妊娠期糖尿病与血糖正常孕妇胰岛素抵抗及胰岛β细胞功能比较

The comparison of insulin resistance and pancreatic β-cell function in normal pregnant women and gestational diabetes mellitus

目的对比观察妊娠期糖尿病(GDM)与血糖正常孕妇胰岛素抵抗及胰岛β细胞功能。方法选择187例有GDM危险因素的产妇进行前瞻性研究,于早孕期和中孕期进行口服葡萄糖耐量试验(OGTT)检查,根据OGTT结果分为GDM组(86例)和非GDM组(对照组,101例)。检测两组胰岛素水平,采用稳态模型评估胰岛素抵抗指数(HOMA-IR)、胰岛β细胞功能指数(HOMA-β),计算早期胰岛素分泌指数(ΔI30/ΔG30)、混合胰岛素敏感度(ISIcomp)并比较。结果 GDM组早孕期、中孕期的HOMA-IR显著高于对照组,ΔI30/ΔG30、ISIcomp显著低于对照组。与早孕期相比,中孕期对照组和GDM组的HOMA-IR显著高于早孕期,ΔI30/ΔG30、ISIcomp显著低于早孕期。结论 GDM患者早孕期就存在明显的胰岛素抵抗。应进行严格管理,控制血糖,保护胰岛β细胞功能,从而改善妊娠结局。

Objective To compare of insulin resistance and pancreaticβ-cell function in normal pregnant women and gestational diabe-tes mellitus. Methods 187 cases of pregnant women with risk factors for GDM was collected in prospective study. OGTT was conducted in early and middle pregnancy and insulin level was detected. Homeostasis model assessment for insulin resistance index（ HOMA-IR）and pancreaticβ-cell function index（ HOMA-β）was calculated. Early insulin secretion index（ΔI30/ΔG30 ）,mixed insulin sensitivity（ ISIcomp）were calcu-lated and compared between the two groups. Results In the GDM group,we found 86 cases in control group,we found 101 cases in pregnant women. In early and middle pregnancy in GDM group,HOMA-IR was significantly higher,ΔI30/ΔG30 ,ISIcomp significantly lower than the con-trol group. Compared with early pregnancy,HOMA-IR in GDM group and the control group in middle pregnancy was significantly higher than that of early pregnancy.ΔI30/ΔG30 ,ISIcomp was significantly lower than that of early pregnancy. Conclusion In pregnant women with gestational diabetes during early pregnancy,there is a significant insulin resistance. We should strictly manage and control fasting glucose,protect isletβ-cell function,and thereby improving pregnancy outcomes.