Longitudinal changes of insulin resistance parameters, adipocytokines, and bone formation markers in healthy non-obese pregnant women

[M. Z. Pijanović]

120 listova

Farmacija - Medicinska biohemija / Pharmacy - Medical biochemistry

Tokom normalne, nekomplikovane trudnoće dolazi do prolaznog razvoja fiziološke insulinske rezistencije, intenziviranja oksidativnog stresa, kao i do promena u parametrima lipidnog statusa majke, ali još uvek nisu poznati svi mehanizmi koji utiču na ove promene. Poslednjih godina se sve veći značaj u ovom kontekstu pridaje i tkivima koja su se tradicionalno posmatrala kao depo energije (masno tkivo), ili kao deo potpornog i lokomotornog sistema (kost), a za koje je dokazano da produkuju niz metabolički aktivnih medijatora. U prva dva trimestra trudnoće majka skladišti najveći deo nutrijenata koje unosi. Poslednji trimestar trudnoće karakteriše ubrzan rast fetusa i pojačan transfer nutrijenata kroz placentu i zbog toga kod majke dolazi do intenziviranja kataboličkih procesa, kao i do razvoja fiziološke rezistencije tkiva na insulin. Tokom trudnoće razvija se lipidni profil koji se kod negravidnih žena smatra proaterogenim. Takođe dolazi i do porasta koncentracije HDL-holesterola, koji ima ateroprotektivna, antiinflamatorna i antioksidativna svojstva. Slobodni kiseonikovi radikali nastaju u aerobnom metabolizmu i igraju značajnu ulogu kao sekundarni glasnici. S druge strane, to su visoko reaktivna jedinjenja koja reaguju sa biološkim molekulima i dovode do njihovog oštećenja. Zato postoji niz mehanizama antioksidativne zaštite u organizmu. Poremećaj njihove ravnoteže, u kome dolazi do stvaranja viška reaktivnih radikala, dovodi do oksidativnog stresa. Trudnoća je stanje koje karakteriše povećana podložnost oksidativnom stresu, a praćena je i kompenzatornim povećanjem koncentracije parametara koji spadaju u sistem antioksidativne zaštite. U trudnoći dolazi do fiziološke regulacije urođenog imunskog odgovora radi prevencije odbacivanja fetusa. Masno tkivo produkuje biološki aktivne medijatore koji se nazivaju adipocitokini od kojih su najznačajniji leptin i adiponektin. Trudnoća se smatra stanjem centralne rezistencije na leptin, koja bi mogla imati uticaj na akumulaciju energetskih zaliha i biti povezana sa rastućom insulinskom rezistencijom. Moguće je i da je adiponektin jedan od medijatora koji utiče na regulaciju metabolizma glukoze u trudnoći...

Normal uncomplicated pregnancy is characterized by a transient development of physiological insulin resistance, intensifying of oxidative stress, as well as by changes in maternal lipid status, but the mechanisms of these changes are still incompletely understood. Tissues that are traditionally seen as energy storage (adipose tissue), or as a part of the locomotor system (bones), produce a number of metabolically active mediators. They are increasingly being recognized as a part of mechanisms of aforementioned changes. During the first and second trimester, a major part of nutrients is being stored. The third trimester is characterized by an accelerated fetal growth, so the maternal catabolic processes intensify and the physiological insulin resistance develops. The changes of maternal lipid status lead towards a more atherogenic state. The HDL-cholesterol also increases, and it has atheroprotective, anti-inflammatory, and antioxidative properties. Reactive oxidative species are products of oxidative metabolism and they have an important role as second messengers. On the other hand, they are highly reactive and can lead to a damage of biomolecules. They are normally counterbalanced by different anti-oxidative mechanisms. The oxidative stress occurs when the reactive species are produced in excess. Pregnancy is a state of increased susceptibility to oxidative stress, due to an increased basal oxygen consumption. At the same time, antioxidative mechanisms increase. The innate immune response is also regulated during pregnancy, so that fetus doesn’t get rejected. Adipose tissue produces biologically active mediators- adipocytokines, among which the most important are leptin and adiponectin. Pregnancy is considered to be a state of central leptin resistance, that might influence the accumulation of energy storage and could be connected to the insulin resistance. Adiponectin is a possible mediator implicated in the regulation of the glucose metabolism in pregnancy. Pregnancy and lactation are also associated with the changes in calcium absorption and turnover. This is reflected in the changes of bone turnover parameters in blood...

trudnoća, insulinska rezistencija, leptin, adiponektin, osteokalcin, N-terminalni propeptid prokolagena tip 1, vitamin D, HDL-holesterol, oksidativni stres

pregnancy, insulin resistance, leptin, adiponectin, osteocalcin, aminoterminal propeptide type 1 procollagen, vitamin D, HDL-cholesterol, oxidative stress

577.17:[618.2:616.379-008.04(043.3)

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