不同糖耐量状态孕妇的胰岛素敏感性与胰岛β细胞功能的研究

Insulin sensitivity and islet β-cell function in pregnant women with different glucose tolerance status

目的评估不同糖耐量状态孕妇的胰岛素敏感性和胰岛β细胞功能的特点。方法 GCT阳性受试者1561例,进一步行100g OGTT,其中正常糖耐量(NGT)651例,糖耐量减低(IGT)301例,妊娠糖尿病(GDM)609例。IGT组分为1小时血糖异常(1h-IGT)、2h或3h血糖异常(2/3h-IGT)。用胰岛素敏感性指数ISPMatsuda、HOMA-IR评估胰岛素敏感性,HOMA-β、1相和2相胰岛素分泌指数、胰岛素分泌敏感性指数(ISSI)评估胰岛β细胞功能。结果 GDM组与IGT组年龄、TG水平显著高于NGT组(P均<0.01)。从NGT组→IGT组→GDM组,ISI-Matsuda依次降低(P均<0.01);NGT组、IGT组HOAM-IR结果相近,显著低于GDM组(P均<0.01);各组HOMA-β差异无统计学意义(P>0.05);IGT组与NGT组1相、2相胰岛素分泌指数差异无统计学意义,均高于GDM组(P均<0.01);ISSI依次降低(P均<0.01)。在IGT亚组中,1 h-IGT组ISSI低于2/3h-IGT组。结论与NGT组比较,IGT组、GDM组临床特征无法区分。IGT组、GDM组胰岛素敏感性降低与胰岛β细胞功能障碍并存,且GDM组更加严重。与IGT其他亚组比较,1h-IGT状态更差。

Objective To evaluate insulin sensitivity and β-cell function in pregnant women with different glucose tolerance status. Methods After 100g 3-h OGTT, 1561 pregnant women were classified from gestational diabetes mellitus （GDM） to gestational impaired glucose test （GIGT） and to normal glucose tolerance（NGT）. Those with IGT were divided into three subgroups： 1-h hyperglycemia （lh-IGT）, 2- or 3-h hyperglycemia （2/3h-IGT）. From the data of OGTT, we calculated insulin sensitivity index （ISI-Matsuda）and HOMA-IR, and insulin secretion （homeostasis model assessment for the estimate of β-cell secretion（HOMA-β）, first- and second-phase insulin secretion）. The product of the first-phase index and the ISI was calculated to obtain the insulin secretion-sensitivity index（ISSI）. Results Women with GDM and IGT were older and had higher serum triglyceride level than those with NGT （all P〈 0.01）. Women with NGT had the highest ISI, followed by those with IGT and GDM. HOMA-IR results were similar in both groups of IGT and NGT, but significantly lower （P〈0.01）than those for NGT. HOMA-β results were comparable with those for NGT and IGT and GDM（all P〉 0.05）; first- and second-phase insulin secretion were comparable in IGT and NGT but significantly higher than in GDM group（P〈0.01）. ISSI was higher in women with NGT than in women with either IGT or GDM. Among IGT subgroups, the 1h-IGT subgroup showed the lowest ISSI. Conclusions IGT and GDM are clinically indistinguishable, and both groups are different from women with NGT. Women with GDM and IGT show impaired insulin secretion and insulin sensitivity, although these detections are more pronounced in women with GDM. As compared with other IGT subgroup, 1h-IGT could be considered as a more severe condition.