中文摘要：

目的：探讨妊娠期糖尿病（GDM）患者母乳中视黄醇结合蛋白4（RBP4）的变化以及临床意义。方法选择 GDM孕妇60例，非 GDM正常孕妇45人为对照组。GDM组根据母乳喂养量分为高母乳喂养组及低母乳喂养组。分娩时采集脐血、产后收集初乳及成熟乳，分别用放射免疫（RIA）法和酶联免疫（ELASA）法测定胰岛素和 RBP4水平；记录新生儿出生体重和产后复查时体重增加量。结果GDM组脐带血的 RBP4和胰岛素（INS）分别为（14.9±2.6）μg／L 和（8.3±1.9）μU ／mL，均高于对照组的（12.4±2.7）μg／L 和（6.0±2.1）μU ／mL （P 均＜0.01）。GDM组初乳 RBP4和 INS 分别为（16.9±4.2）μg／L 和（11.3±3.1）μU ／mL，均高于对照组的（13.3±4.5）μg／L 和（9.2±2.8）μU ／mL （P 均＜0.01）；GDM组成熟乳 RBP4（16.1±4.0）μg／L明显高于对照组的（12.5±3.1）μg／L （P ＜0.01）；但是两组胰岛素水平比较差异无统计学意义（P ＞0.05）。GDM组高母乳喂养者的成熟乳 RBP4低于低母乳喂养者（P ＜0.01）；GDM组乳汁 RBP4水平影响因素分析显示，初乳 RBP4水平均与其对应的胰岛素水平呈正相关（r ＝0.45，P ＜0.01）；初乳 RBP4水平与孕期体重增加量呈正相关（r ＝0.37，P ＜0.01）；GDM组脐血中的 RBP4水平与新生儿出生体重呈正相关（r ＝0.43，P ＜0.01）。高母乳喂养组成熟乳中 RBP4水平与婴儿体重增加呈负相关（r ＝－0.49，P ＜0.01）。结论GDM母乳中 RBP4参与婴儿生长发育调节，母乳喂养者体内 RBP4水平较低。

英文摘要：

Objective To understand the alteration of retinol binding protein 4 （RBP4）in breast milk of women with gestational diabetes mellitus （GDM）and its clinical significance.Methods Sixty pregnant women diagnosed with GDM were selected as the cases.In the case group,breastfeeding amount reached more than 80% were defined as high -breastfeeding group while less than 20% were defined as low -breastfeeding.At the same time,45 nomal pregnant women were selected as the controls.Cord blood samples were collected during the delivery.Colostrums and mature milk samples were collected after the delivery.RBP4 and insulin concentrations were measured using enzyme -linked immunosorbent assay （ELISA ） and radioimmunoassay （RIA ） respectively.Infant birth weight and weight gain during postpartum reexamination were recorded.Results The concentrations of RBP4 and insulin in cord blood of GDM group （1 4.9 ± 2.6 μg/L and 8.3 ±1 .9 μU /mL）were higher than that in control group（1 2.4 ±2.7 μg/L and 6.0 ±2.1 μU /mL,P 〈0.001 ）.RBP4 and insulin concentrations in colostrums of GDM group （1 6.9 ±4.2 μg/L and 1 1 .3 ±3.1 μU /mL）were higher than in controls （1 3.3 ±4.5 μg/L and 9.2 ±2.8 μU /mL,P 〈0.01 ）.While in mature milk,RBP4 concentrations of GDMgroup were higher than that in controls （1 6.1 ±4.0 μg/L vs.1 2.5 ±3.1 μg/L,P 〈0.01 ）.Insulin concentrationsof two groups were not significantly different.Comparing with low -breastfeeding group,RBP4 concentrations in mature milk of high -breastfeeding group were significantly lower （P 〈0.01 ）.Cord blood RBP4 levels were positively correlated with infant birth weight （r =0.43,P 〈0.01 ）.At the same time,in the colostrums,RBP4 levels were positively correlated with insulin levels （r =0.45,P 〈0.01 ）and maternal weight gain during pregnancy （r =0.37,P 〈0.01 ）.RBP4 concentrations in mature milk of high -breastfeeding group were negatively correlated with weight gain of infants （r =-0.49,P 〈0.01 ）.Conclusion RBP4 in b