改良妊娠期胰岛素敏感性传统评价指标的可行性研究

Feasibility of modified indicators in assessment of insulin sensitivity in pregnant women

目的 探讨用改良后公式来评估妊娠期胰岛素敏感性的可行性.方法 对纳入的319名孕妇于妊娠24 ～ 32周行75 g口服葡萄糖耐量试验（OGTT）,根据诊断结果分为妊娠期糖尿病（GDM）组（47名）与OGTT正常组（272名）,比较空腹和服糖后60、120 min时2组孕妇的血糖、胰岛素和C肽水平.选择妊娠期胰岛素敏感性传统评价公式ISOGTT为参考指标并作为自变量,以用C肽替代胰岛素的3个改良后公式ISOGTTc-pep、ISHOMAc-pep和ISQUICKIc-pep为因变量,对这些因变量与白变量之间的相关性进行分析.结果 GDM组空腹、服糖后60 min与服糖后120 min时血糖水平[（4.9±1.0） mmol/L、（10.0±1.9） mmol/L、（8.5±1.9） mmol/L]均明显高于OGTT正常组[（4.2±0.4） mmol/L、（6.9±1.4） mmol/L、（6.1±1.0） mmol/L],差异均有统计学意义（均P＜0.01）;用ISOGTT与改良后的ISOGTTc-pep公式计算,GDM组胰岛素敏感性均明显低于OGTT正常组[ISOGTT：（59±31）比（91±42）,ISOGTTc-pep：（384±130）比（559±169）],差异均有统计学意义（均P＜0.01）;在简单线性回归中,公式ISOGTTc-pep、ISHOMAc-pep、ISQUICKIc-pep与ISOGTT均明显相关（相关系数分别为0.912、-0.701、0.788,均P＜0.01）,其中公式ISOGTTc-pep与ISOGTT的相关性最强.将上述变量应用到曲线模型中,幂模型为最佳模型,其相关性与简单线性回归结果相似（决定系数分别为0.889、0.712和0.690,均P＜0.01）.结论 改良后的3个妊娠期胰岛素敏感性评估公式与公式ISOGTT均有明显相关性,因此可以用C肽值替代胰岛素值来评估妊娠期胰岛素敏感性,公式ISOGTTc-pep是改良后评估妊娠期胰岛素敏感性的较好指标.

Objective To evaluate the feasibility of modified indicators in assessment of insulin sensitivity in pregnant women.Methods Three hundred and nineteen women undergoing 75 g oral glucose tolerance test （OGTT） at 24 to 28 weeks of gestation were enrolled and divided into gestational diabetes mellitus （GDM） group and normal group according to the results of OGTT.The blood glucose,insulin and C peptide were measured and compared between the two groups at fasting,60 and 120 min after oral glucose load.The correlations was analyzed by taking insulin sensitivity derived from OGTT （ISOGTT） as independent variable,ISOGTTc-pep,insulin sensitivity derived from homeostasis model assessment （ISHOMAc-pep） and quantitative insulin sensitivity check index （ISQUICKIc-pep） as dependent variables out insulin being replaced by C peptide.Results The blood glucose in GDM group at fasting,60,120 min after oral glucose load were all significantly higher than those in normal group [（4.9±1.0）mmol/Lvs （4.2±0.4）mmol/L,（10.0±l.9）mmoL/L vs （6.9±l.4）mmol/L,（8.5±1.9） mmol/L vs （6.1 ± 1.0） mmol/L] （P ＜0.01）.The ISOGTT and modified ISOGTTc-pep were both significantly lower in GDM group compared with those in normal group [ISOGTT：（59 ± 31） vs （91 ± 42）,ISOGTTc-pep：（384 ± 130） vs （559 ± 169）,all P ＜ 0.01].The ISOGTTc-pep,ISHOMAc-pep and ISQUICKIc-pep were all significantly correlated with ISOGTT in simple linear regression （r =0.912,-0.701,0.788,all P ＜ 0.01）,among them the ISOGTTc-pep had the strongest correlation with ISOGTT.The power model was the best model after applying above formulas into the curve model,which got a similar outcome with the linear regression （r2 =0.889,0.712,0.690,all P ＜0.01）.Conclusions The three modified formulas,ISOGTTc-pep,ISHOMAc-pep and ISQUICKIc-pep with insulin being replaced by C peptide,especial ISOGTTc-pep are all significantly correlated with ISOGTT,which are good indicators to assess the insulin sensitivity in pregnant women.