不同糖耐量状态孕妇胰岛β细胞功能与产后转归的研究

Isletβ-cell function and postpartum outcomes in pregnant women with different glucose tolerance status

目的研究不同糖耐量状态孕妇胰岛素敏感性(IS)、胰岛β细胞分泌功能及产后转归情况。方法 376例50g葡萄糖负荷试验(GCT)阳性者,再行75g OGTT。采用胰岛素敏感指数(ISIMatsuda)、胰岛β细胞代偿胰岛素抵抗的分泌能力(ISSI)对糖耐量正常组(GNGT,298名)、妊娠期糖耐量减低(GIGT,47例)组及妊娠期糖尿病(GDM,31例)组进行评价,分析影响因素,追踪产后转归情况。结果 ISI-Matsuda在GNGT组、GDM组及GIGT组依次递减[(93.98±24.66)vs(71.41±33.75)vs(57.36±23.26),P均<0.01];ISSI在GNGT组、GIGT组及GDM组依次降低[(132233.10±26049.05)vs(74736.81±11163.93)vs(53099.99±20380.48),P均<0.01]。Pearson相关分析显示,LDL-C、TG、高敏C反应蛋白(hsC-RP)与ISI-Matsuda及ISSI呈负相关(P<0.01)。糖耐量异常孕妇产后34.3%仍存在糖代谢异常,转为T2DM者ISSI下降最明显。结论 GIGT以IR为主,GDM以胰岛素分泌缺陷为主。胰岛素分泌功能受损孕妇产后易发生T2DM。

Objective To study the correlation of insulin sensitivity and islet 13-cell function with postpartum outcomes in pregnant women with different glucose tolerance status. Methods After 75 g- OGTT, 376 cases of pregnant women were divided into gestational diabetes mellitus （GDM, n = 31 ） group, gestational impaired glucose test （ GIGT, n = 47 ） group and normal glucose tolerance （ GNGT, n = 298 ） group. Insulin sensitivity index （ISI-Matsuda）, islet cell insulin secretion compensation ability （ISSI） and influence factors were analyzed, meanwhile, postpartum outcomes were recorded. Results From GNGT group to GDM group to GIGT group, ISI-Matsuda were decreased successively （P〈0.01）. From GNGT group to GIGT group to GDM group, ISSI were decreased successively too （P〈0.01）. Pearn correlation analysis showed that TG, LDL-C and hs-CRP were significantly negatively related to ISI-Matsuda and ISSI. 34% postpartum women with impaired glucose regulation presented with abnormal glycometabolism, ISSI were significantly lower in postpartum women who turned to type 2 diabetic mellitus. Conelusion GIGT gives priority to insulin resistance , and GDM gave priority to insulin secretion defects. Postpartum women with worse insulin secretion function would be more likely to turn to 2 type diabetic mellitus.