高龄妊娠糖尿病患者铁代谢水平与胰岛素抵抗的相关性

Correlation between iron metabolism and insulin resistance in elderly patients with gestational diabetes mellitus

目的探讨高龄妊娠糖尿病(GDM)患者铁代谢水平与胰岛素抵抗的相关性。方法测定高龄GDM患者(GDM组,106例)、糖耐量正常的孕妇(对照组,106例)的血糖、血脂、血红蛋白(HB)及铁代谢等指标。比较2组贫血的发生情况,并采用Pearson线性相关和多元线性回归分析铁代谢水平与胰岛素抵抗的相关性。结果与对照组比较,GDM组贫血的发生率明显降低(P<0.05)。胰岛素抵抗指数(HOMA-IR)与孕前体质量指数(BMI)、空腹血糖(FBG)、HB、甘油三酯(TG)、血清铁蛋白呈正相关,与空腹胰岛素(FINS)呈负相关(P<0.05);胰岛素分泌指数(HOMA-IS)与孕前BMI、FBG、HB、TG、血清铁蛋白呈负相关,与FINS呈正相关(P<0.05)。多元线性回归分析显示,孕前BMI、TG、HB及血清铁蛋白是GDM患者HOMA-IR的独立危险因素(P<0.05)。结论高龄GDM患者铁储备明显增加,且与胰岛素抵抗存在一定相关性,进一步加重了GDM的病情。

Objective To explore the correlation between iron metabolism and insulin resistance in elderly patients with gestational diabetes mellitus(GDM). Methods Blood glucose, blood lipid, hemoglobin(HB) and iron metabolism were measured in elderly GDM patients(GDM group, n=106) and pregnant women with normal glucose tolerance(control group, n=106). The incidence of anemia was compared between two groups, and Pearson linear correlation and multiple linear regression were used to analyze the correlation between iron metabolism level and insulin resistance. Results Compared with control group, the incidence of anemia in GDM group was significantly reduced(P<0.05). Homeostasis model assessment of insulin resistance(HOMA-IR) had significant positive correlation with prepregnancy BMI, FBG, HB, TG and serum ferritin, and significant negative correlation with FINS(P<0.05). HOMA-insulin secretion(IS) has significant negative correlation with pre-pregnancy BMI, FBG, HB, TG and serum ferritin, and significant positive correlation with FINS(P<0.05). Multiple linear regression analysis showed that pre-pregnancy BMI,TG, HB and serum ferritin were independent risk factors of HOMA-IR in GDM patients(P<0.05). Conclusions Iron reserve is significantly increased in elderly patients with GDM, and correlated with insulin resistance, which further aggravates the GDM condition.