运动加饮食干预对妊娠糖尿病患者胰岛素抵抗和血清脂联素及内脂素水平的影响

Effects of Exercise and Diet Intervention on Insulin Resistance and Serum Adiponectin and Visfatin Levels in Patients with Gestational Diabetes Mellitus

目的探讨运动加饮食干预对妊娠糖尿病(GDM)患者胰岛素抵抗(IR)及血清脂联素、内脂素水平的影响。方法选取妊娠24～28周的孕妇88例,按美国糖尿病学会(ADA)2009年GDM诊断标准,将孕妇分为GDM组(38例)和糖耐量正常组(NGT组,50例)。测定两组孕妇的空腹血糖(FBG)、空腹胰岛素(FINS)、血脂〔三酰甘油(TG)、总胆固醇(TC)、高密度脂蛋白胆固醇(HDL-C)、低密度脂蛋白胆固醇(LDL-C)〕、脂联素、内脂素,并计算胰岛素抵抗指数(HOMA-IR)及体质指数(BMI)。给予GDM组孕妇为期12周的家庭运动干预及饮食控制治疗,跟踪随防所有孕妇,并于孕37～40周再次检测上述指标。结果 (1)干预前(中孕期,孕24～28周),GDM组患者FBG、FINS、HOMA-IR、TG、LDL-C、内脂素水平显著高于NGT组,而脂联素水平则显著低于NGT组,差异均有统计学意义(P<0.05)。Spearman线性相关分析显示,HOMA-IR与年龄、孕周、TG、内脂素水平呈正相关(均P<0.05),与脂联素水平呈负相关(P<0.05)。(2)干预后(孕晚期,孕37～40周),GDM组孕妇BMI、FBG、HOMA-IR、内脂素水平高于NGT组,而脂联素水平低于NGT组,差异均有统计学意义(P<0.05);且FINS、TG、LDL-C水平较GDM组干预前下降,BMI较GDM组干预前增加,差异均有统计学意义(P<0.05)。Spearman线性相关分析表明:脂联素水平与孕周、FBG水平呈负相关(均P<0.05);内脂素水平与孕周、FINS水平呈正相关(均P<0.05)。结论孕中期GDM孕妇存在低脂联素、高内脂素水平及高HOMA-IR;运动加饮食干预能有效控制GDM患者血脂、脂联素、内脂素水平,改善胰岛素抵抗。

Objective To investigate the effects of exercise and diet intervention on insulin resistance （IR） and serum adiponectin （ADP） and visfatin levels in patients with gestational diabetes mellitus （GDM）. Methods Totally 88 pregnant women in their 24 - 28 gestational weeks were divided into GDM group （ n = 38 ） and glucose tolerance in normal pregnant women （NGT） group （n = 50） based on the ADA 2009 GDM diagnostic standards. The fasting blood glucose （FBG）, fasting insulin （FINS）, blood lipid, ADP, and visfatin were determined. The insulin index （HOMA -IR） and body mass index （BMI） were calculated. The GDM group was provided with household - based diet intervention and exercise. All the subjects were tracked, and the above indicators were measured in the 37 ~ 40 gestational weeks. Results Before the intervention （ during the mid - tri- mester） , the levels of FBG, FINS, HOMA - IR, TG and LDL - C in the GDM group were significantly higher than in the NGT group （ all P 〈 0.05 ） ; meanwhile, the level of visfatin was significantly higher and the ADP level significantly lower than the NGT group （ all P 〈 0. 05 ）. In addition, HOMA - IR was positively correlated with age, gestational week, TG, and visfatin levels （P 〈 0.05 ）, and negatively with ADP levels （ P 〈 0. 05 ）. After the intervention （ during the late pregnancy）, the BMI, FBG, HOMA - IR, and visfatin were significantly higher in the GDM group than in NGT group whereas the adiponect!n was significantly lower （ P 〈 0. 05 ） . Spearman linear analysis showed that the adiponectin level was negatively correlated with the gestational week and FBG level （ P 〈 0.05 ）, whereas the visfatin was negatively correlated with the gestational week and FINS level （ P 〈 0.05 ）. Conclusion Pregnant women have low ADP, high visfatin and high HOMA -IR during the mid -trimester. Exercise combined with diet intervention can effectively control blood lipid, ADP, and visfatin levels and improving insulin resistance in GDM patients.