妊娠期糖代谢异常患者胰岛素和C肽释放试验的分析

Analysis of insulin and C-peptide releasing test in women with abnormal glucose metabolism during pregnancy

目的 观察正常妊娠妇女、妊娠期合并糖耐量减低 (GIGT)及妊娠期糖尿病 (GDM )患者孕期胰岛素、C肽水平的变化 ,探讨妊娠期糖代谢变化的规律 ,了解其胰岛 β细胞的功能状况。 方法 用放射免疫法测定正常妊娠妇女 3 1例 (Ⅰ组 )、妊娠期合并糖耐量减低 (GIGT)患者 3 6例 (Ⅱ组 )、妊娠期糖尿病(GDM )患者 3 1例 (Ⅲ组 )的外周血胰岛素、C肽水平。 结果 Ⅰ、Ⅲ组胰岛素、C肽均随孕周逐渐上升 ,Ⅱ、Ⅲ组孕 3 1周时胰岛素水平 [(13 .95± 3 .15 )mIU/L、(15 .10± 2 .96)mIU /L]和C肽水平 [(0 .60± 0 .2 1)pmol/ml、(0 .80± 0 .3 1) pmol/ml]明显高于Ⅰ组 [(11.40± 3 .2 7)mIU/L、(0 .44± 0 .2 6)pmol/ml ,P <0 .0 5 ] ,产后各组胰岛素、C肽水平均下降。Ⅰ、Ⅱ、Ⅲ组孕 3 8周胰岛素水平 [(17.90± 3 .85 )mIU/L、(18.3 1±3 .83 )mIU/L、(19.0 2± 4.16)mIU/L ,P >0 .0 5 ]、C肽水平 [(0 .69± 0 .2 8) pmol/ml、(0 .75± 0 .2 2 ) pmol/ml、(0 .93± 0 .46) pmol/ml,P >0 .0 5 ] ,产后胰岛素水平 [(7.71± 2 .2 3 )mIU /L、(8.2 8± 2 .3 4)mIU /L、(8.76±3 .3 1)mIU /L ,P >0 .0 5 ]和C肽水平 [(0 .2 4± 0 .14 )pmol/ml、(0 .2 6± 0 .13 ) pmol/ml、(0 .2 7± 0 .13 ) pmol/ml,P >0 .0 5 ]之?

Objective To investigate the changes of plasma insulin and C peptide level in women with gestational diabetes mellitus(GDM), gestational impaired glucose tolerance(GIGT) and normal pregnant and to find out the patterns of glucose metabolism in pregnancy and the function of islet β cell in patients with gestational impaired glucose metabolism Methods Thrity one normal pregnant women (group Ⅰ), 36 GIGT (group Ⅱ)and 31 GDM (group Ⅲ) were selected. Insulin and C peptide levels were measured by radioimmunoassay. Results Insulin and C peptide levels of groups Ⅰand Ⅲ increased with the gestational age and decreased at postpartum. At 31 weeks of gestation, insulin and C peptide levels of group Ⅱ and group Ⅲ were significantly higher than that of group I [insulin: (13.95±3.15) mIU/L and (15.10±2.96)mIU/L vs (11.40±3.27) mIU/L; C peptide: (0.60 ±0.21) pmol/ml and (0.80±0.31) pmol/ml vs (0.44±0.26) pmol/ml, P <0.05]. No significant differences was shown among these 3 groups at 38 gestational weeks and postpartum ( P >0.05). The peak value of insulin and C peptide was found at the first hour postprandially in group I, while at the second hour in group Ⅱ and Ⅲ. Conclusions Insulin resistance during pregnancy becomes stronger gradually with pregnant progress. Women with abnormal glucose metabolism during pregnancy would have more insulin resistance which leads to the damage of insulin secretion. These women should have long term followed up.