孕早期内脏脂肪通过调节脂肪源性外泌体miRNA-148家族影响妊娠期糖尿病发生风险的队列研究

前期工作发现孕妇内脏脂肪（VF）与体质指数（BMI）相关性低，VF与BMI相比可更好反映全身脂肪的分布，可能更加精确的反映妊娠期糖尿病（GDM）的发生风险。VF调节脂肪源性外泌体miRNA-148家族引起胰岛素抵抗可能是肥胖导致GDM发病的重要机制。目前此类研究极为有限，故本项目拟进行前瞻性队列研究，确定孕早期VF调节脂肪源性外泌体miRNA-148家族在GDM的发病机制。（1）对孕4-12周孕妇行超声检查，测量VF，评价VF与BMI对GDM的影响，选择合适的肥胖指标；（2）对孕20周脂肪源性外泌体miRNA分离提取技术，完成GDM孕妇与非GDM孕妇之间的miRNA-148家族miRNA表达量的差异，采用中介分析研究孕早期VF调节脂肪源性外泌体miRNA-148家族影响GDM。研究结果有助于对VF及脂肪源性外泌体miRNA对GDM发病作用理解，有效筛查GDM的高危孕妇，对其提供干预指导。

Based on preliminary work, we found that there was a low correlation between visceral fat (VF) and body mass index (BMI) in pregnant women. Visceral fat can be better reflect the central distribution of body fat, may be more accurate in predicting the risk of gestational diabetes mellitus. The visceral fat may affect the gestational diabetes mellitus by regulating the adipose-derived exosome miRNA-148 family. (1) We use ultrasonography to measure the visceral fat at 4-12 weeks of pregnancy, to evaluate the effect of visceral fat and body mass index on GDM, and select the appropriate indicators of obesity; (2) Extracting the miRNA-148 family of exosomes derived from adipose tissue, analysis the expression of miRNA-148 family between pregnant women with gestational diabetic and normal pregnant women, mediation analysis is an application of causal modeling, screening the appropriate exosomal miRNA-148 family and explore the mechanism of visceral fat affecting gestational diabetes mellitus. The results of this study will help to understand the pathogenesis of gestational diabetes mellitus, screening high-risk pregnant women with gestational diabetes, and provide technical support and effectively guide clinical practice.