蒙古科技大学包头医学院第一附属医院产科门诊定期产检及住院待产的孕妇,参照2013年WHO诊断标准于孕24~28周诊断为妊娠糖尿病(GDM)患者60例,根据孕前体质量指数(BMI)水平分为标准组(BMI 18.5~23.9 kg/m²)、超重组(BMI 24~28 kg/m²)、肥胖组(BMI≥28 kg/m²),每组20例;另外选取血糖正常、BMI为18.5~23.9 kg/m²的孕妇20例作为对照组,所有入选对象均于37~40周分娩。入院后详细记录孕妇年龄、身高、孕前体重;同时分别测定各组分娩前空腹血糖、空腹胰岛素、糖化血红蛋白、血脂(总胆固醇、甘油三酯、高密度脂蛋白胆固醇及低密度脂蛋白胆固醇)、超敏CRP(hs-CRP),并计算胰岛素抵抗指数(HOMA-IR),用酶联免疫吸附法测定外周血Chemerin值。结果:GDM三组Chemerin、空腹血糖、空腹胰岛素、糖化血红蛋白、HOMA-IR、甘油三酯、低密度脂蛋白胆固醇、hs-CRP检测值均高于正常对照组;GDM超重组、GDM肥胖组Chemerin、空腹血糖、空腹胰岛素、糖化血红蛋白、HOMA-IR、hs-CRP高于GDM标准组;GDM肥胖组甘油三酯、低密度脂蛋白胆固醇高于GDM标准组。结论:孕前超重及肥胖体型的GDM孕妇糖脂代谢异常、炎症增加,代谢综合征风险增高。

Objective: To investigate the relationship between Chemerin, lipid metabolism and gestational diabetes mellitus in pregnant women with different body sizes before pregnancy. Methods: A total of 60 pregnant women with gestational diabetes mellitus (GDM) diagnosed at 24-28 weeks of gestation according to the WHO diagnostic criteria in 2013 were selected from the obstetric outpatient department of the First Affiliated Hospital of Baotou Medical College, Inner Mongolia University of Science and Technology from October 2018 to October 2019.They were divided into the standard group (BMI 18.5-23.9 kg/m²), the overweight group ( BMI 24-28 kg/m²) and the obesity group (BMI≥28 kg/m²) according to the level of pre-pregnancy body mass index (BMI), with 20 cases in each group.In addition, 20 pregnant women with normal blood glucose and BMI of 18.5-23.9 kg/m² were selected as the control group.All the selected subjects were delivered at 37-40 weeks.The age, height and pre-pregnancy weight of pregnant women were recorded in detail after admission; at the same time, fasting blood glucose, fasting insulin, glycosylated hemoglobin, blood lipids (total cholesterol, triglyceride, high-density lipoprotein cholesterol and low-density lipoprotein cholesterol) and high-sensitivity CRP (hs-CRP) were measured before delivery in each group, and insulin resistance index (HOMA-IR) was calculated.Chemerin value in peripheral blood was determined by enzyme-linked immunosorbent assay. Results: The Chemerin, fasting blood glucose, fasting insulin, glycosylated hemoglobin, HOMA-IR, triglyceride, low-density lipoprotein cholesterol and hs-CRP in three GDM groups were higher than those in the normal control group.The Chemerin, fasting blood glucose, fasting insulin, glycosylated hemoglobin, HOMA-IR and hs-CRP in the GDM overweight and GDM obese groups were higher than those in the GDM standard group; the triglyceride and low-density lipoprotein cholesterol in the GDM obese group were higher than those in the GDM standard group. Conclusion: GDM pregnant women with overweight and obesity before pregnancy have higher risk of risk of abnormal glucose and lipid metabolism, increased inflammation and metabolic syndrome.