贵州医科大学学报

2015, v.40;No.172(01) 76-79+82

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妊娠糖尿病胰岛素抵抗影响因素的研究
A Study on Insulin Resistance in Gestational Diabetes Mellitus and Affecting Factors

王凯航;向菲;
WANG Kaihang;XIANG Fei;Department of Endocrinology,Guiyang Medical College;Section of Endocrinology and Metabolism,the Second People's Hospital of Guiyang City;

摘要(Abstract):

目的:比较妊娠糖尿病患者与正常糖耐量妊娠孕妇胰岛素抵抗、胰岛β细胞功能,探讨胰岛素抵抗的影响因素。方法:通过口服葡萄糖耐量试验(OGTT)结果分为妊娠糖尿病组(GDM组)30例及正常糖耐量组(NGT组)30例,比较两组孕妇的一般资料、OGTT实验前、实验后0.5 h、1 h、2 h、3 h的血糖和胰岛素值,采用稳态模式胰岛β细胞分泌指数(HOMA-β)、胰岛素早相分泌指数(ΔI30/ΔG30)、OGTT胰岛素曲线下面积(AUCI)、OGTT葡萄糖曲线下面积(AUCG)、稳态模式胰岛素抵抗指数(HOMA-IR)以及混合胰岛素敏感度(ISIcomp)评价胰岛β细胞功能及胰岛素抵抗程度,并与两组孕妇的一般资料作相关性分析。结果:(1)与NGT组组相比,GDM组年龄较大,孕前体重、葡萄糖负荷试验(GCT)时体重、孕前体重指数(BMI)及GCT时BMI、甘油三酯(TG)较高(P<0.05或0.01);(2)GDM组孕妇各时点血糖值均高于NGT组(P<0.01);GDM组孕妇除OGTT0.5 h外各时点胰岛素水平GDM组均高于NGT组(P<0.01);GDM组孕妇的血糖峰值、胰岛素峰值较对照组推迟0.5 h,于OGTT 1 h达高峰;(3)与NGT组比较,GDM组△I30/△G30下降,OGTT AUCG及AUGI增高,HOMEIR增高,ISIcomp降低(P<0.01);(4)△I30/△G30与TG、年龄高度负相关(r=-0.319,-0.358,P<0.01),HOMA-IR与TG(β=0.295,P<0.05)、孕前BMI(β=0.327,P<0.05)、C反应蛋白(CRP)(β=0.225,P<0.05)独立正相关,ISIcomp与孕前BMI(β=-0.267,P<0.05)、TG(β=-0.319,P<0.05)独立负相关。结论:GDM孕妇胰岛素抵抗增加,早相胰岛素分泌功能受损,糖脂代谢紊乱、慢性胰岛素抵抗以及炎性反应可能与GDM的发生有关。
Objective: To compare insulin resistance and pancreatic islet β cell function of healthy pregnant women with those of gestational diabetes mellitus( GDM) women and to explore the influencing factors on insulin resistance. Methods: Based on the result of oral 75 g glucose tolerance test( OGTT),thirty patients with GDM and thirty healthy pregnant women as control group were enrolled into the study as GDM group and NGT group respectively. General data of pregnant women in the two groups were compared and their blood sugar and insulin levels were compared before OGTT and 0. 5 h,1 h,3 h after OGTT. Homeostasis model β-cell function assessment( HOMA-β),early phase insulin secretion index( ΔI30/ ΔG30),area under curve of glucose( AUCG),area under curve of insulin( AUCI),homeostasis model insulin resistance assessment index( HOMA-IR),and insulin sensitivity index composite( ISIcomp) were calculated for evaluation of insulin resistance and pancreatic β cell function,and correlation with general data of the two groups of pregnant women was analyzed. Results:( 1) Compared with NGT group,patients in GDM group were generally older,with greater prepregnancy weight and glucosieloading test( GCT) body weight. The triglycerides( TG) in blood,prepregnancy BMI and GCT BMI of GDM group were significantly higher than those of NGT group( P <0. 01 or 0. 05);( 2) The blood sugar levels of GDM group at all time points were higher than those of NGT group. The insulin levels of GDM group at all time points,except 0. 5 h after OGTT,were higher than those of NGT group( P < 0. 01). The peak sugar blood level and peak insulin level of GDM were delayed from 0. 5 h after OGTT to 1 h after OGTT compared with NGT group;( 3) HOME-IR was higher and ISIcomp was lower in GDM group than those in control group( P < 0. 05). AUCI and AUCG in GDM group were higher than those in control group( P < 0. 05). AUCI and AUCG in GDM group were higher than those in control group( P < 0. 05). △I30/ △G30in GDM group was lower than that in control group( P < 0. 05),and no significant difference was found in HOMA-β between the two groups;( 4) ΔI30/ ΔG30was highly correlated with triglycerides and age( r =- 0. 319,- 0. 358,P < 0. 01);Multiple regression analysis showed that HOME-IR was positively correlated with triglycerides( β =0. 295,P < 0. 05),pre-pregnancy BMI( β = 0. 327,P < 0. 05) and C-reactive protein( CRP)( β =0. 225,P < 0. 05),while ISIcomp was negatively correlated with triglycerides( β =- 0. 319,P < 0. 05)and pre-pregnancy BMI( β =- 0. 267,P < 0. 05). Conclusions: Insulin resistance increases in GDM pregnant women. Damage of early phase insulin secretion,glucose and lipid metabolism disorders,chronic insulin resistance and inflammatory reactions may relate with GDM.

关键词(KeyWords): 糖尿病,妊娠;血糖;胰岛素抵抗;胰岛β细胞;葡萄糖耐量试验
diabetes,gestational;blood glucose;insulin resistance;pancreatic β cell;oral glucose tolerance test

Abstract:

Keywords:

基金项目(Foundation): 贵阳市科技与民生计划项目[(2013103)3号]

作者(Author): 王凯航;向菲;
WANG Kaihang;XIANG Fei;Department of Endocrinology,Guiyang Medical College;Section of Endocrinology and Metabolism,the Second People's Hospital of Guiyang City;

Email:

DOI: 10.19367/j.cnki.1000-2707.2015.01.020

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