妊娠期糖代谢变化及其与胎盘催乳素的关系

Changes of Carbohydrate Metabolism in Normal Pregnancy and Its Relationship with Placental Lactogen Concentrations

目的探讨正常妊娠过程中孕妇糖耐量、胰岛素释放、胰岛素敏感性变化及其与胎盘催乳素的关系。方法对９４例正常孕妇进行７５ｇ葡萄糖耐量试验，检测各时相血糖和胰岛素水平，计算胰岛素曲线下面积（ＩＡＵＣ）与血糖曲线下面积（ＧＡＵＣ），并观察胰岛素敏感指数（ＩＡＩ）的变化，同时检验空腹人体胎盘催乳素（ＨＰＬ）。结果ＩＡＵＣ、ＧＡＵＣ、ＩＡＩ及ＨＰＬ均随孕期延长而升高，各孕期比较，差异有显著性（Ｐ＜０．０５）；多重相关分析显示，ＨＰＬ与ＧＡＵＣ、ＩＡＵＣ、ＩＡＩ均呈显著正相关关系。但在消除了ＩＡＵＣ和ＩＡＩ的影响后，ＨＰＬ与ＧＡＵＣ无相关关系。结论妊娠期表现高胰岛素血症及胰岛素敏感性下降，并与ＨＰＬ有关；ＨＰＬ是影响妊娠期糖代谢变化的因素之一。

Objective To observe the changes of glucose metabolism and its relationship with human placental lactogen (HPL) in normal pregnant women. Method 94 normal pregnant women had their serum HPL concentration tested and had undergone a 75g oral glucose tolerance tests (OGTT). Both serum insulin and glucose levels at different time intervals were determined, and the areas under curve (IAUC, GAUC) were caculated, also insulin resistance (IAI) was evaluated.Results GAUC, IAUC, IAI and HPL are all significantly increased with advance of gestation ( P <0.05). Mutiple correlation coefficient study demonstrated that HPL is significantly positively correlated with GAUC, IAUC and IAI( P <0.001). But when IAUC and IAI were controlled, the relationship between HPL and GAUC was not found.Conclusion There are hyperinsulinemia and insulin resistance during pregnancy, and they are related to HPL. HPL is one of the factors that contributing to carbohydrate metabolism changes during pregnancy.