遗传、肥胖与妊娠糖尿病的关系

The relationship of genetics, obesity and gestational diabetes mellitus

目的 探讨遗传、肥胖与妊娠糖尿病(GDM)的关系。方法 1997年2月～1998年12月在我院产科门诊确诊为GDM孕妇92例为GDM组;随机抽取同期孕24～28周及孕38～40周糖筛查阴性孕妇70例为对照组。两组分别于产前初诊时详细询问糖尿病家族史及孕前体重、身高,计算孕前体重指数(BMI);并分别于孕28～34周、孕38～40周、产时胎盘娩出后及产后2个月空腹静脉血测血浆胰岛素。结果①GDM组平均孕前体重指数(23.44±3.98)kg/m^2,与对照组平均孕前体重指数(19.38±3.13)kg/m^2相比,差异有显著性(P<0.01);GDM组糖尿病家族史阳性率为25.00%,与对照组1.43％相比,差异有显著性(P<0.01)。②GDM组中糖尿病家族史(+)性者,孕38～40周、产后2个月胰岛素水平明显高于(-)性者,差异有显著性(P<0.01)。孕28～34周、产时两组间差异无显著性(P>0.05)。GDM组中BWI≥kg/m^2者于孕38～40周胰岛素水平明显高于BWI正常者,差异有显著性(P<0.05);孕28～34周、产后2个月两组之间差异无显著性(P>0.05);产时BWI偏高者,胰岛素水平明显低于BWI正常组(P<0.05)。结论 糖尿病是由遗传因素及环境因素共同参与和(或)相互作用引起的,其中肥胖与遗传占重要地位。

Objective To determine the relationship between genetics, obesity and gestational diabetes mellitus (GDM). Methods To obtain the family history of CDM in 92 cases of GDM ( group Ⅰ) and 70 cases of normal pregnant women (group Ⅱ ) . The body weight before gestation and the height were obtained for the calculation of body weight index (BWI) of the two groups. Plasma insulin in two groups were tested by radioimmunoassay. Results ① The average BWI and positive family history of GDM of group Ⅰ were 23.44±3.98 kg/m2 and 25.00% respectively which were significantly higher than those of group Ⅱ ( 19.38±3.13 kg/m2, 1.43% ; P < 0.01, P < 0.01). ② For women with positive family history of GDM in group Ⅰ , in-sul in levels in third trimester and within 2 months after delivery were higher than those of negative ones (P < 0.01). In second trimester and during delivery, there were no significant differences between women with positive and negative history. In group I insulin levels in women with BWI≥24 kg/m2 were higher than those with BWI≤24 kg/m2 in third trimester ( P < 0.05); there were no significant differences between the two kinds of women in second trimester and within 2 months after delivery; during delivery insulin levels in BWI≥24 kg/m2 group were lower than those in BWI≤24 kg/m2 group (P < 0.05). Conclusions Genetics and obesity were associated with an increased risk of GDM.