妊娠期血清vaspin水平变化及其与妊娠期糖尿病发病关系的前瞻性队列研究

Gestational diabetes mellitus (GDM) is an important pre- disease of type 2 diabetes mellitus (T2DM). As a new adipocytokine possessing insulin sensitizing effect, vaspin is closely related to T2DM development. However, the association between vaspin and GDM remains to be urgently researched. Prospective cohort study design method was used to ascertain the impact of maternal serum vaspin level during pregnancy on GDM risk in Chinese women. 2000 pregnant women at week 8 were recruited in the cohort as baseline population. The follow-up survey will be conducted at different phases during pregnancy with closing monitoring of GDM incidence. The changes in serum vaspin level at different phases of gestation and the relation between serum vaspin and insulin resistance are described. Combined with information of personal history, pregnancy history, family history, history of diseases and physical activities, the interactive effects of above-mentioned risk factors and maternal serum vaspin during pregnancy on risk of GDM are comprehensively analyzed. The present study would provide important prospective population evidences for etiology research of GDM and its risk predictor screening in early pregnancy. Our findings would provide theoretical guidance for GDM prevention and control, so as to promote maternal and child health.

妊娠期糖尿病(gestational diabetes mellitus，GDM)是2型糖尿病的重要前驱疾病。vaspin作为一种具有胰岛素增敏作用的新型脂肪因子，与2型糖尿病发生发展密切相关，但其与GDM发病的关系亟待研究。本项目采用前瞻性队列研究的方法，以孕8周为起点入选2000例妊娠妇女为基线人群，建立前瞻性妊娠队列，随访研究对象孕期健康状况，检测孕期不同阶段血清vaspin水平，监测GDM发病情况，描述母体孕期血清vaspin水平变化及其与胰岛素抵抗的相关性，结合研究对象个人史、孕产史、家族史、疾病史、体力活动等多种危险因素信息，综合分析血清vaspin与GDM发病风险的关联，探讨血清vaspin与相关危险因素在GDM发生中的交互作用，为GDM病因学研究及妊娠早期GDM风险预测指标的筛选提供重要的前瞻性人群证据，从而为我国GDM发病的预防控制提供重要的理论指导依据，促进母婴健康。

研究目的：描述妊娠女性血清vaspin因子在孕期不同阶段的变化特点，检验血清vaspin因子水平与妊娠期糖尿病（gestational diabetes mellitus, GDM）发病的关联。研究方法：采用前瞻性队列研究结合巢式病例对照研究的方法，选择在孕期随访中发生GDM的30例，按照年龄和BMI进行1:1配对选择相应对照30例，调用孕8-12周，孕24周，孕32周和孕36周血清样本，进行不同孕周阶段血清vaspin因子水平检测，分别描述病例组和对照组vaspin水平的变化特点。利用巢式病例对照研究设计的方法，选择孕期随访中发生GDM的330例和按年龄、BMI进行1:1匹配选择对应的330例健康孕妇作对照，调用孕早期8-12周血清样本，进行基线vaspin因子检测，比较病例组和对照组的差别。将孕早期vaspin因子水平按照四分位分组，采用logisitic回归模型，以GDM占比最低的第二分位组为参照组，分别计算vaspin因子其余分位组GDM发病的OR值及相应的95%CI。结果：血清vaspin水平在孕早期最高，孕中期有所下降，到孕晚期再次上升，GDM病例组和对照组的变化特点类似。孕早期vaspin因子平均水平在GDM组高于对照组但未达到统计学显著水平（0.44（0.29-0.78）vs 0.41（0.31-0.60））。多因素分析结果显示，以vaspin水平第二分位[0.30,0.42)ng/ml组为参照组，孕早期血清vaspin水平第一分位<0.30ng/ml组和第四分位≥0.69ng/ml组发生GDM的风险均升高，OR（95%CI）为1.70（95%CI 1.08-2.70）和2.09（95%CI 1.33-3.31）。结论：孕早期血清vaspin水平过高或过低均可增加妊娠女性发生GDM的风险，表明孕早期血清vaspin水平对GDM的发生风险有一定预测价值。