妊娠期糖尿病患者血浆胰岛素和C肽水平变化

Level changes of insulin and C-peptide in pregnancy of gestational diabetes mellitus

目的 :了解妊娠期胰岛细胞的功能状况 ,探讨胰岛素、C肽水平检测诊断妊娠期糖尿病(GDM )及妊娠期糖耐量减低 (IGT)的意义。方法 :用时间分辨荧光法测定对GDM患者 (A组 ,5 3例 )、IGT患者 (B组 ,6 0例 )、正常妊娠妇女 (C组 ,5 0例 )及正常非妊娠妇女 (D组 ,5 0例 )的胰岛素和C肽水平及变化。结果 :(1)孕晚期C组孕妇血清中胰岛素、C肽水平开始上升并明显高于D组(P <0 .0 1) ,产时出现蜂式分泌高峰 ;(2 )胰岛素水平孕 2 8- 34周时A、B组明显高于C组 (P <0 .0 1) ,而孕 38～ 4 0周时略有下降 ;(3)孕 2 8～ 34周时A组C肽水平明显高于B、C组 (P <0 .0 1) ,而产时明显低于C组 (P <0 .0 1) ,产后A、B组仍明显高于C组 (P <0 .0 5 )。结论 :孕 2 8～ 34周GDM病人胰岛素和C肽出现显著高于正常妊娠胰岛素水平的小峰 ,在孕晚期可帮助GDM诊断 ,小峰的出现可能与组织的胰岛素敏感性有关。

Objective :To understand the β-cell function in gestational and interpret the diagnostic significance of plasma insulin and c-peptide on gestational diabetes mellitus (GDM) and gestational impaired glucose tolerance (IGT). Method: Test the plasma insulin and c-peptide in 53 cases of GDM (group A), 60 cases of IGT (group B), 50 cases of normal pregnant women (group C) and 50 cases of healthy non-pregnant women (group D). Results: (1) In the third trimester insulin, c-peptide levels of group C were higher than the of group D ( P <0.01). They increased and peaked during delivery. (2) At 28～34 insulin levels of group A and B were higher than those of group C ( P <0.01), but tend to decrease by the end the third trimester and peaked during delivery. (3) At 28～34 weeks, c-peptide of group A were significantly higher than those in the group B and C ( P <0.01) and were lower than that in group C during delivery ( P <0.05). Insulin and c-peptide of groups A, B and C dropped gradually within 2 months after delivery, but in group A and B they were significantly higher than those of group C ( P <0.01). Conclusions: In the third trimester insulin and c-peptide of group A, B had small peaking secretion. The phenomena could help to diagnose GDM in the third trimester. The reason maybe associated with the tissue susceptibility to insulin.