妊娠期糖尿病患者孕中期至孕足月胰岛素抵抗变化的临床分析

Degree of insulin resistance(IR) of the gestational diabetic patients from the second trimester to term pregnancy

目的探讨妊娠期糖尿病（GDM）及妊娠期糖耐量受损（GIGT）患者孕中期至孕足月胰岛素抵抗（IR）的程度及其变化。方法选择孕期经饮食治疗血糖控制良好的A1级GDM患者36例（A组）,GIGT患者37例（B组）,同期糖耐量正常的孕妇90例为对照组（C组）。监测各组孕24~28周和孕足月时的空腹血糖（FPG）、空腹血胰岛素（FINS）浓度,评价各孕期IR程度及孕24~28周时胰岛β细胞功能和妊娠结局。结果孕24~28周,A组患者的IR水平高于C组患者,差异有统计学意义（P〈0.05）,B、C组IR差异无统计学意义（P〉0.05）。到孕足月,B组患者的IR程度加重,高于C组（P〈0.05）,而A组患者IR水平呈下降趋势。从正常妊娠、GIGT到GDM孕妇,其胰岛β细胞功能依次下降（P〈0.05）。经饮食控制,GDM和GIGT患者妊娠结局与正常妊娠差异无统计学意义（P〉0.05）。结论 GDM患者在孕24~28周甚至更早出现明显的IR,到足月妊娠呈异常下降趋势,这可能提示GDM患者存在胎盘功能的下降。GIGT患者在孕足月呈现明显的IR。

Objective To investigate the degree of insulin resistance（IR） the gestational diabetic patients and the gestational impaired glucose tolerance patients from the second trimester to term pregnancy.Methods 36 pregnant women with GDM and 37 with gestational impaired glucose intolerance（GIGT） were recruited and served as Group A and Group B respectively.Women in both Group A and B were managed by Dietary control only and kept their CBG at appropriate level.90 cases with normal pregnancy were served as control group（Group C）.We measured and compared such parameters as blood glucose,blood insulin level and IR in 24~28 gestational weeks and at term,the function of pancreatic islet β-cell,and recorded their pregnancy outcomes.Results During 24~28 gestational weeks,the value of IR Group A was more severe than that in Group B and Group C（P0.05）.There was no significant difference of the IR between Group B and Group C（P0.05）.At term,the IR in Group B became higher than that of Group C（P0.05）,While the IR in Group A was no more different to that in Group C（P0.05）.The function of pancreatic islet β-cell in decreasing order were Group C,Group B and Group A（P0.05）.there were no significant differences in the pregnancy outcomes among the three groups because of tight control of blood sugar by diet therapy alone.Conclusion During 24-28 gestational weeks,The IR and metabolic abnormalities in GDM women are more severe compared with that in normal pregnancy.At term the IR in GDM women mitigates,it may result from the rapidly decline of placental function.