Relationship between High Serum Cystatin C Levels and the Risk of Gestational Diabetes Mellitus

Aims

Serum cystatin C (CysC) has recently been shown to be associated with the incidence of type 2 diabetes mellitus (T2DM) and progression to the pre-diabetic state. The aim of this study was to explore the relationship between serum CysC and the risk of gestational diabetes mellitus (GDM) in Chinese pregnant women.

Methods

This cross-sectional study consisted of 400 pregnant women including111 with GDM and 289 with normal glucose tolerance at 24–28 weeks of gestation. The subjects were further divided into four groups according to the CysC quartiles, and their clinical characteristics were compared. The serum CysC concentration was measured using immunoturbidimetry and the degree of insulin resistance was assessed by the homeostasis model assessment of insulin resistance (HOMA-IR).

Results

Serum CysC levels were significantly higher in pregnant women with GDM than in the healthy pregnant women[1.0(0.8–1.8) vs 0.7(0.6–1.0), P<0.01). The Spearman’s correlation analysis showed that serum CysC was positively associated with HOMA-IR(r = 0.118, P<0.05) and the occurrence of GDM(r = 0.348, P<0.01). The pregnant women were divided into quartiles according to their serum CysC concentrations. Compared to the first quartile, pregnant women in Q2 (OR, 2.441; P = 0.025), Q3 (OR, 3.383; P = 0.001) and Q4 (OR, 5.516; P<0.001) had higher risk of GDM after adjusted for age, BMI, HbA1c and HOMA-IR. Further, with a rise in the serum CysC, there was an increasing trend in the HOMA-IR levels (P<0.05). A binary logistic regression analysis after adjusting for other confounding variables revealed a significant and independent association between serum CysC and GDM [OR = 14.269; 95% confidence interval, 4.977–40.908, P<0.01].The receiver operating characteristic curve analysis revealed that the optimal cutoff point for serum CysC to indicate GDM was 0.95mg/L.

Conclusions

Serum CysC is significantly and independently associated with insulin resistance and GDM. It may be a helpful biomarker to identify the risk of GDM in Chinese pregnant women.     

Embryo Quality May Be Associated With Serum Inhibin B Levels but Not With Serum or Follicular Fluid Levels of Other Components of the Activin–Follistatin–Inhibin Axis

ObjectiveWe investigated the potential associations of embryo quality with serum and/or follicular fluid (FF) concentrations of the molecules of the activin–follistatin–inhibin (AFI) axis and antimüllerian hormone and aimed to identify molecules that could predict a positive assisted reproductive technology (ART) outcome.MethodsIn this cross-sectional study, we measured AFI hormone and antimüllerian hormone levels in the serum and FF of follicles (n = 101) obtained from healthy oocyte donors who underwent an assisted reproductive technology course (n = 32). After egg retrieval, embryos were characterized as good or bad quality according to the European Society of Human Reproduction and Embryology criteria. Women were divided into 3 groups (<50%; 50%-66.7%; and >66.7%) according to the percentage of good quality embryos obtained.ResultsThere was no difference between good and bad quality embryos in any of the molecules measured in FF. Moreover, there was no difference in the parameters measured in the serum among women according to the percentage of good quality embryos (ie, suitable for transfer or freezing) except for inhibin B, which tended to increase along with a good quality embryo rate (55.6 ± 7.9 vs 95.3 ± 14.3 vs 113.9 ± 36.9; P = .045).ConclusionsAmong the molecules of the AFI axis, only serum but not FF inhibin B levels were marginally associated with good quality embryo rates.     

The Relationship Between Maternal Serum Iron and Zinc Levels and Their Nutritional Intakes in Early Pregnancy with Gestational Diabetes

The aim of this study was to investigate the association between maternal iron/zinc serum levels and their nutritional intake in early pregnancy with gestational diabetes. The maternal serum zinc/iron levels were measured in 1,033 healthy singleton pregnant women aged 20–35 between 14 and 20 weeks of gestation, within two groups: namely, normal and gestational diabetes, and participants were followed up to 24–28 weeks of gestation. Food frequency questionnaire was used to assess nutritional intakes of iron/zinc. The main outcome was gestational diabetes screened with the 50-g glucose challenge test and diagnosed with oral glucose tolerance test at 24–28 weeks of gestation. Gestational diabetes occurred in 72 (6.96 %) of 1,033 women in study. There was a statistical relationship between early pregnancy maternal serum iron and gestational diabetes, mean (SD), 143.8 (48.7) vs. 112.5 (83.5)?μg/dl, P value of <0.0001. There was no statistical significant difference in zinc levels and iron/zinc nutritional intake between groups. The results remained unchanged after using regression model for adjustment of potential risk factors with an adjusted OR of 1.006 (95 % CI 1.002 to 1.009; P?=?0.001) for early pregnancy maternal serum iron to cause gestational diabetes. The receiver–operator characteristic curve identified that a maternal serum iron above 100 μg/dl in early pregnancy is the optimum cutoff value for predicting gestational diabetes, which showed a sensitivity and specificity of 80.6 and 50.7 %, respectively. In conclusion, high maternal serum iron in early pregnancy could increase the risk of gestational diabetes. Also, it could be used as a sensitive and specific predictor for gestational diabetes.     

孕早中期血清脂联素、抵抗素、铁蛋白水平及与妊娠期糖尿病的相关性分析

目的:研究孕早中期血清抵抗素、脂联素及铁蛋白水平与妊娠期糖尿病的相关性。方法:选取孕早期(11-13周)、孕中期(24-28周)诊断为GDM的孕妇46例作为试验组(GDM组),及同期糖代谢正常的孕妇46例作为对照组(NGT组),检测和比较两组孕早、中期血清脂联素、抵抗素、铁蛋白水平,计算各期胰岛素稳态模型抵抗指数(HOMA-IR),并对孕早中期血清抵抗素、脂联素及铁蛋白(SF)水平与HOMA-IR进行相关性分析。结果:与NGT组比较,GDM组孕早、中期血清脂联素水平均显著降低,且孕早期血清脂联素水平与HOMR-IR呈负相关(r=-0.21,P0.05);孕早、中期血清SF水平均显著升高,且孕早期血清SF水平与IR呈正相关(r=0.238,P0.05);孕早期血清抵抗素水平无明显变化(P0.05),但孕中期血清抵抗素水平显著降低(P0.05)。多元线性回归分析结果显示孕早期血清铁蛋白水平对HOMA-IR的影响更显著,孕早期SF每升高1μg/l,HOMA-IR提高0.179。孕早期SF水平作为预测GDM发病的血清学阈值为≥23.2μg/L。结论:孕早期血清脂联素及SF水平变化均与GDM的发病相关,孕早期血清SF水平可能作为早期诊断和预防GDM的血清学指标。     

Evaluation of Serum Selenium Levels in Turkish Women with Gestational Diabetes Mellitus, Glucose Intolerants, and Normal Controls

The aim of the study was to investigate the association between serum selenium levels in patients with gestational diabetes mellitus (GDM) and glucose intolerants and compare them with those of glucose-tolerant pregnant women. This cross-sectional study was prospectively performed in a total of 178 pregnant women undergoing a 50-g oral glucose tolerance test between 24 and 28 weeks of gestation who were grouped according to their status of glucose tolerance as with gestational diabetes (group A, abnormal 1- and 3-h glucose tolerance test; n = 30), glucose intolerant (group B, abnormal 1-h but normal 3-h glucose tolerance test; n = 47), or normal controls (group C, normal 1-h glucose test; n = 101). Serum selenium levels were measured with a graphite furnace atomic absorption spectrophotometer using a matrix modifier. Median maternal age and gestational age at the time of diagnosis in group A (gestational age = 24.8 [24-27]), group B (gestational age = 24.7 [24-27]), and group C (gestational age = 25 [24-28]) did not differ. Patients with gestational diabetes mellitus and those with glucose intolerants had lower selenium level than that of the normal pregnant women (P < 0.001). There was a significant inverse correlation between selenium and blood glucose level, and also selenium supplementation might prove beneficial on patients with GDM and prevent or retard them from secondary complications of diabetes.     

Opposing Effects of Activin A and Follistatin on Developing Skeletal Muscle Cells

Activin and the activin-binding protein follistatin modulate a variety of biological processes and are abundant at sites of muscle development. Activin and follistatin were expressed in developing chick pectoral musclein vivoand in primary cell culture. Addition of recombinant activin inhibited muscle development in a dose-dependent manner as measured by the number of nuclei in myosin heavy chain positive cells and creatine phosphokinase activity. Conversely, follistatin potentiated muscle development. The effects of activin were found to be distinct from those of the related protein transforming growth factor (TGF) β1. Muscle development was repressed by activin at all time points investigated and did not recover with the removal of activin following a limited exposure. In contrast, while myogenic differentiation in TGFβ1 was initially repressed, muscle marker expression recovered to control levels—even in the continued presence of TGFβ1. Fibroblast growth factor (FGF) had little effect on inhibiton of muscle development caused by activin A. However, inhibition of development produced by TGFβ increased with increasing concentrations of FGF. Finally, early expression of myoD and myf5 mRNA by muscle cultures in the presence of activin and follistatin was analyzed. Activin-treated cultures expressed reduced myoD and myf5 levels at 1.5 days after plating. Myf5 levels in follistatin-treated cultures were elevated, but, surprisingly, these cultures showed a reduction in myoD levels. These data suggest that endogenously expressed activin and follistatin are important modulators of muscle development.     

Association of Lower Serum Cholesterol Levels with Higher Risk of Osteoporosis in Type 2 Diabetes

ObjectiveTo determine whether a correlation exists between bone mineral density and circulating lipoprotein levels and whether these variables are independently associated with osteoporosis in patients with type 2 diabetes.MethodsIn a cross-sectional analysis, 159 patients with type 2 diabetes were compared with 70 patients without diabetes selected from an outpatient endocrinology clinic in a tertiary care institute during a 1-year period. Variables were gathered through history, physical examination, and laboratory findings, including blood chemistry studies and dual-energy x-ray absorptiometry.ResultsOf the 229 study patients, 86 (37.6%) had osteoporosis. In the patients with diabetes, the mean ± SD of age, weight, total cholesterol, and low-density lipoprotein (LDL) cholesterol in those with and without osteoporosis was 72.3 ± 10.4 years versus 63.6 ± 11.0 years, 74.2 ± 14.4 kg versus 83.7 ± 15.5 kg, 178.4 ± 33.7 mg/dL versus 194.1 ± 33.9 mg/dL, and 100.0 ± 27.1 mg/dL versus 114.2 ± 30.2 mg/dL, respectively (P < 0.01 for all variables). After adjustment for other variables, multiple logistic regression analysis showed that the presence of diabetes was associated with a lower risk of osteoporosis. Similarly, older age and lower body weight, LDL levels, and serum calcium levels were independently associated with lumbar spine osteoporosis in patients with diabetes, in comparison with older age and lower weight in patients without diabetes. Lower weight and older age were associated with femoral neck and total hip osteoporosis in patients with diabetes, in comparison with only older age in patients without diabetes.ConclusionThe presence of type 2 diabetes is associated with a lower risk of osteoporosis. In patients with type 2 diabetes, a lower LDL level is more likely to be associated with osteoporosis at the lumbar spine. (Endocr Pract. 2007;13:620-628)     

Differential Expression and Release of Activin A and Follistatin in Chronic Rhinosinusitis with and without Nasal Polyps

Background

Chronic rhinosinusitis with (CRSwNP) and without nasal polyps (CRSsNP) should be regarded as distinct clinical entities based on differential inflammatory mediator and remodeling profiles. Activin A, a member of the TGF-β superfamily, plays an important role in inflammation and remodeling in the lower airways, although its expression and release in the upper airways remain undescribed.

Objective

To investigate the expression of activin A and its inhibitor follistatin in nasal tissue samples from CRSsNP and CRSwNP patients, and to monitor the spontaneous release of these molecules in a human mucosal model.

Methods

Protein levels were determined using ELISA for activin A, follistatin, TGF-β1 and indicator proteins (IL-5, ECP, IFNγ) in 13 CRSsNP, 23 CRSwNP, and 10 control samples. The spontaneous release rate and the release ratios of activin A, follistatin and TGF-β1 were determined in 9 CRSsNP and 7 CRSwNP tissue fragments cultured ex-vivo. The induction of activin A and TGF-β1 by one another was studied in 7 CRSsNP tissue fragments cultured ex-vivo.

Results

Significantly higher concentrations of activin A, follistatin, TGF-β1, and IFNγ were observed in CRSsNP compared with CRSwNP samples, whereas the concentrations of IL-5 and ECP were significantly lower. Follistatin was positively and linearly correlated with activin A in CRSsNP and CRSwNP. Activin A, follistatin and TGF-β1 were all spontaneously released by the samples, although the relative ratios released by tissue fragments from CRSsNP and CRSwNP samples were significantly different, with a higher follistatin/activin A-ratio and a follistatin/TGFß1-ratio (with less overall TGF-β1) in CRSwNP than in CRSsNP. Furthermore, TGF-β1 enhanced activin A secretion in CRSsNP tissue fragments cultured ex-vivo.

Conclusion

The differences in tissue concentrations and spontaneous release rates for activin A and follistatin in different CRS samples support the hypothesis that CRSsNP and CRSwNP are two distinct disease entities with respect to remodeling patterns.     

The Association of Gestational Weight Gain and Adverse Pregnancy Outcomes in Women with Gestational Diabetes Mellitus

Objective: To explore the association of excessive gestational weight gain (GWG) defined by the Institute of Medicine (IOM) targets and adverse perinatal outcomes in gestational diabetes mellitus (GDM) pregnancies, and whether a modified target might be related to a lower rate of adverse perinatal outcomes for GDM.Methods: This retrospective cohort study involved 1,138 women of normal glucose tolerance (NGT) and 1,200 women with GDM. Based on the IOM target, pregnancies were classified to appropriate GWG (aGWG), inadequate GWG, and excessive GWG (eGWG). Modified GWG targets included: upper limit of IOM target minus 1 kg (IOM-1) or 2 kg (IOM-2), both upper and lower targets minus 1 kg (IOM-1-1) or 2 kg (IOM-2-2).Results: The proportions of women achieving eGWG were 26.3% in NGT and 31.2% in GDM (P = .036); in comparison, for aGWG NGT, the risks of large for gestational age (LGA) were significantly higher in eGWG NGT (adjusted odds ratio &lsqb;OR] 1.47; 95% confidence interval &lsqb;CI] 1.02 to 2.13), aGWG GDM (adjusted OR 1.42; 95% CI 1.03 to 1.95), and eGWG GDM (adjusted OR 2.70; 95% CI 1.92 to 3.70). GDM pregnancies gaining aGWG based on the modified GWG targets (IOM-2, IOM-1-1, and IOM-2-2) had a lower prevalence of LGA and macrosomia delivery than that for similar pregnancies using the original IOM target (all P<.05).Conclusion: For aGWG GDM according to the IOM target, adhering to a more stringent weight control was associated with decreased adverse outcomes. A tighter IOM target might help to reduce the prevalence of adverse pregnancy outcomes.Abbreviations: aGWG = appropriate gestational weight gain; BG = blood glucose; BMI = body mass index; CI = confidence interval; eGWG = excessive gestational weight gain; GDM = gestational diabetes mellitus; GW = gestational weeks; GWG = gestational weight gain; HbA1c = hemoglobin A1c; iGWG = inadequate gestational weight gain; IOM = Institute of Medicine; LGA = large for gestational age; NGT = normal glucose tolerance; NICU = neonatal intensive care unit; OGTT = oral glucose tolerance test; OR = odds ratio; PARp = partial population attributable risks; SGA = small for gestational age     

Inverse Association between Serum Bilirubin Levels and Arterial Stiffness in Korean Women with Type 2 Diabetes

Background

Considerable evidence suggests that bilirubin is a potent physiologic antioxidant that may provide important protection against cardiovascular disease (CVD) and inflammation. We investigated the relationship between serum total bilirubin (TB) levels and arterial stiffness, measured by the brachial-ankle pulse wave velocity (baPWV), in patients with type 2 diabetes.

Methods

We conducted a cross-sectional analysis of 1,711 subjects with type 2 diabetes (807 men and 904 women; mean age, 57.1 years). The subjects were stratified based on gender-specific tertiles of TB values, and a high baPWV was defined as greater than 1,745 cm/s ( >75th percentile).

Results

The serum TB concentration was negatively correlated with the duration of diabetes, HbA1c, the 10-year Framingham risk score, and baPWV and was positively correlated with high-density lipoprotein cholesterol and the eGFR in both genders. Inverse association between TB categories and unadjusted prevalence of high PWV was only observed in women. After adjusting for confounding factors, the TB levels were inversely associated with a greater risk of a high baPWV, both as a continuous variable [a 1-SD difference; odds ratio (OR), 0.70; 95% confidence interval (CI), 0.54–0.90; P = 0.005] and when categorized in tertiles (the highest vs. the lowest tertile; OR, 0.49; 95% CI, 0.28–0.85; P = 0.011) in women but not in men. The relationship remained significant even after adjusting for retinopathy and nephropathy.

Conclusions

Low TB levels were significantly associated with arterial stiffness in Korean women with type 2 diabetes. Our data suggested that bilirubin may protect against macrovascular disease in diabetic women.     

妊娠期糖尿病对子代主要先天畸形风险的影响

目的:探讨孕妇妊娠期糖尿病对子代先天畸形风险的影响,为优生优育提供参考。方法:对我院妇产科收治的124例糖尿病孕妇的临床资料进行前瞻性分析,同时选取150正常孕妇作为对照组,运用产前超声对糖尿病孕妇和正常孕妇的胎儿的先天畸形进行对比分析。结果:妊娠期糖尿病孕妇子代的先天畸形的风险明显高于正常孕妇(RR=2.24,95%CI=0.85-5.88)。结论:孕妇妊娠期糖尿病可对子代的各系统先天畸形造成较大影响,对孕早期进血糖监测是必要的。     

妊娠期糖尿病患者血清NRG4、FGF-23、PGRN水平及其临床意义

摘要 目的：探讨妊娠期糖尿病患者血清神经调节蛋白4(NRG4)、成纤维细胞生长因子-23(FGF-23)、前颗粒体蛋白(PGRN)水平及其临床意义。方法：选择2018年4月至2019年11月我院诊治的90例妊娠期糖尿病患者作为糖尿病组,选择同期在我院进行健康体检的90名健康孕妇作为对照组。检测两组血清NRG4、FGF-23、PGRN水平,血脂指标[高密度脂蛋白（HDL）、总胆固醇（TC）、甘油三酯（TG）和低密度脂蛋白（LDL）]水平,肝功能指标[谷草转氨酶（AST）、谷丙转氨酶(ALT)]水平,血糖和胰岛素指标[空腹血糖（FPG）、空腹胰岛素(FINS)]水平,并计算抗胰岛素抵抗指数(HOMA-IR)、胰岛素敏感性指数（ISI）和胰岛?茁细胞功能指数(HOMA-β)。分析各临床指标间的关系。结果：与对照组相比,糖尿病组体质量指数（BMI）、TG、TC、FPG、FINS、HOMA-IR、NRG4、FGF-23、PGRN明显升高（P<0.05）,ISI和HOMA-β明显下降（P<0.05）。血清NRG4、FGF-23、PGRN与ISI和HOMA-β均呈负相关（P<0.05）,与BMI、TG、TC、FPG、FINS、HOMA-IR均呈正相关（P<0.05）。TG与NRG4表达联系密切（β=0.007,P<0.05）,ISI和HOMA-IR与FGF-23表达联系密切（β=-6.674、0.048,P<0.05）,FPG和TC与PGRN表达联系密切（β=22.308、0.507,P<0.05）。结论：妊娠期糖尿病患者血清NRG4、FGF-23、PGRN水平异常升高,并参与妊娠期糖尿病患者的糖脂代谢和胰岛素抵抗,检测其水平有助于评估妊娠期糖尿病的糖脂代谢异常情况。     

Gestational Heat Stress Alters Postnatal Offspring Body Composition Indices and Metabolic Parameters in Pigs

The study objectives were to test the hypothesis that heat stress (HS) during gestational development alters postnatal growth, body composition, and biological response to HS conditions in pigs. To investigate this, 14 first parity crossbred gilts were exposed to one of four environmental treatments (TNTN, TNHS, HSTN, or HSHS) during gestation. TNTN and HSHS dams were exposed to thermal neutral (TN, cyclical 18–22°C) or HS conditions (cyclical 28–34°C) during the entire gestation, respectively. Dams assigned to HSTN and TNHS treatments were heat-stressed for the first or second half of gestation, respectively. Postnatal offspring were exposed to one of two thermal environments for an acute (24 h) or chronic (five weeks) duration in either constant TN (21°C) or HS (35°C) environment. Exposure to chronic HS during their growth phase resulted in decreased longissimus dorsi cross-sectional area (LDA) in offspring from HSHS and HSTN treated dams whereas LDA was larger in offspring from dams in TNTN and TNHS conditions. Irrespective of HS during prepubertal postnatal growth, pigs from dams that experienced HS during the first half of gestation (HSHS and HSTN) had increased (13.9%) subcutaneous fat thickness compared to pigs from dams exposed to TN conditions during the first half of gestation. This metabolic repartitioning towards increased fat deposition in pigs from dams heat-stressed during the first half of gestation was accompanied by elevated blood insulin concentrations (33%; P = 0.01). Together, these results demonstrate HS during the first half of gestation altered metabolic and body composition parameters during future development and in biological responses to a subsequent HS challenge.     

A Mathematical Model for the Actions of Activin,Inhibin, and Follistatin on Pituitary Gonadotrophs

The timed secretion of the luteinizing hormone (LH) and follicle stimulating hormone (FSH) from pituitary gonadotrophs during the estrous cycle is crucial for normal reproductive functioning. The release of LH and FSH is stimulated by gonadotropin releasing hormone (GnRH) secreted by hypothalamic GnRH neurons. It is controlled by the frequency of the GnRH signal that varies during the estrous cycle. Curiously, the secretion of LH and FSH is differentially regulated by the frequency of GnRH pulses. LH secretion increases as the frequency increases within a physiological range, and FSH secretion shows a biphasic response, with a peak at a lower frequency. There is considerable experimental evidence that one key factor in these differential responses is the autocrine/paracrine actions of the pituitary polypeptides activin and follistatin. Based on these data, we develop a mathematical model that incorporates the dynamics of these polypeptides. We show that a model that incorporates the actions of activin and follistatin is sufficient to generate the differential responses of LH and FSH secretion to changes in the frequency of GnRH pulses. In addition, it shows that the actions of these polypeptides, along with the ovarian polypeptide inhibin and the estrogen-mediated variations in the frequency of GnRH pulses, are sufficient to account for the time courses of LH and FSH plasma levels during the rat estrous cycle. That is, a single peak of LH on the afternoon of proestrus and a double peak of FSH on proestrus and early estrus. We also use the model to identify which regulation pathways are indispensable for the differential regulation of LH and FSH and their time courses during the estrous cycle. We conclude that the actions of activin, inhibin, and follistatin are consistent with LH/FSH secretion patterns, and likely complement other factors in the production of the characteristic secretion patterns in female rats.     

Middle Iron-Enriched Fructose Diet on Gestational Diabetes Risk and on Oxidative Stress in Offspring Rats

Gestational diabetes mellitus (GDM) is associated with increased insulin resistance and a heightened level of oxidative stress (OS). Additionally, high iron consumption could also increase insulin resistance and OS, which could aggravate GDM risk. The aim of this study is to evaluate a high fructose diet (F) as an alternative experimental model of GDM on rats. We also have evaluated the worst effect of a fructose iron-enriched diet (FI) on glucose tolerance and OS status during pregnancy. Anthropometric parameters, plasma glucose levels, insulin, and lipid profile were assessed after delivery in rats fed an F diet. The effects observed in mothers (hyperglycemia, and hyperlipidemia) and on pups (macrosomia and hypoglycemia) are similar to those observed in women with GDM. Therefore, the fructose diet could be proposed as an experimental model of GDM. In this way, we can compare the effect of an iron-enriched diet on the metabolic and redox status of mother rats and their pups. The mothers’ glycemic was similar in the F and FI groups, whereas the glycemic was significantly different in the newborn. In rat pups born to mothers fed on an FI diet, the activities of the antioxidant enzyme glutathione peroxidase (GPx) and glutathione-S-transferase in livers and GPx in brains were altered and the gender analysis showed significant differences. Thus, alterations in the glycemic and redox status in newborns suggest that fetuses are more sensitive than their mothers to the effect of an iron-enriched diet in the case of GDM pregnancy. This study proposed a novel experimental model for GDM and provided insights on the effect of a moderate iron intake in adding to the risk of glucose disorder and oxidative damage on newborns.     

妊娠期糖尿病血清和脂肪组织内脂素的表达

目的:探讨妊娠期糖尿病孕妇内脂素水平与糖代谢的关系.方法:检测血清中内脂素、FIN、FIG水平,计算HOMA-IR,用RT-PCR法检测脂肪组织中内脂素mRNA的表达.结果:(1)妊娠期糖尿病组孕妇血清内脂素、FPG、HOMA-IR、FIN明显高于对照组.(2)妊娠期糖尿病组孕妇内脏脂肪组织中的内脂素的表达明显高于对照组,且妊娠期糖尿病组孕妇内脏组织中内脂素的表达明显高于表皮脂肪组织.(3)血清中内脂素的水平与内脏脂肪组织及HOMA-IR呈正相关.结论:妊娠期糖尿病孕妇脂肪组织中内脂素表达上调,导致血液循环中内脂素水平升高,参与GDM孕妇血糖调节.     

Association of Oxidative Stress Biomarkers with Gestational Diabetes Mellitus in Pregnant Women: A Case-Control Study

Objective

The relationship between gestational diabetes mellitus (GDM) and oxidative stress has not been fully elucidated. This study examined the association between biomarkers of oxidative stress and GDM.

Methods

We conducted a case-control study which included 36 women presenting with GDM and 36 asymptomatic matched control subjects who visited Guangzhou Women and Children’s Medical Centre, China, from June 2012 to December 2012. Pregnant women were prospectively recruited to the study, and blood samples were collected at the time of a routine oral glucose tolerance test. These samples were then analyzed for levels of endocrine and surrogate markers of oxidative stress.

Results

Compared to control subjects, women with GDM exhibited elevated values for plasma glucose, insulin, and insulin resistance (IR), and showed reduced HOMA pancreatic β-cell function (HOMA-B), insulin sensitivity index (ISI), insulinogenic index, and corrected insulin response at 24–28 weeks gestation. A bivariate logistic regression analysis showed that levels of high-sensitivity C reactive protein (hs-CRP) and high fluorescence reticulocytes at fasting, and hs-CRP in a 1-h OGTT, were significantly associated with GDM. A linear regression analysis showed that levels of hs-CRP (P = 0.003) and reticulocytes (P = 0.029) at fasting were associated with IR, and levels of hs-CRP (P = 0.002) and monocytes (P = 0.006) in a 1-h OGTT were associated with ISI.

Conclusions

Pregnant women with GDM developed a pathological IR and exhibited β-cell dysfunction. Their decreased ability to compensate for oxidative stress was associated with increased IR and a reduced ISI, which might be important factors in GDM.     

Association of Soluble (Pro) Renin Receptor with Gestational Diabetes Mellitus

ObjectiveThere is a need to identify biomarkers for gestational diabetes mellitus (GDM). Recently the soluble pro-renin receptor (s[Pro]RR) has been shown to be associated with GDM. We investigated the association of s(Pro) RR levels in Asian Indians with GDM.MethodsWe recruited 222 pregnant females, 147 without GDM (non-GDM) and 75 with GDM visiting antenatal clinics in Tamilnadu in South India. We included singleton pregnancy and excluded those with pre-existing diabetes mellitus or hypertension. Oral glucose tolerance tests (OGTTs) were performed, and GDM was diagnosed using the International Association of Diabetes and Pregnancy Study Group criteria. s(Pro)RR was measured by enzyme-linked immunosorbent assay (ELISA). Receiver operating characteristic (ROC) curves were used to identify s(Pro) RR cut-off points to identify GDM.ResultsThe mean levels of the s(Pro)RR were significantly higher in subjects with GDM (34.0 ± 12 ng/mL, P < .001) compared to non-GDM (21.4 ± 6.5 ng/mL). The proportions of subjects with GDM were 11 (15%) in the first tertile of s(Pro)RR (< 19.61 ng/mL), 20 (27%) in the second (19.62-26.8 ng/mL), and 44 (59%) in the third tertile (> 26.8 ng/mL). In multiple logistic regression analysis, s(Pro)RR showed a significant association with GDM (odds ratio [OR]: 1.201, 95% confidence interval [CI]: 1.065-1.355, P = .003) after adjusting for potential con-founders. A s(Pro)RR cut-off of 23.3 ng/mL had a C statistic of 0.828 (95% CI: 0.738-0.918, P < .001), sensitivity of 68%, and specificity of 70% to identify GDM.Conclusionss(Pro)RR levels are higher in females with GDM, and this could be used as a potential biomarker. (Endocr Pract. 2015;21:7-13)     

血清IL-17 与妊娠期糖尿病发病及新生儿出生体重的相关性研究

目的:探讨母体与脐血清白介素-17(interleukin-17 IL-17)与妊娠期糖尿病发病(gestational diabetes mellitus GDM)及新生儿出生体重相关性。方法:收集我院足月GDM患者26例为病例组,孕24-28周经50g葡萄糖筛查试验无异常者26例为对照组,分娩前收集两组母血清及脐血清,检测母血清空腹血糖及空腹胰岛素,稳态模型评估胰岛素抵抗(homeostasis model assessment insulin resistance HOMA-IR)。检测两组母血清及脐血清IL-17水平,探讨与妊娠期糖尿病发病及新生儿出生体重相关性。结果:GDM组空腹胰岛素、HOMA-IR、母血清IL-17、脐血清IL-17与对照相比具有统计学差异(P<0.05)。相关研究发现,母血清IL-17水平与HOMA-IR存在明显正相关(r=0.718,P<0.001),脐血清IL-17与新生儿体重存在相关性(r=0.686 P<0.001),但脐血清IL-17水平与母血清IL-17水平无相关性(r=-0.339,P=0.0899)。结论:IL-17可能通过胰岛素抵抗参与了GDM的发生。