妊娠期糖尿病患者与正常孕妇妊娠中晚期胰岛素抵抗及胰岛B细胞功能观察

Longitudinal changes in insulin resistance and pancreatic beta-cell function in pregnant women with normal and abnormal glucose metabolism from second trimester to third trimester.

目的前瞻性纵向观察中期妊娠诊断为妊娠期糖尿病(GDM)患者及血糖正常孕妇在妊娠中晚期胰岛素抵抗及胰岛B细胞功能变化,并比较两者之间的差别。方法 2009年2月至2010年3月在中山大学孙逸仙纪念医院产前检查的82例孕妇于妊娠20～24周行葡萄糖耐量试验(OGTT)及胰岛素释放试验,诊断为GDM43例为GDM组,血糖正常的39例为对照组。于32～36周复查OGTT及胰岛素释放试验,纵向观察两组孕妇胰岛素抵抗及胰岛B细胞功能的变化。结果两组的胰岛B细胞分泌指数(HOMA-β)晚期妊娠均高于中期妊娠,时间主效应有统计学意义(F=7.863,P=0.007);GDM组的早期胰岛素分泌指数(△I30/△G30)中期妊娠及晚期妊娠均低于对照组,组间主效应差异有统计学意义(F=6.052,P=0.018),但GDM组从中期妊娠到晚期妊娠有所升高,而对照组逐渐下降。GDM组的血糖曲线下面积(AUCG)在中期妊娠及晚期妊娠均大于对照组(分别为P<0.0001,P=0.001),同时对照组的AUCG晚期妊娠显著高于中期妊娠(P=0.001);稳态模式胰岛素抵抗指数(HOMA-IR)及混合胰岛素敏感度的时间及组间主效应差异均无统计学意义。结论中晚期妊娠正常孕妇及GDM患者胰岛素抵抗均增加,后者胰岛素抵抗程度高于前者,胰岛B细胞代偿功能两者均增强;GDM组的早期胰岛素分泌功能较正常妊娠组下降。胰岛素抵抗和胰岛素分泌代偿不足是GDM发生、发展的重要机制。

Objective To observe the change of insulin resistance and pancreatic beta-cell function during pregnancy in women with normal metabolism of glucose and who diagnosed of GDM and GIGT in second trimester. Methods Oral glucose tolerance test and insulin releasing test were performed on 82 study subjects between 20^th and 24^th gestational weeks and between 32^nd and 36^th gestational weeks, of whom 43 were diagnosed GDM between 20^th and 24^th gestational weeks. We wanted to observe the change of insulin resistance and pancreatic beta-cell function during pregnancy of them. Results The time effect of homeostasis model assessment-β （HOMA-β） （ F = 7. 863, P = 0. 007 ）, HOMA-β in third tri- mester was higher than in second trimester in both groups. The group effect of A △I30/△G30 （ F = 6. 052, P = 0. 018 ） were significant, △I30/△G30 in GDM group was lower than in control group in either trimester. Area under curve of glucose （AUCG） in GDM group were statistically higher than in control group in second and third trimester（P 〈 0. 0001 ）. In control group, AUCG of third trimester is statistically higher than AUCG of second trimester （ P = 0. 001 ）. Conclusions Insulin resistance aggravated and β-cell＇ s ability to compensate for the increased insulin resistance by modulating insu- lin secretion aggravated as gestational week increased from second trimester to third trimester in women diagnosed with GDM in second trimester and with normal metabolism of glucose . While A △I30/△G30 in GDM group is lower than preg- nant women with normal metabolism of glucose.