关键词: 糖尿病, 妊娠, 胰岛素抵抗, 糖脂代谢

Abstract: Objective  To detect the changes of plasma Visfatin levels in gestational diabetes mellitus(GDM) patients at different gestational weeks, and to analyze its clinical significance. 
Methods  The pregnant women systematically examined in our hospital were selected as the research subjects. All pregnant women enrolled underwent oral glucose tolerance test(OGTT) from 24 to 26 weeks of gestation; 40 cases diagnosed with GDM were assigned to GDM group, and 40 cases with normal glucose tolerance(NGT) to NGT group. The plasma Visfatin levels in the two groups were determined by ELISA at 24-26 weeks of gestation, and the GDM group was subdivided into the high Visfatin subgroup(n=20) and low Visfatin subgroup(n=20) according to the median Visfatin. Glycolipid metabolism indexes were detected and Homeostasis model assessment insulin resistance(HOMA-IR) was calculated. The plasma Visfatin was measured at 31-33 weeks and 38-40 weeks of gestation, and the neonatal body mass and body length were recorded to calculate ponderal index. 
Results  The plasma Visfatin level in high Visfatin subgroup, low Visfatin subgroup of the GDM group and NGT group were increased with the increase of gestational age(P＜0.05). The plasma Visfatin level in high Visfatin subgroup of GDM group was higher than that in the low Visfatin subgroup at 24-26 weeks of gestation, and the level in low Visfatin subgroup was higher than that in the NGT group(P＜0.05). There was no statistically difference of Visfatin level at 31-33 weeks and 38-40 weeks of gestation among high Visfatin subgroup, low Visfatin subgroup and NGT group(P＞0.05). The pregnant fasting glucose, glycosylated hemoglobin, fasting insulin, HOMA-IR as well as triglyceride, total cholesterol, low density lipoprotein cholesterol at 24-26 weeks of gestation in high Visfatin subgroup were higher than that of low Visfatin subgroup, and the above indicators were higher in low Visfatin subgroup than in NGT group(P＜0.05); the plasma high-density lipoprotein cholesterol at 24-26 weeks of gestation was lower in high Visfatin subgroup than in low Visfatin subgroup, and the level was lower in low Visfatin subgroup than in NGT group(P＜0.05). Pearson correlation analysis showed that plasma Visfatin in GDM group was positively correlated with HOMA-IR(r=0.429, P=0.036) at 24-26 weeks of gestation, HOMA-IR(r=0.568, P=0.025) at 31-33 weeks of gestation, and HOMA-IR(r=0.672, P=0.003) at 38-40 weeks of gestation. The neonatal body mass and ponderal index in high Visfatin subgroup of GDM group were higher than that of the low Visfatin subgroup, which were higher in the low Visfatin subgroup than in the NGT group(P＜0.05). 
Conclusion  The plasma Visfatin is increased with the increase of gestational age. The plasma Visfatin at 24-26 weeks of gestation in patients with GDM is higher than that of NGT pregnant women. Visfatin at 24-26 weeks of gestation is related to the disorder of glucose and lipid metabolism and promotes fetal intrauterine development in patients with GDM.

Key words: diabetes, gestational, insulin resistance, glucose and lipid metabolism