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不同时点糖代谢异常孕妇胰岛素抵抗与?细胞功能特征的研究

程兰   

  1. 天津市中心妇产科医院
  • 收稿日期:2011-07-22 修回日期:2012-01-09 出版日期:2012-02-15 发布日期:2012-02-15
  • 通讯作者: 程兰

Study on Characteristic of Insulin Resistance and Pancreatic β- cell Function in Different Time Point of Pregnant Women with Abnormal Glucose Tolerance Conditions

  • Received:2011-07-22 Revised:2012-01-09 Published:2012-02-15 Online:2012-02-15

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摘要： 摘要 目的：描述不同时点糖代谢异常孕妇胰岛素抵抗（IR）和胰岛素分泌特点，阐明不同糖耐量状态人群IR和?细胞分泌功能的不同。方法：收集孕前体质指数正常，无孕前糖尿病及其他内分泌疾病史，无其他妊娠合并症与并发症，50g葡萄糖负荷试验阳性患者504例，行OGTT及胰岛素释放试验。依ADA诊断标准分组，计算HOMA-IR、 HOMA-β及△PI/△PG，比较不同时点血糖异常患者的胰岛素抵抗及?细胞功能。结果：1、不同时点糖代谢异常患者胰岛素释放趋势不同。 2、 HOMA-IR结果，与NGT组相比，糖代谢异常组均有不同程度增加， GDM组与NGT组、GDM组与GIGT2、3组，GIGT0组与GIGT3、NGT组,GIGT1组与GIGT3、NGT组，GIGT2组与NGT组间差异均有统计学意义（P<0.05）；3、 HOMA-β结果，与NGT组相比，糖代谢异常各组均有下降，组间比较差异有统计学意义（P<0.05）。△PI/△PG值各组与NGT组相比均呈下降趋势，NGT与GDM组间差异有统计学意义（P<0.05）。结论：妊娠期糖代谢异常患者胰岛素释放特点不同，不仅存在胰岛素抵抗，还有?细胞功能的受损，GIGT中不同时点血糖异常者具有潜在不同的代谢特异性，GIGT0、GIGT1与GDM相近似，GIGT3的代谢特点与正常组近似。故加强对妊娠期糖代谢异常患者的管理，及早干预，尽量减轻胰岛细胞的过度分泌，延缓β细胞功能的衰竭，可降低母婴并发症的发生。

关键词: 妊娠期糖代谢异常, 胰岛素抵抗, β细胞功能

Abstract: 【Abstract】　Objective: To study the characteristics of insulin resistance and pancreatic β- cell function in pregnant women with different abnormal glucose tolerance conditions，reveal the difference of insulin resistance and pancreatic β- cell secretion in abnormal glucose metabolism course Methods: Collected 504 patients with normal body mass index 、regular antenatal care and 50Ggct(+)in our hospital , without diabetes history and other pregnancy complications,who carried out oral glucose torelance test (OGTT) and insulin release test. Classified into normal glucose tolerance (NGT) , isolated impaired fasting glucose ( GIGT0) , isolated impaired glucose tolerance after drinking glucose water 1 hour(GIGT1)、2 hour(GIGT2)、3 hour(GIGT3)and Gestational diabetes mellitus (GDM) groups based on OGTT result according to ADA. HOMA-IR 、HOMA-β、and △PI/△PG of different groups were statistically analyzed by SPSS10.0. Results : 1、The trend of different time points in abnormal glucose metabolism course were not same. 2、Compared to NGT group , HOMA-IR was increased by 36.4%、22.5%、19.7%、6.4% and 39.9% respectively in GIGT0、GIGT1、GIGT2、GIGT3andGDM。3、The level of HOMA-β was decreased by 11.7%、6.5%、7%、1.4% and 12.3% respectively in GIGT0、1、2、3andGDM；△PI/△PG ratio was decreased in GIGT0、1、2、3 and GDM，but the diversity had statistical significance in NGT and GDM group only（P<0.05）。Conclusion: Patients with abnormal glucose metabolism not only have stronger IR compared with normal pregnancies ,but also have significant decline in pancreatic β- cell function. GIGT is actually a heterogeneous metabolic disorder，GIGT3 was resembles that of NGT, andGIGT0、GIGT1 of GIGT were seem as GDM ，both conditions are characterized by increased of glycemia, insulin resistance, and decreased β- cell function.So we should strengthen the administration to abnormal glucose metabolism patients,intervention as early as possible ，in order to decreased the complications .

Key words: Gestational diabetes mellitus, Insulin resistance, β- cell function