妊娠期糖代谢异常患者的糖脂代谢水平及其关系的研究

Lipid and Glucose Metabolism and Their Relationship in Patients with Gestational Impaired Glucose Metabolism

目的 分析妊娠期糖代谢异常孕妇的血脂水平以及糖代谢与脂代谢的关系.方法 选取于2003-2005年在我院门诊行产前检查的孕24～28周、常规50g葡萄糖筛查血糖≥7.8 mmol/L的妊娠妇女406例,行口服75 g葡萄糖耐量试验(OGTT)试验同时,测定总胆固醇(TC)、三酰甘油(TG)、高密度脂蛋白胆固醇(HDL-c)、低密度脂蛋白胆固醇(LDL-c)、载脂蛋白A1(ApoA1)和载脂蛋白B(ApoB).根据OGTT结果,分为妊娠期糖尿病组(GDM,115例),妊娠期糖耐量减低组(GIGT,60例)及糖筛查阳性组[GCT(+),231例].并记录孕妇年龄,孕产次,分娩孕周等.结果 GDM组TG水平高于GIGT组和GCT(+)组,而HDL-c、ApoB水平低于GIGT组和GCT(+)组,差异均有统计学意义(P＜0.05),3组的TC、LDL-c水平间差异无统计学意义(P＞0.05).TG与空腹血糖(FPG)、糖化血红蛋白(HbA1c) 、胰岛素抵抗指数(HOMA-IR)呈正相关,而与胰岛素敏感指数(IAI)、胰岛β细胞功能指数(HBCI)呈负相关,而HDL-c水平与FPG、HbA1c水平呈负相关,与HBCI呈正相关.结论 妊娠期糖代谢异常患者存在着异常的脂代谢,血脂异常与胰岛功能和胰岛素抵抗存在着密切关系.

Objective To investigate the serum lipid levels,and glucose metabolism and lipid metabolism in pregnant women with glucose metabolism disorders.Methods Totally 406 pregnant women at 24-28 gestational week,who received antenatal care in the clinic of our hospital from 2003 to 2005 and whose 50g glucose challenge test ≥7.8mmol/L,were given 75g glucose oral glucose tolerance test(OGTT).And at the same time they were given determinations of serum total cholesterol(TC),triglyceride(TG),high density lipoprotein cholesterol(HDL-c),low density lipoprotein cholesterol(LDL-c),apolipoprotein A1(ApoA1) and apolipoprotein B(ApoB).They were divided according to the results of OGTT as gestational diabetes group(GDM,n=115),gestational impaired glucose tolerance group(GIGT,n=60) and positive glucose challenge test group(GCT(+),n=231).The age of the pregnant women,number of gravidity and parity,and delivery pregnancy week were all recorded.Results The TG level in GDM group was higher than those in GIGT and GCT(+) groups,but the levels of HDL-c and ApoB were lower than those in GIGT group and GCT(+) group(P<0.05).There was no significant difference in levels of TC and HDL-c among the three groups(P>0.05).The TG level was positively correlated with the levels of fasting plasma glucose(FPG),glycosylated hemoglobin(HbA1c) and Homa insulin resistance index(HOMA-IR);and it was negatively correlated with the levels of insulin sensitivity index(IAI),index of beta-cell function(HBCI).The level of HDL-c was negatively correlated with the levels of FPG and HbA1c,but positively with the level of HBCI.Conclusion The patient with gestational impaired glucose metabolism has abnormal lipid metabolism.The serum lipid disorder is closely associated with pancreatic islets secretion function and insulin resistance.