First trimester insulin resistance and subsequent preeclampsia:: A prospective study
First trimester insulin resistance and subsequent preeclampsia:: A prospective study
复制标题
DOI：
10.1210/jc.87.4.1563
复制
发表时间：
2002-04-01
影响因子：
5.8
通讯作者：
Thadhani, R
中科院分区：
文献类型：
--
作者：
Wolf, M;Sandler, L;Thadhani, R
胰岛素抵抗与先兆子痫的发病机制有关，但前瞻性数据有限。 SHBG 是非怀孕个体胰岛素抵抗的标志物，尚未在怀孕期间进行详细研究。我们进行了一项前瞻性、巢式、病例对照研究，以检验以下假设：胰岛素抵抗增加（以妊娠早期 SHBG 水平降低为标志）与随后先兆子痫风险增加相关。研究人员测量了 45 名随后出现先兆子痫（血压大于或等于 140/90 mm Hg；蛋白尿，通过试纸检测大于或等于 2+，或妊娠 20 周后大于或等于 300 mg/24 小时）的 45 名未产妇以及随机选择的 90 名血压正常的未产妇对照者的妊娠早期 SHBG 水平。与对照组相比，患有先兆子痫的女性妊娠早期 SHBG 水平显着降低（302 +/- 130 vs. 396 +/- 186 nmol/L；P < 0.01）。 SHBG 每增加 100 nmol/L，先兆子痫风险就会降低 31% [比值比 (OR)，0.69；比值比 (OR)，0.69； 95%置信区间（CI），0.55，0.88； P<0.011。调整多重 Logistic 回归模型中的协变量后，妊娠早期 SHBG 与先兆子痫之间的关联仍然显着（每增加 100 nmol/L；OR，0.66；95% Cl，0.47、0.92；P = 0.01）。当按体重指数对受试者进行分层时（瘦：体重指数 = 25 kg(m(2)），超重女性的 SHBG 水平低于瘦女性（286 +/- 156 对比 410 +/- 166 nmol/ 升；P < 0.01），并且在每个分层中，先兆子痫女性的 SEEG 水平低于各自的对照组。在多变量分析中，SHBG 与 在瘦女性中，先兆子痫的发生率增强，血清 SHBG 每增加 100 nmol/L，子痫前期风险就会降低 55%（OR，0.45；95% CI，0.27，0.77；P < 0.01），而在超重女性中，这种关联有所减轻（OR，1.02；95% CI，0.62，1.69；P）。 = 0.9）。我们 得出的结论是，妊娠早期胰岛素抵抗增加与随后的先兆子痫独立相关。妊娠早期 SHBG 水平可能是先兆子痫的一个有用的生物标志物，特别是对于那些被认为处于低风险的瘦女性。
Insulin resistance is implicated in the pathogenesis of pre-eclampsia, but prospective data are limited. SHBG, a marker of insulin resistance among nonpregnant individuals, has not been studied in detail during pregnancy. We conducted a prospective, nested, case-control study to test the hypothesis that increased insulin resistance, marked by reduced first trimester SHBG levels, is associated with increased risk of subsequent preeclampsia. First trimester SHBG levels were measured in 45 nulliparous women who subsequently developed preeclampsia (blood pressure, greater than or equal to140/90 mm Hg; proteinuria, either greater than or equal to2+ by dipstick or greater than or equal to300 mg/24 h, after 20 wk gestation) and in 90 randomly selected normotensive nulliparous controls. Compared with controls, women who developed preeclampsia had significantly reduced first trimester SHBG levels (302 +/- 130 vs. 396 +/- 186 nmol/liter; P < 0.01). Every 100 nmol/liter increase in SHBG was associated with a 31% reduced risk of preeclampsia [odds ratio (OR), 0.69; 95% confidence interval (CI), 0.55, 0.88; P < 0.011. After adjusting for covariates in a multiple logistic regression model, the association between first trimester SHBG and preeclampsia remained significant (per 100 nmol/liter increase; OR, 0.66; 95% Cl, 0.47, 0.92; P = 0.01). When subjects were stratified by body mass index (lean: body mass index, = 25 kg(m(2)), overweight women had lower SHBG levels than lean women (286 +/- 156 vs. 410 +/- 166 nmol/ liter; P < 0.01), and within each stratum, women with pre-eclampsia had lower SEEG levels than their respective controls. In a multivariable analysis, the association between SHBG and preeclampsia strengthened among lean women, such that every 100 nmol/liter increase in serum SHBG was associated with a 55% reduction in the risk of preeclampsia (OR, 0.45; 95% CI, 0.27, 0.77; P < 0.01), whereas in overweight women, the association was mitigated (OR, 1.02; 95% Cl, 0.62, 1.69; P = 0.9). We conclude that increased early pregnancy insulin resistance is independently associated with subsequent preeclampsia. First trimester SHBG levels may be a useful biomarker for preeclampsia, especially among lean women who otherwise would be perceived to be at low risk.