妊娠初期检测血糖和胰岛素预测糖代谢异常的临床意义

The clinical value of blood glucose and insulin detection in early period of pregnancy on predicting abnormal glucose metabolism

目的探讨妊娠初期空腹血糖（FPG）与妊娠期糖代谢异常的相关性。方法单胎非孕前糖尿病孕妇277例，在妊娠初期（〈19周）检测FPG、空腹血胰岛素、胰岛素抵抗指数。在妊娠24～36周行100g口服葡萄糖耐量试验（OGrTT），按OGTT结果进行分组，妊娠期糖耐量受损（GIGT）组24例，妊娠期糖尿病（GDM）组23例，OGTT1h高血糖（HG-1）组26例，正常组204例。结果GDM组和HG．1组FPG、空腹血胰岛素、胰岛素抵抗指数均明显高于正常组[（4．58±0．36）、（4．58±0．38）mmol／L比（4．20±0．33）mmol／L，（9．4±1．1）、（9．3±2．1）U／L比（7．0±2．1）U／L，2．0±0．4、2．0±0．3比1．3±0．4，P〈0．05]，但GIGT组仅FPG[（4．45±0．36）mmol／L]高于正常组（P〈0．05）。控制年龄、体质指数、2型糖尿病家族史、体育活动等因素后，糖代谢异常的相对危险度与妊娠初期FPG、空腹血胰岛素和胰岛素抵抗指数有关（P〈0．05）。结论妊娠初期FPG、空腹血胰岛素和胰岛素抵抗指数对糖代谢异常有预测作用。

Objective To investigate the correlation of fasting plasma glucose （FPG） in early period of pregnancy and abnormal glucose metabolism during gestation period. Methods Two hundred and seventy-seven women with single pregnancy and non-propregnant diabetes mellitus were selected. FPG, fasting insulin,insulin resistance index were detected in early period of pregnancy （ 〈 19 weeks）. One hundred g oral glucose tolerant test （OGTY） was taken during 24-36 weeks. According to OGTY,patients were divided into gestational impaired glucose tolerance （GIGT） group （24 cases）,gestational diabetes mellitus（GDM） group（23 cases）,OGrlT 1 h higher blood glucose （HG-1） group （26 cases） and normal group （204 cases）. Results FPG,fasting insulin and insulin resistance index of GDM group and HG-1 group were obviously higher than those of normal group [ （4.58± 0.36）, （4.58 ± 0.38 ） mmol/L vs. （4.20 ± 0.33 ） mmol/L, （9.4 ±1.1 ）, （9.3 ±2.1 ） U/L vs. （7.0 ± 2.1 ） U/L, 2.0 ± 0.4,2.0 ± 0.3 vs. 1.3 ±0.4, P 〈 0.05 ]. FPG of GIGT group [（4.45 ±0.36） mmol/L] was higher than that of normal group （P 〈0.05）. After controlled age, body mass index, family history of type-2 diabetes mellitus and sport exercises, the relative risk degree of blood glucose metabolism had correlation with FPG, fasting insulin and insulin resistance index in early period of pregnancy （P 〈 0.05 ）. Conclusion FPG, fasting insulin and insulin resistance index in early period of pregnancy can predict abnormal glucose metabolism.