The Relationship Between Tumor Necrosis Factor-α, Its Soluble Receptors And Insulin Resistance In The Patients With Gestational Diabetes Mellitus

Objective To investigate the pathophysiological role of tumor necrosis factor -α(TNF-α) and its soluble receptors(sTNFR-1,sTNFR-2) in pregnant insulin resistance (IR) in the patients with gestational diabetes mellitus and to learn the relationship between TNF-α,sTNFR-1,sTNFR-2 and BMI. Methods 10 age-matched healthy non-pregnant women, 40 healthy pregnant women(11 of them in the first trimenon,14 in the second trimenon and 15 in the third trimenon) and 40 women with gestational diabetes mellitus (14 of them in GIGT, 26 in GDM) have been involved in the study . fasting serum TNF-α,sTNFR-1,sTNFR-2 were detected by ELISA,C-peptide (C-P), Insulin (FINS) by RIA and fasting blooding glucose (FBG) by glucose oxidase method .At the same time height ,weight before and after pregnancy,circumference of hip and thigh were examined ,Then index of insulin resistance and body mass was calculated. The relationship between TNF-α,sTNFR-1, sTNFR-2 and IRI,BMI was analized. Results All studied parameters in non-pregnancy, the first trimenon, the second trimenon, the third trimenon , GIGT , GDM were respectively followed: TNF-α 31.8±12.0 34.7±14.1 49.9±18.3 69.5±9.3 89.9±15.4 99±22.7pg/ml, sTNFR-1 906.8±130.8 1024.0±98.7 1167.7±63.0 1186.9±83.7 1192.9±65.2 1174.7±111.7 pg/ml,sTNFR-2 66.3±17.9 82.9±19.5 104.4±19.7 140.9±24.6 202.9±24.6 205.9±57.5pg/ml, BMI 21.2±1.4 21.3±1.8 23.6±2.3 25.4±1.6 27.3±2.2 27.8±1.5kg/m2, IRI 0.19±0.06 0.20±0.15 0.32±0.22 0.61±0.26 0.93±0.23 1.02±0.42。In healthy pregnancy in the third trimenon the studied parameters of serum TNF-α, sTNFR-2,BMI , IRI were all significantly higher (P<0.01) than non-pregnancy, the first trimenon and the second trimenon. In gestational diabetes mellitus (GIGT and GDM) these values were even higher than in any subgroups of healthy pregnancy (P<0.01).Significant (P<0.01) positive linear correlations were found in gestational diabetes mellitus between TNF-α, sTNFR-2, BMI and IRI( r=0.632,0.494,0.479 P<0.05),While serum sTNFR-1 level was not associated with IRI(r=0.185 P>0.05). In gestational diabetes in multiple linear stepwise regression analysis studying the dependency of IR the parameters BMI, TNF-α, sTNFR-2 were all significant (P<0.05) .Conclusion Firstly,TNF-αand sTNFR-2 play an important pathophysiological role in pregnant insulin resistance in gestational diabetes mellitus (GIGT and GDM) . Secondly,significant positive linear correlations were found in gestational diabetes mellitus among BMI,TNF-αand IRI. Finally,TNF-αdidn't completely depend on BMI in pregnancy , That the pregnant women in china are not as obesity as foreigner and TNF-αpartially comes from placenta perhaps could explain it.