Study On The Relationship Between The Sex Hormone-binding Globulin And Gestatiozal Diabetes Mellitus In Cord Blood And Amniotic Fluid

PrefaceGDM is the varying degree sugar metabolism which is refers formerly the womanwho doesnot have the diabetes also not to have the sugar torelance to decrease and thegestation period initial contact or occurs to be unusual. GDM seriously threatens thefemale infant health, also hasthe long term influence to the patient and their thechildren.The degree of the gestation period insulin resistance (IR) increase is positivlycorrelated with GDM. Sex hormone-binding globulin(SHBG), a kind of glucoprotein。is pro-duced by liver, which can differentially combine with sex hormone,participatein its transport, and modify the concentration of bioactive sex hormone. Itslevel is regulated by many hormones such as sex hormone, thyroid, prolactin, insulinand so on. It's showed in present study that SHBG is a risk factor of diabetes mellitus.The structure of IGF-Ⅰand insulin is similar to the single-chain alkaline more skin,its structure has 45% similarity with insulin, It has function of promotion of growth anddevelopment for material metabolism and falling blood glucose. The mother and thefetus are two relatively independent systems. Fetal circulation of IGF-Ⅰfrom theplacenta and fetus, the regulation of IGF-Ⅰplay a major role in fetal growth anddevelopment. GDM also concerns with the growth hormone-insulin -insulin typegrowth factor axis disorders.Therefore, we have further discussed the relations betweentthe insulin-like growth factor-Ⅰ(IGF-Ⅰ) and the insulin and the GDM. At presentSHBG and IGF-Ⅰin adults have many of expression, but expressed concern about fetal rarely. Our objective:(1) To compare GDM pregnant with normal woman's embryo inamniotic fluid glucose insulin level and SHBG level,to know about the level of theexistence of differences.(2)To Discusse the relatity among SHBG with IGF-Ⅰandthe risk factor of GDM such as amniotic fluid glucose,insulin levels,newbornbody weight,thereby to find a sensitive index to predict the development and progressof GDM. (3) Through examining the level of fluid glucose, insulin, SHBG andinsulin type growth factor in amnio fluid, we can find a routine screening GDMsensitive indicators. Thus we seeks toindicate GDM arises and development of a moresensitive indicator.Methods1. experimental groupingThe experiment includes two groups: The fetus of pregnant women in 36-41gestational age 60 cases 1) the fetus of diabetic pregnant women 30 cases andnormal the fetus of pregnant women 30 cases .2) By weight the fetus into three groups:＜2500g is less than for embryo age (SGA) 12 cases Which GDM 5 cases and thecontrol group 7 cases; 2500g-4000g is suitable for the embryo age (AGA) 30cases(GDM 13 examples, comparison group 7 examples);≥4000g is bigger than theembryo age (LGA), 18 cases. Which GDM 12 cases and the control group 7 cases.2. collecting sampleWe surrogated 10-12 hour fasting blood from the female elbow with 2 ml, weused the hexokinase method to measuring blood glucose immediately. Neonatalcord blood, fetal placenta is delivered after clamping the umbilical cord ends, the twoends of the umbilical cord in the center immediately with 5 ml syringe piercingumbilical vein to take 5ml. Geostationary an hour later, the 2000 switch/min, 10minutes, centrifugal precipitation, supernatant from -80℃at low temperature to keepthe refrigerator for the same batch testing SHBG. We collected 2 tuble(5ml)of the theamniotic fluid of pregnant women in obstetric ambu-lant clinic and ward, It was at rest and acentried for 1 hour, one for being kept in一20℃refrigeratory for measuringamniotic fluid glucose, the other being kept in一80℃refrigeratory for measuringInsulin,SHBG,IGF-Ⅰ. and the data of patients(age stature,avoirdupois,pressure)andNewborn (The height, the head encircles, body weight).3.index measureMeasure amniotic fluid SHBG and amniotic fluid IGF-Ⅰconcentration by ELIsa.Measure the amniotic fluid glucose and fasting blood gluse by the method ofglucose oxidation enzyme. Measure the amniotic fluid insulin by the method ofSolid-phase RIA.4. statistics the analysisthe data is analysed by SPSS10.0 statistic software, the compare between twogroup adopt t-test, the relation of two variables adopt beeline correlation analy.Result1. GDM surrogate fasting glucose was significantly higher than normal surrogate。Thelevel of fetus SHBG in amniotic fluid and Cord blood was significan lowercompared with that of normal fetus. The difference is remarkable(P＜0.05). Theconcentration of the amniotic fluid glucos and the amniotic fluid insulin in the fetusof pregnant women with GDM,was significantly higher than those in the fetus ofnormal pregnant women(P＜0. 05)。Weight newborns is significant difference.2. By weight the fetus into three groups:＜2500g is less than for embryo age (SGA)12cases; 2500g-4000g is suitable for the embryo age (AGA) 30 cases;≥4000g isbigger than the embryo age (LGA), 18 cases. Different groups of the level ofamniotic fluid IGF-Ⅰ, insulin amniotic fluid, amniotic fluid glucose was statisticallysignificant (P＜0.01, P＜0.05)。The amniotic fluid SHBG concentration in the fetusof diabetic pregnant women was significan lower compared with the fetus of normalpregnant women in the group of SGA, AGA and LGA. The amniotic fluid IGF-Ⅰconcentration in the fetus of diabetic pregnant women was significan higher compared with the fetus of normal pregnant women in the group of SGA, AGAand LGA.The concentration of the amniotic fluid glucos and the amniotic fluidinsulin in the fetus of pregnant women with GDM,was significantly higher than thosein the fetus of normal pregnant women(P＜0. 05) in the group of SGA, AGA andLGA.3.In the control group Amniotic fluid IGF-Ⅰin the control group and birth weight werepositively correlated (r=0.68 P＜0.001). Amniotic fluid IGF-Ⅰin the control groupSGA, AGA and LGA were 60.45±8.77 ng/m L, 75.96±10.21ng/mL, 93.76±14.08ng/mL. Compared with the AGA group, Amniotic fluid IGF-Ⅰlevels in SGAgroup was significantly lower (t=4.65, P＜0.01), in LGA group was significantlyhigher (t=7.84, P＜0.01).4.In GDM Group amniotic fluid IGF-Ⅰlevels and birth weight were positively correlated(r=0.32 P＜0.001). Amniotic fluid IGF-Ⅰin the GDM group SGA, AGA and LGAwere81.67±9.98 ng/m L, 108.78±11.32 ng/mL, 128.26±13.76ng/mL.Compared with the AGA group, Amniotic fluid IGF-Ⅰlevels in SGA group wassignificantly lower (t=4.73, P＜0.01), in LGA group was significantly higher (t=7.88 P＜0.01).Cloclusion1. GDM surrogate fasting glucose was significantly higher than normal surrogate。Theamniotic fluid SHBG concentration in the fetus of diabetic pregnant women wassignifican lower compared with the fetus of normal pregnant women. Compared withthe control group, the levels of amniotic fluid glucose and insulin amniotic fluid inGDM group increased significantly. Amnio centesis in fetal associated diseasesurveillance, can detect amniotic fluid glucose, nsulin levels in amniotic fluid andamniotic fluid levels of SHBG, This kind of detection can be GDM conventionalscreening tests. In order to find GDM happen in the future,the combined detection isrelatively sensitivity than separate detection of amniotic fluid detection glucose orinsulin levels in amniotic fluid. 2. The amniotic fluid SHBG concentration in the pregnant women with GDM wassignificantly reduced, Through detecting the level of the amniotic fluid SHBGcould be predicted a potential risk of GDM happening, and determine fetaldevelopment.3. The amniotic fluid IGF-Ⅰconcentration in the pregnant women with GDM wassignificantly increased, IGF-Ⅰand birth weight was positively correlated, amnioticfluid IGF-Ⅰlevels can be used as indicators of fetal growth and development.