妊娠期妇女葡萄糖筛查试验及胰岛素释放水平分析

Analysis of Glucose Challenge Test and levels of insulin releasing in pregnant women

目的观察孕24～28周孕妇行葡萄糖筛查试验（GCT）时空腹和服糖后血糖、胰岛素水平，了解胰岛素抵抗的程度，分析葡萄糖筛查试验在妊娠糖尿病的诊断价值。方法550例孕24～28周孕妇行葡萄糖筛查试验，其中58例孕妇同时采用免疫发光法检测了胰岛素释放水平。结果GCT正常孕妇的空腹血糖水平（4．36±0．33）mmol／L明显低于健康非妊娠育龄妇女（4．82±0．38mmol／L）（P〈0．05），GCT异常孕妇（4．53±0．35）mmol／L空腹血糖水平分别与GCT正常孕妇和健康非妊娠育龄妇女比较，均无显著性差异（P〉0．05）。GCT异常孕妇112例，其中GDM13例，占总数2．4％，妊娠期合并糖耐量减低（GIGT）30例，占总数5．5％。GCT异常孕妇空腹和服糖后1h胰岛素水平分别为8．1±3．5mIU／L、94．5±42．7mlU／L，明显高于GCT正常孕妇5．4±1．6mlU／L、36．3±20．2mlU／L（P〈0．05）。结论妊娠期妇女会呈现“加速饥饿状态，并以空腹时的相对性低血糖现象为临床特征。GCT筛查异常孕妇经过OGTY不能诊断为GDM和GIGT者的孕妇随孕周发展，仍有可能进一步发展为GDM。

Objective To observe levels of glucose and insulin in pregnant women at 24-28weeks of gestation, to understand degree of insulin resistance, to investigate the value of 50g Glucose Challenge Test in diagnosis of gestational diabetels mellitus （GDM）. Methods 550 pregnant women with 50g GCT in our hospital, these were divided into groups ,whose 50g GCT values were ≥7.8 mmol/L, ≤7. 8 mmol/L. Insulin was measured by radioimmunoassay. Results The fasting glucose levels of normal GCT（4. 36 ±0. 33 mmol/L） were significantly lower than healthy non-pregnant women. The fasting glucose levels of abnormal GCT（4. 53 ± 0. 35 mmol/ L） weren＇ s significantly different with mormal GCT and healthy non-pregnant women. There were 112 cases with abnormal GCT, 13 eases of GDM（2.4% ） ,30 cases of GIGT（5.5% ）. The fasting insulin and the insulin at the first hour postprandially of pregnant women with abnormal GCT were significantly higher than that with nomarl GCT. Conclusions The pregnant women display ＂accelerating starvation＂ with clinical symptoms of relatively lower fasting glucose concentration. The 50g GCT value is important in the diagnosis of GDM. The pregnant women with abnormal GCT ,but with normal OGTT, are possible to develop GDM with pregnant progress.