妊娠期糖尿病孕妇OGTT时胰岛素值测定及意义

Detection of insulin level and its significance in OGTT in pregnant women with gestational diabetes mellitus

目的:探讨妊娠期糖尿病(Gestational diabetes mellitus,GDM)孕妇行葡萄糖耐量试验(Glucose tolerancetest,OGTT)时胰岛素测定值的变化及其意义。方法:用化学发光法和酶测定法分别测定55例GDM组和50例正常孕妇在孕24～28周间行OGTT时的空腹胰岛素、甘油三酯(Triglyceride,TG)和胆固醇(Total Cholesterole,TC)、以及服用葡萄糖后1 h、2 h和3 h胰岛素值,并计算胰岛素抵抗指数(HOMA-IR)。结果:GDM组与正常孕妇组空腹胰岛素值分别为(14.7±5.1)mU/L和(18.1±6.4)mU/L,差异无统计学意义(P>0.05);服用葡萄糖后1 h和2 h胰岛素测定值GDM组为(123.5±34.1)mU/L和(78.8±23.6)mU/L,正常孕妇组为(48.6±11.2)mU/L和(27.5±8.4)mU/L,分别两两比较差异有统计学意义(P均<0.01)。GDM组血TC和TG均显著高于正常孕妇组,分别为(6.9±2.1)mmol/L、(5.8±1.4)mmol/L和(4.6±1.7)mmol/L、(2.7±0.7)mmol/L(P均<0.05)。GDM组HOMA-IR与TG和TC均有相关性,相关系数r分别为0.67和0.78(P均<0.05),而正常孕妇组HOMA-IR与TG和TC均无相关。结论:GDM孕妇胰岛素分泌相对不足与高血糖有关,因此GDM孕妇合理平衡膳食,控制血糖水平改善胰岛素不足状态,以利于改善母儿预后。

Objective：To explore the change of insulin level and its significance in oral glucose tolerance test（OGTT） in pregnant women with gestational diabetes mellitus（GDM）. Methods：Chemiluminesence method and enzymic method were used to detect the levels of fasting insulin,triglyceride（TG） and total cholesterole（TC） in OGTT and the insulin levels at one,two and three hours after intake of glucose during 24~28 gestational weeks of 55 pregnant women in GDM group and 50 normal pregnant women in control group,insulin resistance index was calculated. Results：The fasting insulin level in GDM group and control group were（14.7±5.1） mU/L and（18.1±6.4） mU/L,respectively,there was no significant difference between the two groups（P0.05）;the insulin levels at one and two hours after intake of glucose were（123.5±34.1） mU/L and（78.8±23.6） mU/L in GDM group,（48.6±11.2） mU/L and（27.5±8.4） mU/L in control group,respectively,there was significant difference between the two groups（P0.01）.The blood TC and TG levels in GDM group were（6.9±2.1） mmol/L and（5.8±1.4） mmol/L,respectively,which were significantly higher than those in control group（（4.6±1.7） mmol/L and（2.7±0.7） mmol/L,respectively）（P0.05）.In GDM group,there was correlation between insulin resistance index and TG,TC,the related coefficients were 0.67 and 0.78,respectively（P0.05）;in control group,there was no correlation between insulin resistance index and TG,TC. Conclusion：Relative deficiency of insulin secretion in pregnant women with GDM is related to hyperglycemia,thus,reasonable and balanced diet of pregnant women with GDM,well controlled blood glucose and improvement of insulin deficiency may be helpful to improve the prognosis of mothers and infants.