关键词: 糖尿病, 妊娠, Apelin, 胰岛素抵抗, 葡萄糖代谢障碍

Abstract: Background　Gestational diabetes mellitus （GDM） is one of the most common complications in pregnancy.Studies have found that a novel fat factor Apelin，the endogenous ligand of APJ receptor，is closely related to insulin resistance and participates in the process of glucose metabolism in vivo.Objective　To investigate the serum Apelin level and its possible role in glycolipid metabolism in GDM patients.Methods　From Department of Endocrinology，the First Affiliated Hospital of Anhui Medical University，196 pregnant women at 24-32 weeks of gestation were enrolled from October 2018 to May 2019.Data were recorded，including general demographic information，glycemic parameters measured by the 2-hour 75-gram oral glucose tolerance test （OGTT） 〔fasting blood glucose（FBG），1-hour postprandial glucose （1 hBG），2-hour postprandial glucose （2 hBG）〕，insulin response parameters measured by the 2-hour insulin response test （IRT）〔fasting insulin（FINS），1-hour postprandial insulin （1 hINS），2-hour postprandial insulin （2 hINS） 〕，and parameters of C-peptide〔fasting C-peptide（FCP），1-hour postprandial C-peptide（1 hCP），2-hour postprandial C-peptide（2 hCP）〕，serum lipid parameters（TC，TG，HDL-C and LDL-C），and calculated HOMA-IR，homeostasis model assessment of β-cell function （HOMA-β），insulin sensitivity index （ISI） modified beta-cell function index（MBCI），glucose AUC（AUC-G），insulin AUC（AUC-I），and ELISA-detected fasting serum Apelin.The Apelin level and glycolipid metabolism parameters were analyzed between those with normal and abnormal glucose metabolism（NGT and GDM groups，98 cases respectively） stratified by OGTT results，and were further analyzed between those with normal and higher LDL-C in NGT group（NGT-NL and NGT-HL subgroups，44 cases and 54 cases respectively） and in GDM group（GDM-NL and GDM-HL subgroups，49 cases respectively），respectively.Results　Compared with NGT group，GDM group showed higher average levels of FBG，1 hBG，2 hBG，FINS，1 hINS，2 hINS，FCP，2 hCP，HOMA-IR，AUC-G，and AUC-I，but lower average HOMA-β and ISI （P<0.05）.They also showed significantly lower average serum Apelin level （P<0.001）.GDM patients with normal LDL-C had lower average level of serum Apelin than NGT patients with normal or higher LDL-C（P<0.05），so did GDM patients with higher LDL-C （P<0.05）.Pearson correlation analysis showed that serum Apelin was negatively correlated with pre-pregnancy BMI，FBG，1 hBG，2 hBG，FINS，2 hINS，FCP，1 hCP，2 hCP，HOMA-IR，AUC-G，and AUC-I （P<0.05），but was positively correlated with ISI （P<0.05）.Multivariate Logistic regression analysis showed that Apelin was the influencing factor of GDM 〔OR=0.977，95%CI（0.964，0.990），P<0.001〕.Conclusion　Apelin level is negatively correlated with insulin resistance in advanced stages of pregnancy. The serum Apelin level in GDM patients is significantly reduced，and Apelin is the influencing factor of GDM in advanced stages of pregnancy.Apelin may be involved in the glucose metabolism of GDM.

Key words: Diabetes, gestational；Apelin；Insulin resistance；Glucose metabolism disorders