婴幼儿胰岛素敏感性与母孕期糖代谢情况及糖尿病家族史的关系

Influence of maternal glucose metabolism during pregnancy and family history of diabetes on insulin sensitivity in infants and toddlers

目的探讨影响婴幼儿期胰岛素敏感性的相关因素。方法对北京大学第三医院儿童保健中心2006年1月到2008年5月建档并定期体检的符合人选标准的246名婴儿和120名幼儿进行回顾性分析，用胰岛素稳态模型法（homeostasis model assessment，HOMA）计算胰岛素抵抗指数（insalin resistance，IR）、胰岛素作用指数（insulin action index，IAI）、血糖胰岛素比值（fasting glucose—to—insulin ratio，FGIR）以及胰岛细胞功能（HOMA-β）。数据用中位数（M）和P25～P75表示，不同孕母孕期糖代谢情况及糖尿病家族史时各指标差异的比较采用多个独立样本非参数秩和检验，有组间差异者（P〈0．05）再进行组间比较，调整P值结果以P〈0．017为差异有统计学意义。结果母孕期有糖尿病的婴儿HOMA-IR[3．24（2．76-4．12）]和HOMA—β[164．00（114．44～192．85）]高于母孕期无糖代谢异常的婴儿[1．51（0．86～2．50）和67．07（41．83～106．22）]（Z分别=3．76、3．35，P均〈0．017），而IAI[-7．18（-7．41～-7．02）]和FGIR[7．31（5．82～8．55）]低于母孕期无糖代谢异常的婴儿[-6．41（-6．92～-5．85）和14．84（9．49～24．79）]，差异均有统计学意义（Z分别=3．76、3．71，P均〈0．017）；与母孕期有糖耐量受损的婴儿相比，母孕期有糖尿病的婴儿HOMA-IR增高（Z=3．19，P〈O．017）、IAI降低（Z=3．19，P〈0．017）。母孕期无糖代谢异常和仅有糖耐量受损的婴幼儿胰岛素敏感性差异无统计学意义（P〉0．017）。一级亲属有糖尿病史与无糖尿病家族史的婴、幼儿比较HOMA—IR增高、IAI和FGIR降低[婴儿：HOMA—IR为3．24（2．73～4．13）和1．41（0．84～2．50）；IAI为-7．18（-7．42～-7．00）和-6．34（-6．91～-5．82）；FGIR为7．31（5．40～7．48）和14．87（9．53～25．17）。幼儿：HOMAIR为3．98（2．62～4．80）和1．70（0．92～3．04）；IAI为7．38（-7．57～～6．97）和6．54（-7．11～-5．92）；FGIR为6．17（6．04-8．00）和12．65（8．33～21．53）。P均〈0．017]，婴儿期HOMA-β增高[164．00（137．82～198．00）和67．06（40．40～106．83），P〈0．017]。结论母孕期有糖尿病和／或一级亲属有糖尿病史的婴幼儿胰岛素敏感性降低。

Objective To explore the related factors of insulin sensitivity in infants and toddlers. Methods From January 2006 to May 2008, 246 infants and 120 toddlers who had regular physical check-ups at the Children Healthcare Center of Third Hospital of Peking University were selected in this retrospective study. The homeostasis model assessment insulin resistance index （HOMA-IR）, insulin action index（IAI）, fasting glucose to-insulin ratio （FGIR） and HOMA -β cell function （HOMA-β） were measured with the homeostasis model analysis. According to different glucose metabolic situation of the pregnant mothers and diabetes family history, the infants and toddlers were divided into different groups. The above indicators were compared among groups. Results In infants with maternal diabetes, the levels of HOMA IR and HOMA 13 were 3.24（2.76-4.12） and 164.00（114.44-192.85）, higher than those born to mothers without abnomal glucose metabolism [1.51（0.86 2.50） and 67.07（41.83 -106.22）2,while the levels of IAI and FGIR were lower [-7.18（ 7.41-7.02） and 7.31（5.82-8.55） vs -6.41（-6.92 -5.85） and 14.84（9.49 24.79）1 （Z=3.76,3.35,3.76 and 3.71, P〈0.017）. Compared with infants of maternal impaired glucose tolerance,the level of HOMA IR was higher （Z= 3.19, P〈0. 017） in infants with maternal diabetes,the level of IAI was lower（Z= 3.19, P〈0.017）. No significant difference of insulin sensitivity were observed between infants with and without maternal impaired glucose tolerance （P〉 0. 017）. The level of HOMA-IR was higher in infants and toddlers with diabetes in first-degree relatives [infants： 3.24（2.73 4.13） vs 1.41（0.84-2.50） ; toddlers： 3.98（2.62-4.80） vs 1.70（0.92 3.04）; P〉0. 017], while the levels of IAI and FGIR were lower [infants： IAI, 7.18（ 7.42- -7.00） vs -6.34（-6.91-5.82） ; FGIR, 7.31（5.40-7.48） vs 14.87（9.53 25.17） ; toddlers.. IAI, -7.38（-7.57-6.97） vs - 6. 54 （ - 7.11- 5. 92 ） ; FGIR, 6.17（6.048.00） vs 12.65（8.33- 21.53）, P〈0.017], and the level of HOMA-β was higher just in the infants [164.00（137.82- 198.00） vs 67.06（40.40-106.83）, P〈0. 017]. No significant difference was observed in infants with second-degree relatives diabetes and without diabetic family history group （P〉0. 017）. Conclusions Maternal diabetes and diabetic family history in first-degree relatives were significantly related to the decrease of insulin sensitivity in infants and toddlers.