胰岛素抵抗对血糖正常孕妇妊娠结局的影响

Influence of insulin resistance on pregnancy outcomes of pregnant women with normal glucose

目的了解口服糖耐量试验(OGTT)中血糖正常的孕妇是否存在胰岛素抵抗,探究胰岛素抵抗与妊娠不良结局的关系。方法选取2015年6月至2016年6月在上海交通大学附属第六人民医院产检并分娩的正常孕妇457例,随访孕妇分娩期的生化指标、分娩结局及新生儿的信息,按稳态模型胰岛素抵抗指数(HOMA-IR)将457例孕妇分成两组:正常组(HOMA-IR<2.8,n=399)和胰岛素抵抗组(HOM A-IR≥2.8,n=58),分析两组之间的生化指标及妊娠结局。结果 457正常孕妇中有12.69%存在胰岛素抵抗。胰岛素抵抗组与正常组孕前BMI、收缩压比较差异有统计学意义(t值分别为-8.740、-2.438,均P<0.05);生化指标中,高密度脂蛋白、尿酸、空腹胰岛素、1h胰岛素、2h胰岛素、空腹血糖、2h血糖、基础胰岛素分泌功能指数(HOMA-β)、混合胰岛素敏感性指数(ISIcomp)两组比较差异均有统计学意义(t值分别为3.004、-5.998、-22.533、-7.568、-8.744、-6.416、-2.411、-7.316、16.692,均P<0.05);新生儿方面,胰岛素抵抗组新生儿体重比正常组稍高,差异有统计学意义(t=-2.742,P<0.05)。相关分析结果显示胰岛素抵抗与巨大儿及妊娠期高血压疾病的发生呈正相关(r值分别为0.106、0.125,均P<0.05)。回归分析结果显示胰岛素抵抗是巨大儿及妊娠期高血压疾病发生的危险因素之一(OR=2.601,95%CI为1.048~6.455;OR=9.092,95%CI为2.680~30.845)。两组巨大儿、妊娠期高血压疾病发生率比较差异有统计学意义(χ~2值分别为4.526、16.516,均P<0.05)。结论一部分血糖正常的孕妇存在胰岛素抵抗,胰岛素抵抗是巨大儿、妊娠期高血压疾病发生的危险因素之一,提示减轻胰岛素抵抗可改善母婴结局。

Objective To investigate the insulin resistance of normal pregnant women in oral glucose tolerance test（OGTT） and to explore the relationship between insulin resistance and adverse pregnancy outcomes.Methods Totally 457 normal pregnant women who had prenatal examination and delivered in Shanghai Sixth People＇s Hospital during June 2015 to June 2016 were selected.The biochemical indexes,delivery outcomes and neonatal information of the pregnant women during the delivery period were followed up.According to the homeostasis model assessment-insulin resistance index（HOMA-IR）,the cases were divided into two groups,normal group（HOMA-IR〈2.8,n=399） and insulin resistance group（HOMA-IR≥2.8,n=58）.The biochemical indexes and pregnancy outcomes between two groups were analyzed.Results Among 457 normal pregnant women,12.69% presented insulin resistance.There were significant differences in BMI and systolic blood pressure between insulin resistance group and normal group（t value was-8.740 and-2.438,respectively,both P〈0.05）.In biochemical indexes,there were significant differences in high density lipoprotein,uric acid,fasting insulin,1h insulin,2h insulin,fasting blood glucose,2h blood glucose,basal insulin secretion index,mixed insulin sensitivity index（t value was 3.004,-5.998,-22.533,-7.568,-8.744,-6.416,-2.411,-7.316 and 16.692,respectively,all P〈0.05）.The neonatal weight in insulin resistance group was slightly higher than that in normal group,and the difference was statistically significant（t=-2.742,P〈0.05）.Correlation analysis showed that insulin resistance was positively correlated with the occurrence of macrosomia and hypertensive disorder complicating pregnancy（r value was 0.106 and 0.125,respectively,both P〈0.05）.The results of regression analysis showed that insulin resistance was one of the risk factors of macrosomia and hypertensive disorder complicating pregnancy（OR=2.601,95% CI ranged 1.048 to 6.455;OR=9.092,95% CI ranged 2.680 to 30.845）.There were significant differences between two groups in the incidence of macrosomia and pregnancy induced hypertension（χ~2value was 4.526 and 16.516,respectively,both P〈0.05）.Conclusion Some of pregnant women with normal blood glucose suffer from insulin resistance.Insulin resistance is one of the risk factors of fetal macrosomia and hypertensive disorders complicating pregnancy,which suggests that relieving insulin resistance can improve maternal and neonatal outcomes.