Study On The Relationship Between Glucose Metabolism And Bone Metabolism In Women During Pregnancy

Along with the rapid economic development and continuous social progress,people's lifestyles have undergone tremendous changes.The prevention of diseases has entered people's horizons,and the pursuit of high-quality physical health has become a general tendency.Diabetes and osteoporosis are common metabolic disorders,and the relationship between the two is complex.The risk of bone fracture in patients with type 2 diabetes is much higher than that in healthy people.In recent research articles,the risk of diabetes in patients with bone metabolic disorder also increased significantly.Different scholars have published different opinions on the interaction between human glucose metabolism and bone metabolism and how they interact.Glucose metabolism is mainly regulated by the following two aspects in the body.One is by regulating the secretion function of pancreatic beta cells and the change of insulin release quantity as a result,the other is by regulating the target organs`sensitivity on insulin.Substances resisting insulin in pregnant women?such as mammotrophin in human placent,progestational hormone,etc.?are secreted increasingly,so that it leads to a physiological state of insulin resistance by pregnant women.The degree of insulin resistance increases rapidly in the second trimester and remains stabile relatively in the late pregnancy,which can recover automatically in the postpartum women.This special glucose metabolism state during gestation period provides a good model for studying the mechanism of the interaction between the glucose metabolism and the bone metabolism.Before pregnancy with normal glucose metabolism or potential impaired glucose tolerance,Gestational diabetes mellitus appear or is diagnosed during their pregnancy.It doesn`t include the cases that had been diagnosed GDM before pregnancy.The incidence rate of gestational diabetes mellitus is 1%to6%^[12].In recent years,the incidence of gestational diabetes has increased significantly,even as high as 14.2%^[3]or 17.5%^[4]by some reports.In the preceding phase of the study,we found that insulin resistance in pregnant women in the second trimester and the late pregnancy is positively correlated with the bone metabolism markers including the bone synthesis metabolism,the bone turnover rate and the bone catabolism.Furthermore,the correlation is significantly greater in patients with diabetes during pregnancy,which hints that the insulin resistance index of the peripheral organ is closely relative with the hyperfunction of bone synthesis metabolism and catabolism.Insulin index Resistance can only reflect the sensitivity of target organ on insulinaction.In order to find out further the correlation of the secretion function of the pancreas beta cell and the markers of the bone metabolism in the second trimester and the late pregnancy,we carried out the first part of this study.It is relatively longer for the insulin resistance in pregnant women in perinatal period.The bone metabolism status is of utmost importance on the development of the fetal bone.In order to find out the correlation of the insulin resistance index and the bone metabolism markers for pregnant women in perinatal period,we carried out the second part of this study.As a follow-up study,the ultimate aim was to investigate the changes between the glucose metabolism and the bone metabolism of the patients with GDM,and the possible interaction mechanism of both.Part ?:Study on the Correlation between Two Kinds of Pancreatic Beta-cells Function Index and Bone Metabolic Markers in the Late Second Trimester Pregnant WomenObjective:To investigate the relationship between two pancreatic beta-cells functional index and the level of bone metabolism markers such as total type 1procollagen,osteocalcin and beta collagen sequence in the late stage of the second trimester of pregnancy.Methods:Pregnant women of the late stage of the second trimester of pregnancy?from 24 to 26 weeks?were selected,excluding pregnant women with prenatal gestational age less than 24 weeks or more than 26 weeks and 6 days,multiple pregnancy,severe cardiovascular and liver disease,infection in the recent period,diabetes and bone metabolism diseases diagnosed before pregancy.The selected pregnant women totaled 135 cases.Fasting and postprandial blood glucose,fasting insulin,fasting C peptide,total type 1 procollagen amino terminal propeptide,N-terminal osteocalcin,beta-CrossLaps level were measured.The blood glucose was measured by the glucose oxidase method and the others were measured by chemiluminescence analyzing methods.The correlation between pancreatic beta-cells functional index and the level of bone metabolic markers were compared.At the same time,if fasting,postprandial 1H or 2h postprandial blood glucose respectively is greater than or equal to 5.1 mmol/l,10 mmol/l,8.5 mmol/l?one of the three meets?,the selected pregnant women were divided to two groups.One was GDM group?51 cases?and the other was control group?84 cases?.The static beta cell function index HOMA-B=[20*fasting insulin?mU/L?]/[fasting blood glucose?mmol/L?-3.5];the dynamic beta cell function index MBCI=[fasting insulin?mU/l?*fasting blood glucose?mmol/L?]/[postprandial blood glucose 1h?mmol/L?+postprandial blood glucose 2h?mmol/L?-2*fasting blood glucose?mmol/L?].Results:The correlation coefficient of static pancreatic island beta-cell function index and total type 1 procollagen amino terminal propeptide,N-terminal osteocalcin and beta-CrossLaps level in late pregnancy was-0.115,-0.021 and-0.078 respectively,which was not statistically significant?p>0.05?.The correlation coefficient of the dynamic beta cell function index and total type 1 procollagen amino terminal propeptide and beta-CrossLaps level was-0.242?p=0.005?and-0.277?p=0.001?respectively,which was weak negative correlation.The correlation coefficient of the dynamic beta cell function index and total type 1procollagen and N-terminal osteocalcin in the gestational diabetes group was-0.418?p=0.002?and-0.365?p=0.008?respectively,which was a low negative correlation.And the correlation coefficient of the dynamic beta cell function index and beta-CrossLaps level was-0.560?p<0.001?,which was a moderately negative correlation.Conclusion:The correlation of the static pancreatic island beta-cell function index and the three kinds of markers of bone metabolism in the late second trimester pregnant women was not statistically significant,while the dynamic function of pancreatic island beta-cells function index and bone markers related metabolism had a negative correlation,and the correlation in patients with gestational diabetes mellitus group was much more obvious.Part ?:Study on the Correlation between the Insulin Resistance Index and the Bone Metabolism Markers of in Pregnant WomenObjective:To survey the distribution of glycosylated hemoglobin levels andinsulin resistance index in parturient women,also the correlation of the insulin resistance index and total type 1 procollagen amino terminal propeptide,N-terminal osteocalcin and beta-CrossLaps level.Methods:The 190 pregnant women in 38⁴1 weeks of pregnancy were selected,excluding the gestational age less than 37 weeks,multiple pregnancy,severe cardiovascular and liver disease,infection in the recent period,diabetes and bone metabolism diseases diagnosed before pregancy.To exam the level of the fasting blood glucose,glycosylated hemoglobin,insulin,C peptide,total type1 procollagen amino terminal propeptide,N-terminal osteocalcin and beta-CrossLaps level.The blood glucose was detected by the glucose oxidase method.The glycosylated hemoglobin was detected by the high performance liquid chromatography detection.The insulin,C peptide,total type 1 procollagen amino terminal propeptide,N-terminal osteocalcin and beta-CrossLaps level were detected by chemiluminescence analyzing methods.The distribution of glycosylated hemoglobin levels and insulin resistancen index was studied and the correlation of glycosylated hemoglobin,insulin resistance index and the bone metabolic markers was analysed at the same time.According to the glycosylated hemoglobin level is greater than or equal to 5.6%,the pregnant women were divided into abnormal glucose metabolism group?54 cases?and the normal glucose metabolism group?136 cases?and were compared in groups.The insulin resistance index homa-IR=?fasting insulin*fasting blood glucose?/22.5.Results:The median glycosylated hemoglobin of parturient women is 5.4%and the median insulin resistance index was 2.69.The correlation coefficent in pregnant women of insulin resistance index and total type 1 procollagen amino terminal propeptide,N-terminal osteocalcin and beta-CrossLaps level is 0.558?p<0.001?,0.448?p<0.001?and 0.488?p<0.001?respectively and the correlation is positive.In the abnormal glucose metabolism of pregnant women group,the correlation coefficient of insulin resistance index and total type 1 procollagen amino terminal propeptide,N-terminal osteocalcin and beta-CrossLaps level were 0.664?p<0.001?,0.641?p<0.001?and 0.593?p<0.001?respectively and the correlation is significantly positive.Conclusion:There is obvious insulin resistance and?or?high glucose metabolism status beyond the general level in some pregnant women in vivo.The insulin resistance index of parturient pregnant women has a positive correlation with the bone synthesis metabolism,the bone turnover rate and the bone catabolism markers.The correlation among pregnant women with abnormal glucose metabolism is much more obvious.