巨大胎儿血糖水平及胰岛素分泌功能的研究

Blood sugar level and insulin secretion of macrosomia

目的探讨巨大胎儿胰岛素分泌功能,为研究和控制胎儿肥胖及肥胖相关胰岛素抵抗提供依据。方法以2016年7月—2017年6月于西北妇女儿童医院出生的正常新生儿100例(组Ⅲ)及巨大儿200例为研究对象。根据孕前母亲身体质量指数(BMI),将巨大儿进一步分为母亲肥胖的巨大儿(组Ⅰ)及母亲体重正常的巨大儿(组Ⅱ)。新生儿生后采集脐带血5mL,其中2mL用于测血糖,余3mL离心后取出血清,放射免疫法测胰岛素,利用HOMA稳态模型评价胰岛素功能。结果母亲孕前血糖及胰岛素,脐血血糖在每两组间比较,差异均无统计学意义(均P>0.05);母亲孕前BMI、脐血胰岛素(INS)、胰岛素抵抗指数(HOMA-IR)、胰岛素分泌指数(HOMA-β)、胰岛素敏感指数(HOMA-IS)在每两组间比较差异均有统计学意义(母亲孕前BMI:t_(Ⅰ与Ⅲ)=2.33,t_(Ⅱ与Ⅲ)=7.19,t_(Ⅰ与Ⅱ)=2.18,均P<0.05;脐血胰岛素:t_(Ⅰ与Ⅲ)=7.39,t_(Ⅱ与Ⅲ)=2.57,t_(Ⅰ与Ⅱ)=3.71,均P<0.05;HOMAIR:t_(Ⅰ与Ⅲ)=5.70,t_(Ⅱ与Ⅲ)=5.90,t_(Ⅰ与Ⅱ)=2.89,均P<0.05;HOMA-β:t_(Ⅰ与Ⅲ)=10.20,t_(Ⅱ与Ⅲ)=5.15,t_(Ⅰ与Ⅱ)=5.98,均P<0.05;HOMA-IS:tI与Ⅲ=-11.27,t_(Ⅱ与Ⅲ)=-8.77,t_(Ⅰ与Ⅱ)=-3.24,均P<0.05)。且母亲孕前BMI,脐血INS,HOMA-IR,HOMA-IS在正常新生儿、母亲体重正常巨大儿、母亲肥胖巨大儿三组间呈逐渐升高趋势,而HOMA-IS呈逐渐降低趋势。结论巨大胎儿血清胰岛素显著升高,体内存在胰岛素抵抗及胰岛素分泌异常,而母亲肥胖是巨大儿胰岛素抵抗的危险因素。

Objective To investigate the insulin secretion of macrosomia and to provide reference for controlling of fetal obesity and studying of insulin resistance related to obesity.Methods Altogether 100 cases of normal weight newborn babies（group Ⅲ）and 200 cases of macrosomia delivered in Northwest Women＇s and Children＇s Hospital from July 2016 to June 2017 were selected as study objects.Macrosomia cases were further divided into cases of obese mothers （groupⅠ）and cases of normal weight mothers（groupⅡ）according to maternal BMI before pregnancy.Five mL umbilical cord blood was taken after baby was born,and glucose of 2 mL umbilical blood was measured,and serum of 3 mL umbilical blood was taken out by centrifugation and tested with insulin by radioimmunoassay.Insulin function was assessed using HOMA homeostasis model.Results There were no signifiant differences in maternal blood sugar and insulin levels before pregnancy and cord blood sugar level between every two groups（all P〈0.05）.Maternal BMI before pregnancy,umbilical cord blood insulin（INS）,insulin resistance index（HOMA-IR）,insulin secretion index（HOMA-β）,and insulin sensitive index（HOMA-IS）showed statistically significant differences in comparison of every two groups（maternal BMI before pregnancy：tⅠ and Ⅲ=2.33,tⅡ and Ⅲ=7.19,tⅠ and Ⅱ=2.18,all P〈0.05）;umbilical cord blood insulin：tⅠand Ⅲ=7.39,tⅡ and Ⅲ=2.57,tⅠ and Ⅱ=3.71,all P〈0.05;HOMA-IR：tⅠ and Ⅲ=5.70,tⅡ and Ⅲ=5.90,tⅠ and Ⅱ=2.89,all P〈0.05;HOMA-β：tⅠ and Ⅲ=10.20,tⅡ and Ⅲ=5.15,tⅠ and Ⅱ=5.98,all P〈0.05;HOMA-IS：tⅠ and Ⅲ=-11.27,tⅡ and Ⅲ=-8.77,tⅠ and Ⅱ=-3.24,all P〈0.05）.Maternal BMI,cord blood INS,HOMA-IR,and HOMA-IS showed an increasing trend in normal newborns,macrosomia with normal weight mother and macrosomia with obese mother in turn,while HOMA-IS was gradually decreasing.Conclusion Macrosomia have significantly increased serum insulin and insulin resistance and insulin secretion abnormalities.Mother＇s obesity is a risk factor for insulin resistance of macrosomia.