妊娠期糖耐量异常妇女胰岛功能与胰岛素抵抗的相关研究

Clinical study of pancreatic function and insulin resistance in pregnant women with glucose intolerance

目的：研究妊娠期糖耐量异常与胰岛β细胞功能、胰岛素抵抗等的关系。方法：对孕24—36周上海市孕妇共4568例（孕前有糖尿病或糖尿病家族史者排除），先行50g葡萄糖筛查试验，异常者再行75g口服葡萄糖耐量试验（OGTT）-胰岛素释放试验，选取OGTT异常者318例作为试验组，OGTT正常者中随机选取320例作为对照组，获取各阶段的血糖值及血清胰岛素值，通过计算，用胰岛素敏感指数（ISI）、稳态评估模式、胰岛素储备能力／血糖最大升高值（API／APG）了解胰岛β细胞功能及外周胰岛素抵抗情况。结果：OGTT异常组的OGTT后1h血清胰岛素（PI1）、胰岛素释放曲线下面积较OGTT正常组显著增高（P〈0．05），而胰岛素敏感指数、API／APG及HOMA—p细胞较OGTT正常组降低（P〈0．05）。糖尿病（GDM）组与妊娠期糖耐量减退（GIGT）组相比：GDM组的BMI高于GIGT组，而胰岛素敏感指数、HOMA—B细胞低于GIGT组（P〈0．05）。其它指标均无明显差异。结论：妊娠期糖耐量异常形成的主要原因为胰岛素抵抗而非胰岛分泌功能降低。

Objective：To evaluate pancreatic beta-cell function and insulin resistance in pregnant women with abnormal glucose tolerance and gestational diabetes mellitus （GDM）. Methods：After doing 50g glucose screening test and 75g oral glucose tolerance test （OGTT） at 24- 36 weeks/gestation among 4568 pregnant women of Shanghai, a total of 318 women with abnormal glucose tolerance and 320 women with normal glucose tolerance were evaluated. During the OGTr, serum glucose and serum insulin of different time were determined. Insulin sensitivity index, Homeostasis Model Assessment, and delta PI/delta PG were used. Results： Our data indicated that in comparison with normal control group, PI1 and the area under the curve of insulin secretion were significantly high （ P 〈 0.05 ） in abnormal OGTT group. Whereas insulin sensitivity index,delta PI/deha PG and HOMA-beta cell were lower than control group （P 〈 0. 05 ）. In comparison of GDM and GIGT groups, the BMI was significantly high in GDM group （ P 〈 0.05 ）. The insulin sensitivity index and HOMA-beta cell were lower than GIGT group （ P 〈 0.05 ）. Conclusion：Insulin resistance rather than plays an important role in the abnormality of glucose intolerance in pregnancy.