论文标题:妊娠高血压综合征患者外周血瘦素与胰岛素抵抗的相关性研究
Study on the Relationship between Leptin and Insulin Resistance in Patients with Pregnancy Induced Hypertension
论文作者 赵兴娟
论文导师 王素兰；吴小华,论文学位 硕士,论文专业 妇产科学
论文单位 河北医科大学,点击次数 115,论文页数 58页File Size1060k
2005-03-01论文网 http://www.lw23.com/lunwen_83025702/ 妊高征;瘦素; 胰岛素; 胰岛素原; 真胰岛素; 胰岛素敏感指数
Pregnancy-induced hypertension syndrome; leptin; insulin; proinsulin; true insulin; insulin sensitivity index
目的:妊娠高血压综合征(妊高征)是产科常见的严重并发症,是导致围产期母儿发病及死亡的主要原因之一,其病因及发病机制至今尚未完全阐明。近来的研究提出瘦素、高胰岛素血症、胰岛素抵抗与妊娠高血压综合征的发病有一定的关系,用特异的方法测定外周血中胰岛素的水平是正确评价胰岛素抵抗及胰岛B 细胞功能的关键。本实验通过对妊高征患者与正常孕妇外周血中瘦素(leptin,Lep)、胰岛素(insulin,I)、真胰岛素(ture insulin,Ti)、胰岛素原(proinsulin,Pi)、血糖(glucose,Glu)的测定,了解妊高征患者与正常孕妇瘦素水平、胰岛素抵抗、胰岛B 细胞功能的差异,旨在阐明瘦素、胰岛素抵抗在妊高征发病中的意义及两者间的相互关系,从而为研究妊高征的发病机制和治疗新途径提供理论依据。方法:应用酶联免疫吸附法测定50 例妊高征患者(实验组)与30 例正常孕妇(对照组)外周血中的瘦素、真胰岛素、胰岛素原的水平;应用放射免疫法测定胰岛素的水平;应用血糖仪测定空腹血糖水平。计算胰岛素原/真胰岛素(proinsulin/true insulin ,Pi/Ti)比值代表胰岛B 细胞功能;计算胰岛素敏感指数(insulin sensitivity index,ISI)即空腹胰岛素与空腹血糖的成绩的倒数值代表胰岛素抵抗程度。实验数据用均数±标准差或几何均数±标准差表示,偏态
Objective:Pregnancy-induced hypertension syndrome(Pih),is a common and severe obstetric syndrome,and is a major cause of maternal and fetal morbility and mortality , whose etiology and pathophysiology are still not understood. Recent data suggest that pathophsiology of Pih is relation to leptin or hyperinsulinemia or insulin resistance . Evaluating the insulin resistance and B-cell fuction, specificly measured the concentration of insulin is the sticking point.We investigated the levels of leptin(Pi) and insulin(I) and proinsulin(Pi) and true insulin(Ti) and glucose(Glu) from the periheral blood, and knew the difference from the Pih and the normal pregnancy, in order to illuminate the significance of leptin and insulin resistance in the development of hypertensive disorder complicating pregnancy and the relationship of the two, so we could get the evidence to studying the mechanisms of Pih and the new approach of therapy. Methods: The study group consisted of 50 women with pih, the control group consisted of 30 women with normal pregnancy. The serum levels of leptin and proinsulin and true insulin were measured by ELISA(Enzyme-linked immunosorbent assay), the serum levels of insulin was measured by RIA (Radioimmunoassay), the serum level of gluose was measured by glucose-card. The ratial of Pi/Ti(proinsuli/true insulin) expressed B-cell secreting fuction and insulin sensitivity index expressed the insulin sensitivity. The data was showed by ±S or G±s , Pi/Ti was analysed after changed to the normal distribution. All data were analyzed with the SPSS10.0 software, including t-test,Q-test, ANOVA and linear correlation. Results: 1.The comparisons of leptin and insulin and proinsulin and true insulin and glucose in two groups: the median leptin concentration was significantly higher in Pih than in normal pregnancy: compared with control group , the concentration of leptin was obviously higher in mild Pih or middle Pih or severe Pih. Among Pih groups, it had significant statistical difference. The median insulin concentration was significantly higher in Pih than in normal pregnancy: compared with control group , the concentration of insulin was obviously higher in mild Pih or middle Pih or severe Pih. Among Pih groups, it had significant statistical difference. The median proinsulin concentration was significantly higher in Pih than in normal pregnancy: compared with control group, the concentration of proinsulin was obviously higher in mild Pih or middle Pih or severe Pih. Among Pih groups, it had significant statistical difference. But there was no significantly different concentration of true insulin between Pih group and control group, and there was no significantly different concentration of true insulin among Pih groups. Also there was no statistical between Pih group and control group or among groups. 2. Comparisons of Pi/Ti and insulin sensitivity index in two groups: the ratial of Pi/Ti was significantly higher in Pih than in normal pregnancy: compared with control group, the ratial of Pi/Ti was obviously higher in mild Pih or middle Pih or severe Pih. Among Pih groups, it had no significant statistical difference between severe Pih and middle Pih or between middle Pih and mild Pih, but it was obviously higher in severe Pih than mild Pih. The median insulin sensitivity index was significantly lower in Pih than in normal pregnancy: compared with control group , the concentration of leptin was obviously lower in mild Pih or middle Pih or severe Pih. Among Pih groups, it also had significant statistical difference. 3. The correlation of lptin showed significant correlation with proinsulin and negativity correlation with insulin sensitivity index. Conclusions:1. There was hyperinsulinmia in Pih. With the development of Pih, proinsulin was increasing, but true insulin was not changed. It showed that hyperinsulinmia was actually hyperproinsulin, not hypertrueinsulinmia. 2. There was hyperleptinmia in Pih also, so leptin and proinsulin were close to Pih. From the study,we could conclude leptin and proinsulin may be
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