正常妊娠妇女及妊娠期糖尿病患者胰岛素和C肽水平的变化

Changesof Insulin and C peptide in Pregnancy of Gestational Diabetes Mellitus

目的 探讨正常妊娠妇女、妊娠期糖尿病（ＧＤＭ） 及妊娠合并糖耐量减低（ＧＩＧＴ） 患者孕期胰岛素、Ｃ 肽水平的变化，了解其胰岛β细胞的功能状况。方法 用放射免疫法测定ＧＤＭ 患者４８例（Ⅰ组）；ＧＩＧＴ患者３９ 例（Ⅱ组）；正常妊娠妇女４２ 例（ Ⅲ组） ；正常非妊娠妇女２２ 例（ Ⅳ组）的胰岛素和Ｃ肽水平。结果 Ⅲ组孕晚期的胰岛素、Ｃ 肽水平明显高于Ⅳ组（ Ｐ均＜ ０．０１），且从孕３４ 周至孕晚期， 有上升趋势，至产时呈高峰。Ⅰ、Ⅱ组于孕２８～３４ 周时，胰岛素水平明显高于Ⅲ组（ Ｐ＜ ０．０１，Ｐ＜０ ．０５） ，孕３８～４０ 周时略有下降，产时也有峰式分泌，但３ 组比较差异无显著性。Ⅰ组Ｃ 肽水平孕２８～４０ 周时明显高于Ⅱ、Ⅲ两组（Ｐ均＜０ ．０１），产时明显低于Ⅲ组（ Ｐ＜０ ．０５） 。Ⅰ～Ⅲ组产后２ 个月胰岛素、Ｃ肽水平均下降，Ⅰ、Ⅱ组仍明显高于Ⅲ组（Ｐ均＜ ０．０１） 。结论 Ⅰ～Ⅲ组孕晚期的胰岛素、Ｃ肽水平均随孕周逐渐升高，可能和较强的胰岛素抵抗有关。Ⅰ～Ⅲ组产时胰岛素和Ｃ肽的峰式分泌，可能和精神、心理等应力因素有关。ＧＤＭ、ＧＩＧＴ患者产后２ 个月时胰岛素水平多高于正常水平，需进行长期随诊。

Objective To observe the differentchanges of plasmainsulin and c peptide in patients with gestationaldiabetes mellitus (GDM),gestationalimpaired glucose tolerance (GIGT),normal pregnant women, andto detectthefunction ofβ cellin patients with gestationalimpaired glucose metabolism . Methods Testthe plasmainsulin,c peptidein 48 cases of GDM( group Ⅰ) ,39 cases of GIGT(group Ⅱ) ,39 cases of normal pregnant women (group Ⅲ) and 22 cases of healthy non pregnant women (group Ⅳ) by radioimmunoassay. Results (1) Inthirdtrimesterofgroup Ⅲ,insulin,c peptidelevels were higherthan those ofgroup Ⅳ( P< 0 .01).Theyincreasedfrom 28～34 weeksto38～40 weeks,peaked during delivery.Insulin levelsof group Ⅰ and group Ⅱwerehigherthanthoseofgroup Ⅲ( P< 0.01, P<0 .05),buttendedtodecrease bytheend ofthe thirdtrimester and peaked during delivery.During delivery,there was no significantdifferences amongthe three groups.At28～40 weeks,c peptide ofgroup Ⅰwas significantly higherthan thosein groups Ⅱand Ⅲ( P< 0 .01) and waslowerthanthatin group Ⅲduring delivery ( P< 0.05) .Insulin and c peptide ofthese 3 groups dropped gradually within2 monthsafterdeliverybutingroup Ⅰand Ⅱthey weresignificantlyhigherthanthose of group Ⅲ( P< 0.01). Conclusion In third trimesterinsulin and c peptide of group Ⅰ～Ⅲincreased till delivery,thereason maybeassociated withinsulinresistance.GDMhadthesamepeakingsecretionduringdelivery with normal pregnant women and GIGTgroup,this maybe duetothestressduring delivery.Insulinlevelsof most GDMand GIGTwere stillhigherthan normalaftertwo month postpartum ,and should befollowed up carefully.