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目的探讨不同糖耐量状态孕妇血清成纤维细胞生长因子21(FGF21)水平与胰岛β细胞功能的关系。方法选取妊娠24~28周于我院接受50 g糖负荷试验(GCT)阳性的孕妇441例,1周后再行75 g OGTT,根据结果分为GDM组228例、妊娠期IGT(GIGT)组122例及妊娠期NGT(GNGT)组91名。ELISA检测血清FGF21水平,胰岛素抵抗指数(HOMA-IR),胰岛素敏感指数(Matsuda指数),胰岛β细胞功能指数(HOMA-β),第1、2时相胰岛素分泌指数及胰岛β细胞代偿胰岛素抵抗的分泌能力(ISSI)评估胰岛β细胞功能。FGF21与胰岛β细胞功能的相关性采用Pearson相关分析。结果 (1)GDM组和GIGT组BMI,0、1、2、3hPG及1、2、3 hIns均高于GNGT组和GIGT组(P<0.05或P<0.01)。GDM组SBP、DBP、0 hIns和HbA_1c高于GNGT组和GIGT组(P<0.05或P<0.01);(2)GNGT组、GIGT组及GDM组FGF21水平[(101.74±20.40)vs(137.93±25.52)vs(185.69±31.61)ng/L]和HOMA-IR依次升高[1.74(0.91,2.85)vs2.39(1.31,4.87)vs3.38(2.19,6.75)],Matsuda指数[(58.74±15.68)vs(41.62±15.65)vs(39.73±18.98)]和HOMA-β[(157.69±88.41)vs(144.35±78.98)vs(107.30±87.23)]及ISSI[(72253.55±15167.53)vs(42313.91±7112.47)vs(30032.50±11500.24)]依次降低(P<0.05或P<0.01)。GDM组第1、2时相胰岛素分泌指数低于GNGT组和GIGT组(P<0.01),但GNGT组与GIGT组比较,差异无统计学意义(P>0.05);(3)Pearson相关分析显示,FGF21与HOMA-IR呈正相关(r=0.255,P=0.030),与Matsuda指数、HOMA-β、第1、2时相胰岛素分泌指数及ISSI呈负相关(r=0.289、-0.256、-0.224、-0.230、-0.277,P=0.019、0.037、0.045、0.040、0.023)。结论随着糖代谢受损逐渐加重,FGF21水平升高,且与胰岛β细胞功能相关,可能与GDM的发生发展有关。
Objective To investigate the relationship between serum fibroblast growth factor 21 (FGF21) levels and pancreatic β-cell function in pregnant women with different glucose tolerance status. Methods Forty-one pregnant women with GCG positive in our hospital from 24 to 28 weeks of pregnancy were enrolled. One week later, 75 g of OGTT were divided into two groups: 228 cases in GDM group and IGT (GIGT) in pregnancy group 122 cases and 91 gestational NGT (GNGT) group. Serum levels of FGF21, HOMA-IR, Matsuda index, HOMA-β, phase 1 and phase 2 insulin secretion index and pancreatic islet β-insulin compensatory insulin Resistant Secretory Capacity (ISSI) Assess islet beta cell function. The correlation between FGF21 and pancreatic β-cell function was analyzed using Pearson correlation analysis. Results (1) BMI, 0, 1, 2, 3 hPG and 1,2,3 hIns in GDM group and GIGT group were significantly higher than those in GNGT group and GIGT group (P <0.05 or P <0.01). The levels of SBP, DBP, 0 hIns and HbA_1c in GDM group were higher than those in GNGT group and GIGT group (P <0.05 or P <0.01); (2) The levels of FGF21 in GNGT group, GIGT group and GDM group [(101.74 ± 20.40) vs (137.93 ± 25.52) vs (185.69 ± 31.61) ng / L] and HOMA-IR increased [1.74 (0.91,2.85) vs 2.39 (1.31,4.87) vs3.38 (2.19,6.75)], Matsuda index [(58.74 ± (157.69 ± 88.41) vs (144.35 ± 78.98) vs (107.30 ± 87.23) and ISSI [(72253.55 ± 15167.53) vs (42313.91 ± 15.68) vs (41.62 ± 15.65 vs 39.73 ± 18.98 and HOMA-β 7112.47) vs (30032.50 ± 11500.24)] (P <0.05 or P <0.01). GDM group 1, 2 phase insulin secretion index lower than the GNGT group and GIGT group (P <0.01), but there was no significant difference between GNGT group and GIGT group (P> 0.05); (3) Pearson correlation analysis showed , FGF21 was positively correlated with HOMA-IR (r = 0.255, P = 0.030), and negatively correlated with Matsuda index, HOMA-β, 1st and 2nd phase insulin secretion index and ISSI (r = 0.289, -0.256, -0.224 , -0.230, -0.277, P = 0.019, 0.037, 0.045, 0.040, 0.023). Conclusions As the impaired glucose metabolism aggravates, the level of FGF21 is elevated and related to the function of islet β cells, which may be related to the occurrence and development of GDM.