以ADA诊断标准评价妊娠糖尿患者胰岛β细胞功能

Evaluation of pancreatic β-cell function of patients with gestational diabetes mellitus according to ADA diagnostic criteria

目的探讨妊娠糖尿病患者在不同孕期胰岛素抵抗和胰岛B细胞功能。方法对正常非妊娠妇女组（Ⅰ组）、正常妊娠妇女组（Ⅱ组）、妊娠糖尿病组（Ⅲ组）行100g葡萄糖耐量试验测定空腹、30min、1h、2h、3h的血糖和胰岛素。对Ⅱ组和Ⅲ组测定不同孕期的胰岛素水平。计算HOMA-IR和HOMA-β细胞功能指数评价胰岛素分泌功能。结果Ⅱ组和Ⅲ组分娩时胰岛素呈峰式分泌，差异无统计学意义（P〉0．05），其他孕期胰岛素分泌差异有统计学意义（P〈0．01）；Ⅲ组空腹血糖和空腹胰岛素显著高于其它两组（P〈0．01）；Ⅰ组、Ⅱ组和Ⅲ组HOMA-IR分别为（0．86±0．32），（1．13±0．26）和（1．75±0．22），差异有统计学意义；Ⅱ组和Ⅲ组HOMA-β指数分别为（5．20±0．40），（4．36±0．27）。差异有统计学意义（P〈0．01）。结论与正常妊娠组比较，Ⅲ组存在更为明显的胰岛素抵抗，在胰岛素抵抗增强的基础上，Ⅲ组同时存在胰岛β细胞分泌功能的减退。

Objective To study the relationship between the insulin resistance and pancreatic β-cell function in gestational diabetes mellitus during different pregnancy periods. Methods Three groups ： normal non-pregnant women （ group Ⅰ ）, normal pregnant women （group Ⅱ ）and gestational diabetes mellitus （GDM） women（groupⅢ ） were all measured for blood glucose and insulin levels by 100g oral glucose tolerance test after fasting, 30min, lh, 2h, 3h. In order to acquire the insulin levels during different stages of pregnancy, blood test were carried out for Group Ⅱ and Group Ⅲ. HOMA-IR and HOMA-β cell function index were used to evaluate insulin excretion function. Results Insulin levels of group Ⅱ and group Ⅲ are of peak distribution and had no significant difference at birth （ P 〉 0. 05）. However, they showed significant difference at other periods of pregnancy（ P 〈0.01 ）. The blood glucose and insulin levels of group m after fasting was significantly higher than those of Group Ⅰ and Group Ⅱ（ P 〈0. 01 ）. The HOMA-IR values for the three groups were 0. 86 ±0. 32, 1.13 ± 0. 26 and 1.75 ± 0. 22 respectively, which were significantly different （ P 〈 0.05）. The values of pancreatic β-cell function index （ HOMA-β） of the groups Ⅱ and Ⅲ were5.20±0.40, 4.36±0.27, which also showed significant difference （ P 〈0.01）. Conclusion Comparing with the group of normal pregnant women, the group m patients have more insulin resistance, which is accompanied by the decrease of the pancreatic β-cell secretion function.