探讨孕中期血清脂联素(APN)及胰岛素水平与子痫前期(PE)的相关性。

随机选择2009年7月至2010年7月在本院接受产前检查的300例单胎孕妇为研究对象，对其妊娠经过及妊娠结局进行随诊。其中，31例孕晚期时发展为PE，被纳入PE组。对PE组患者按照PE病情分度，将重度子痫前期(SPE)患者纳入SPE组(n＝18)，轻度子痫前期(MPE)患者，纳入MPE组(n＝13)，将同时纳入研究孕晚期仍正常的单胎妊娠妇女30例纳入对照组。于24～28孕周时，对SPE组、MPE组和对照组受试者采用放射免疫法(RIA)测定血清APN、胰岛素及其他相关指标，并进行相关分析。SPE组、MPE组与对照组，SPE组与MPE组孕妇年龄、孕龄及孕前体重指数(BMI)比较，差异无统计学意义(P>0.05)(本研究遵循的程序符合本院人体试验委员会所制定的伦理学标准，得到该委员会批准，分组征得受试对象本人的知情同意，并与之签署临床研究知情同意书)。

①SPE组、MPE组与对照组血清APN水平呈上升趋势，SPE组较对照组明显降低，差异有统计学意义(P<0.01)；SPE组与MPE组、MPE组与对照组比较，差异无统计学意义(P>0.05)。②3组孕妇孕中期空腹血糖(FBG)，总胆固醇(TC)，甘油三酯(TG)，低密度脂蛋白胆固醇(LDLC)和高密度脂蛋白胆固醇(HDLC)水平比较，差异均无统计学意义(P>0.05)。③3组孕妇的血清胰岛素比较，SPE组较对照组明显升高，差异有统计学意义(P<0.01)，SPE组与MPE组、MPE组与对照组比较，差异无统计学意义(P>0.05)。④SPE组血清APN与胰岛素呈负相关(r＝－0.50，P<0.01)，其他两组血清APN与胰岛素无相关性(r＝0.33, r＝－0.02；P>0.05)。SPE组血清APN与收缩压、舒张压呈负相关(r＝－0.97，r＝－0.94；P<0.01)，与TG呈负相关(r＝－0.63, P<0.01)，与HDLC呈正相关(r＝0.54，P<0.05)，与TC和LDLC无相关关系(r＝0.03, r＝0.18；P>0.05)。SPE组血清胰岛素与收缩压呈正相关(r＝0.90，P<0.05)，与TC和TG呈正相关(r＝0.59, r＝0.73；P<0.01)。MPE组血清APN与TG呈负相关(r＝－0.71，P<0.01)，血清胰岛素与TG呈正相关(r＝0.58，P<0.05)。

孕中期血清低APN及高胰岛素血症与PE密切相关。

To study the correlation among the levels of adiponectin(APN), insulin and preeclampsia (PE) in the second trimester of pregnancy.

From July 2009 to July 2010, a total of 300 cases with 24-28 gestational weeks were included into this study. They were divided into PE group (n=31) and control group (n=30) according to gestational outcomes. PE group were further divided into severe preeclampsia group (SPE group, n=18) and mild preeclampsia group (MPE, n=13) according to the degrees of PE. The levels of serum APN and insulin were measured by radioimmunoassay (RIA). The blood pressure and blood lipids were also measured. The correlation of the levels of serum APN, insulin, blood pressure and blood lipids were analyzed. There had no significant difference of age, gestational age and body mass index (BMI) before pregnancy between SPE group, MPE group and control group, also between SPE group and MPE group (P>0.05). The study protocol was approved by the Ethical Review Board of Investigation in Human Being of the Second Affiliated Hospital of Qingdao Medical University. Informed consent was obtained from all participants.

①An increasing trend was found in the level of serum APN from SPE group, also between MPE group and control group. The level of serum APN in SPE group significantly decreased than that of control group (P<0.01). But no significant difference was found between SPE group and MPE group, MPE group and control group (P>0.05). ② There had no significant difference of fasting blood sugar (FBG), total cholesterol (TC), triglycerides (TG), low density lipoproteins-cholesterol (LDLC) and high density lipoproteins-cholesterol (HDLC) in three groups (P>0.05). ③The insulin level was significantly higher in SPE group than that in control group (P<0.01). But no difference was found between SPE and MPE groups (P>0.05), also between MPE and control group (P>0.05). ④ In SPE group, negative correlation was shown between the levels of APN and insulin (r=-0.50, P<0.01), no correlation was found in MPE and control group (r=0.33, r=-0.02; P>0.05). In SPE group, negative correlation was also shown between the levels of APN and blood pressure (r=-0.97, r=-0.94; P<0.01) and TG(r=-0.63, P<0.01). Positive correlation was shown between the levels of APN and HDLC (r=0.54, P<0.05). No correlation was shown between the levels APN and TC and LDLC (r=0.03, r=0.18; P>0.05). Positive correlation was detected between the level of insulin and systolic pressure, TC and TG(r=0.90, P<0.05; r=0.59, P<0.01; r=0.73, P<0.01). In MPE group, negative correlation was shown between the level of APN and TG(r=-0.71, P<0.01), positive correlation was shown between insulin and TG(r=0.58, P<0.05).

Lower APN and higher insulin might be associated with the pathogenesis of PE in the second trimester of pregnancy.