上海交通大学学报（医学版）

上海交通大学学报（医学版）

• 论著（临床研究） • 上一篇    下一篇

妊娠期糖尿病患者胰岛素抵抗及胰岛素分泌功能的评估

王凤环，李华萍   

  1. 上海交通大学附属第六人民医院妇产科， 上海 200233
  • 出版日期:2015-03-28 发布日期:2015-03-26
  • 通讯作者: 李华萍, 电子信箱: hpli819@sohu.com。
  • 作者简介:王凤环（1986—）， 女， 住院医师， 硕士; 电子信箱: 619691220@qq.com； 现在河北省深州市医院妇产科工作。
  • 基金资助:

    上海市科委基金(12ZR1422200)；上海交通大学医学院科技基金（11XJ21059）

Assessment of insulin resistance and insulin secretion function of patients with gestational diabetes mellitus

WANG Feng-huan, LI Hua-ping   

  1. Department of Gynecology and Obstetrics, Shanghai Sixth People's Hospital, Shanghai Jiao Tong University, Shanghai 200233, China
  • Online:2015-03-28 Published:2015-03-26
  • Supported by:

    Foundation of Science and Technology Commission of Shanghai Municipality,12ZR1422200; Science and Technology Foundation of Shanghai Jiao Tong University School of Medicine, 11XJ21059

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摘要：

目的 探讨妊娠期糖尿病（GDM）患者胰岛素抵抗状态及胰岛β细胞分泌功能的变化。方法 以接受产前检查并于孕24～28周行75 g口服葡萄糖耐量试验(OGTT)的孕妇1 825例为研究对象，检测孕妇胰岛素抵抗及胰岛β细胞分泌功能的相关指标。结果 根据75 g OGTT结果，分为糖耐量正常组（NGT组）1 291例，GDM组534例；根据病情严重程度，GDM组分为GDM1组（n=322）、GDM2组（n=160）和GDM3组（n=52）。NGT组服糖后0.5～1 h血糖水平达峰值，而GDM各组于服糖后1 h血糖水平达峰值；GDM各组各时间点血糖水平均高于NGT组，且GDM病情越重血糖值愈高 (P<0.05)。NGT组胰岛素水平于服糖后1 h达到高峰；各GDM组均于服糖后2 h达到高峰，并明显高于其他时段，且病情越重胰岛素水平升高愈明显（P<0.05）。与NGT组比较，各GDM组胰岛素抵抗指数（HOMA-IR）、糖负荷后葡萄糖曲线下面积(AUCG)、糖负荷后胰岛素曲线下面积(AUCI)均明显增高，并且随着GDM病情的加重而逐渐升高（P<0.05）；而混合胰岛素敏感度(ISIcomp)降低(P<0.05)。与NGT组比较，各GDM组胰岛β细胞功能指数(HOMA-β)、糖负荷后30 min胰岛素净增值/葡萄糖净增值的比值(ΔI30/ΔG30)、动态胰岛素分泌指数(MBCI)降低，差异有统计学意义(P<0.05)。GDM组Stumvoll胰岛素分泌1相及2相指数较NGT组降低，且随病情加重而逐渐降低。结论 GDM孕妇胰岛素抵抗明显加剧，胰岛素早期分泌功能受损，且与病情程度有关。

关键词: 妊娠期糖尿病, 胰岛素, 胰岛素抵抗, 胰岛β细胞功能

Abstract:

Objective To explore the insulin resistance and variations of the secretory function of pancreas β-cells of women with gestational diabetes mellitus (GDM). Methods A total of 1 825 pregnant women who underwent prenatal examinations and 75 g oral glucose tolerance test (OGTT) during 24-28 weeks of gestation were selected. Indicators relevant to the insulin resistance and secretory function of pancreatic β-cells were detected. Results According to the results of 75 g OGTT, pregnant women were divided into the normal glucose tolerance (NGT) group (n=1 291) and GDM group (n=534). Patients of the GDM group were further divided into the GDM1 group (n=322), GDM2 group (n=160), and GDM3 (n=52) group according to the severity of disease. The blood glucose level of the NGT group reached the peak 0.5-1 h after the 75 g OGTT and the blood glucose level of the GDM group reached the peak 1 h after the 75 g OGTT. The blood glucose level of the GDM group at each time point was higher than that of the NGT group and the blood glucose level of the GDM group increased with the severity of disease (P<0.05). The insulin level of the NGT group reached the peak 1 h after the 75 g OGTT. The insulin level of the GDM group reached the peak 2 h after the 75 g OGTT and was significantly higher than that of other time points. The insulin level of the GDM group increased with the severity of disease (P<0.05). Compared with the NGT group, HOMA-IR, AUCG after glucose load, and AUCI after glucose load of the GDM group were significantly higher and gradually increased with the severity of disease (P<0.05); ISIcomp was lower (P<0.05); function index of pancreas β-cells (HOMA-β), ratio of net increase of insulin to net increase of glucose 30 min after glucose load (ΔI30/ΔG30), and modified beta-cell function index (MBCI) decreased. The differences were statistically significant (P<0.05). Stumvoll 1 phase and 2 phase insulin secretion indexes of the GDM group were lower than those of the NGT group and gradually decreased with the severity of disease. Conclusion The insulin resistant of pregnant women with GDM is severe and early phase insulin secretion is impaired, which are relevant to the severity of disease.

Key words: gestational diabetes mellitus, insulin, insulin resistance, pancreatic β-cell function