摘要
目的：研究妊娠糖尿病患者胰岛素抵抗及胰岛β细胞功能状态变化的特点，探讨妊娠糖尿病（GDM）可能的发病机制。方法选取2010年1月至2015年1月常规产检的孕妇3008例，孕妇在第1次产前检查（孕20~28周）时，测定血浆空腹血精、空腹胰岛素、总胆固醇（CHOL）、三酰甘油（TG）、高密度脂蛋白（HDI-C）、低密度脂蛋白（LDL-C），并同时进行50 g 葡萄糖筛查试验，其结果≥7.8 mmol/ L 者，进行葡萄糖耐最试验（OGTT）。根据 OGIT 结果将上述孕妇分为妊娠期糖尿病（GDM）组50例；妊娠期糖耐量异常（GIGT）组50例，正常糖耐量（NGT）组50例。比较不同血糖特点患者的血糖曲线下面积（AUCG）、胰岛素曲线下面积（AUCI）、稳态模型评估的胰岛 p 细胞功能指数（HOMA-B）、混合胰岛素敏感度（ISI）、稳态模型评估的胰岛素抵抗指数（HOMA-IR）、胰岛素分泌指数（△I60/△G60）。结果 GDM 组各时间段血糖、FINS、C 肽、HOMA-IR、PGAUC 等指标均明显高于正常对照组，差异均有统计学意义（P 〈0.01）；而 HOMA-β、INSAUC、INSAUC/ PGAUC、△I60/△G60等指标均明显低于正常对照组，差异均有统计学意义（P 〈0.01）；GDM 组各时间段血糖、FINS、C 肽、HOMA-IR、PGAUC 等指标均明显高于GIGT 组，差异均有统计学意义（P 〈0.01）；而 HOMA-β、INSAUC、INSAUC/ PGAUC、△I60/△G60等指标均明显低于GIGT 组，差异均有统计学意义（P 〈0.01）。而 GIGT 组血糖、胰岛素抵抗及胰岛β细胞功能等实验室检测指标与正常对照组比较差异均未见统计学意义（P 〉0.05）。结论 GDM 患者胰岛素抵抗较孕期正常妇女增高，且同时伴有胰岛分泌功能受损，在 GIGT 阶段胰岛素抵抗程度与正常孕妇尚无明显差别。妊娠期糖代谢异常的原因更支持胰岛素抵抗增加而非胰岛β细胞分泌功能障碍。
Objective To study the characteristics of insulin resistance and islet β-cell function in patients with gestational diabetes mellitus,so as to investigate the possible pathogenesis of gestational diabetes mellitus（GDM）. Methods From January 2010 to January 2015,3 008 pregnant women with routine antenatal examination were selected. At the first prenatal examination（gestational age of 20 to 28 weeks）,the levels of fasting plasma hematospermia,fasting insulin,total cholesterol（Chol）,triglycer-ide（TG）,high density lipoprotein（serum HDL）,low density lipoprotein（LDL-C）were detected,and at the same time the 50 g glucose screening test was made,then glucose tolerance test was made for the patients with the results greater than or equal to 7. 8 mmol/ L. According to OGIT results,the pregnant women were divided into gestational diabetes mellitus（GDM）group（50 cases）,gestational impaired glu-cose tolerance（GIGT）group（50 cases）,and normal glucose tolerance（NGT）group（50 cases）. The blood glucose curve area（AUCG）and insulin curve area（AUCI）,homeostasis model assessment of islet beta cell function indexes,mixed insulin sensitivity,homeostasis model assessment of insulin resistance indexes and insulin secretion indexes were compared. Results In GDM group,the levels of FINS, blood glucose,C peptide,HOMA-IR,PGAUC and other indicators at each time point were significantly higher than those in normal control group,and the differences were significant（P 〈 0. 01）,but the lev-els of HOMA-β,INSAUC,INSAUC / PGAUC and beta,Delta I60 / Delta G60 at each time point were significantly lower than those of the normal control group,and the differences were significant（ P 〈0. 01）;the levels of FINS,blood glucose,C peptide,HOMA-IR,PGAUC and other indicators at each＆amp;nbsp;time point were significantly higher than those in GIGT group,and the differences were significant（P 〈0. 01）,but the levels of HOMA-β,INSAUC,INSAUC / PGAUC and Delta I60 / Delta G60 and other in-dicators were significantly lower than those of the GIGT group,and the differences were significant（P 〈0. 01）. There was no significant difference in the levels of blood glucose,insulin resistance and isletβ-cellfunction between the GIGT group and the normal control group（P 〉 0. 05）. Conclusions Insulin resistance in patients with GDM is higher than that of normal women in pregnancy,and the function of pancreatic secretion is impaired at the same time,and there is no significant difference in insulin resist-ance between GIGT group and normal pregnant women. The reason of abnormal glucose metabolism in pregnancy is more supportive of insulin resistance,but not the secretion of islet β-cell.
出处
《中国实用医刊》
2017年第2期30-33,共4页
Chinese Journal of Practical Medicine
关键词
糖尿病
妊娠
胰岛素抵抗
胰岛
β
细胞功能
Diabetes mellitus
Pregnancy
Insulin resistance
Islet β-cell function
