中国医师进修杂志
中國醫師進脩雜誌
중국의사진수잡지
CHINESE JOURNAL OF POSTGRADUATES OF MEDICINE
2012年
1期
9-12
,共4页
赖丽萍%陆泽元%李翠吟%庄雄杰%蒋凤秀%凤香清
賴麗萍%陸澤元%李翠吟%莊雄傑%蔣鳳秀%鳳香清
뢰려평%륙택원%리취음%장웅걸%장봉수%봉향청
谷氨酸脱羧酶%蛋白酪氨酸激酶类%糖尿病,妊娠%随访研究
穀氨痠脫羧酶%蛋白酪氨痠激酶類%糖尿病,妊娠%隨訪研究
곡안산탈최매%단백락안산격매류%당뇨병,임신%수방연구
Glutamate decarboxylase%Protein-tyrosine kinases%Diabetes,gestational%Followup studies
目的 探讨谷氨酸脱羧酶抗体( GAD-Ab)和蛋白酪氨酸磷酸酶抗体(IA-2A)对妊娠期糖尿病(GDM)患者随访的意义.方法 选取GDM患者84例(GDM组)和口服葡萄糖耐量试验正常孕妇82例(对照组),GDM组又分为抗体阳性(GAD-Ab、IA-2A任何一项阳性)组18例和抗体阴性(GAD-Ab、IA-2A均阴性)组66例,分别于孕24～28周、产后6～12周和产后2年进行随访,测定GAD-Ab、IA-2A、胰岛素水平及糖代谢指标.结果 GDM组稳态模型胰岛素抵抗指数(HOMA-IR)高于对照组(3.87±2.17比2.31±0.52,P＜0.05),稳态模型胰岛β细胞功能指数(HBCI)和30 min净增胰岛素/30 min净增血糖(△I30/△G30)低于对照组[206.38±138.06比422.43±228.93和(20.16±11.38) mU/mmol比(26.54±24.30) mU/mmol,P＜ 0.05].抗体阳性组糖尿病家族史、在孕期需胰岛素治疗率均高于抗体阴性组[83.3％(15/18)比28.8％ (19/66)和77.8％(14/18)比30.3％(20/66),P＜0.05],HOMA-IR、△I30/△G30和HBCI均低于抗体阴性组[3.20±0.84比4.02±0.36,(16.81±2.91)mU/mmol比(21.55±11.11) mU/mmol和124.95±5.03比217.43±115.64,P＜0.01)；抗体阻性组产后6～ 12周和2年空腹血糖(FPG)、餐后2h血糖(2hPG)、糖化血红蛋白(HbA1c)均高于抗体阴性组[产后6～ 12周:(8.20±3.11) mmol/L比(5.39±0.76) mmol/L,( 15.22±7.29) mmol/L比(8.15±1.93)mmol/L,(7.26±1.04)％比(5.88±0.41)％；产后2年:(8.91±2.80) mmol/L比(4.93±0.66)mmol/L,( 15.75±7.87) mmol/L比(7.85±1.79) mmol/L,(7.18±1.22)％比(5.64±0.32)％,P＜0.01],而产后2年抗体阳性组△I30/△G30、HBCI明显下降,抗体阴性组无显著变化.抗体阳性组产后6～ 12周和2年分别有16.7％(3/18)、33.3％(6/18)的患者发展为1型糖尿病(T1DM),而抗体阴性组无转为T1DM病例.结论 GDM患者中混有一些亚临床状态的T1 DM患者；孕期需要胰岛素治疗,GAD-Ab和IA-2A阳性者,产后发展为T1DM的几率增加；GAD-Ab和IA-2A阳性是GDM患者产后发展为T1DM的一个重要预测因素.
目的 探討穀氨痠脫羧酶抗體( GAD-Ab)和蛋白酪氨痠燐痠酶抗體(IA-2A)對妊娠期糖尿病(GDM)患者隨訪的意義.方法 選取GDM患者84例(GDM組)和口服葡萄糖耐量試驗正常孕婦82例(對照組),GDM組又分為抗體暘性(GAD-Ab、IA-2A任何一項暘性)組18例和抗體陰性(GAD-Ab、IA-2A均陰性)組66例,分彆于孕24～28週、產後6～12週和產後2年進行隨訪,測定GAD-Ab、IA-2A、胰島素水平及糖代謝指標.結果 GDM組穩態模型胰島素牴抗指數(HOMA-IR)高于對照組(3.87±2.17比2.31±0.52,P＜0.05),穩態模型胰島β細胞功能指數(HBCI)和30 min淨增胰島素/30 min淨增血糖(△I30/△G30)低于對照組[206.38±138.06比422.43±228.93和(20.16±11.38) mU/mmol比(26.54±24.30) mU/mmol,P＜ 0.05].抗體暘性組糖尿病傢族史、在孕期需胰島素治療率均高于抗體陰性組[83.3％(15/18)比28.8％ (19/66)和77.8％(14/18)比30.3％(20/66),P＜0.05],HOMA-IR、△I30/△G30和HBCI均低于抗體陰性組[3.20±0.84比4.02±0.36,(16.81±2.91)mU/mmol比(21.55±11.11) mU/mmol和124.95±5.03比217.43±115.64,P＜0.01)；抗體阻性組產後6～ 12週和2年空腹血糖(FPG)、餐後2h血糖(2hPG)、糖化血紅蛋白(HbA1c)均高于抗體陰性組[產後6～ 12週:(8.20±3.11) mmol/L比(5.39±0.76) mmol/L,( 15.22±7.29) mmol/L比(8.15±1.93)mmol/L,(7.26±1.04)％比(5.88±0.41)％；產後2年:(8.91±2.80) mmol/L比(4.93±0.66)mmol/L,( 15.75±7.87) mmol/L比(7.85±1.79) mmol/L,(7.18±1.22)％比(5.64±0.32)％,P＜0.01],而產後2年抗體暘性組△I30/△G30、HBCI明顯下降,抗體陰性組無顯著變化.抗體暘性組產後6～ 12週和2年分彆有16.7％(3/18)、33.3％(6/18)的患者髮展為1型糖尿病(T1DM),而抗體陰性組無轉為T1DM病例.結論 GDM患者中混有一些亞臨床狀態的T1 DM患者；孕期需要胰島素治療,GAD-Ab和IA-2A暘性者,產後髮展為T1DM的幾率增加；GAD-Ab和IA-2A暘性是GDM患者產後髮展為T1DM的一箇重要預測因素.
목적 탐토곡안산탈최매항체( GAD-Ab)화단백락안산린산매항체(IA-2A)대임신기당뇨병(GDM)환자수방적의의.방법 선취GDM환자84례(GDM조)화구복포도당내량시험정상잉부82례(대조조),GDM조우분위항체양성(GAD-Ab、IA-2A임하일항양성)조18례화항체음성(GAD-Ab、IA-2A균음성)조66례,분별우잉24～28주、산후6～12주화산후2년진행수방,측정GAD-Ab、IA-2A、이도소수평급당대사지표.결과 GDM조은태모형이도소저항지수(HOMA-IR)고우대조조(3.87±2.17비2.31±0.52,P＜0.05),은태모형이도β세포공능지수(HBCI)화30 min정증이도소/30 min정증혈당(△I30/△G30)저우대조조[206.38±138.06비422.43±228.93화(20.16±11.38) mU/mmol비(26.54±24.30) mU/mmol,P＜ 0.05].항체양성조당뇨병가족사、재잉기수이도소치료솔균고우항체음성조[83.3％(15/18)비28.8％ (19/66)화77.8％(14/18)비30.3％(20/66),P＜0.05],HOMA-IR、△I30/△G30화HBCI균저우항체음성조[3.20±0.84비4.02±0.36,(16.81±2.91)mU/mmol비(21.55±11.11) mU/mmol화124.95±5.03비217.43±115.64,P＜0.01)；항체조성조산후6～ 12주화2년공복혈당(FPG)、찬후2h혈당(2hPG)、당화혈홍단백(HbA1c)균고우항체음성조[산후6～ 12주:(8.20±3.11) mmol/L비(5.39±0.76) mmol/L,( 15.22±7.29) mmol/L비(8.15±1.93)mmol/L,(7.26±1.04)％비(5.88±0.41)％；산후2년:(8.91±2.80) mmol/L비(4.93±0.66)mmol/L,( 15.75±7.87) mmol/L비(7.85±1.79) mmol/L,(7.18±1.22)％비(5.64±0.32)％,P＜0.01],이산후2년항체양성조△I30/△G30、HBCI명현하강,항체음성조무현저변화.항체양성조산후6～ 12주화2년분별유16.7％(3/18)、33.3％(6/18)적환자발전위1형당뇨병(T1DM),이항체음성조무전위T1DM병례.결론 GDM환자중혼유일사아림상상태적T1 DM환자；잉기수요이도소치료,GAD-Ab화IA-2A양성자,산후발전위T1DM적궤솔증가；GAD-Ab화IA-2A양성시GDM환자산후발전위T1DM적일개중요예측인소.
Objective To investigate the role ofglutamic acid decarboxylase autoantibody(GAD-Ab)and protein tyrosine phosphatase autoantibody (IA-2A) in postpartum follow-up of gestational diabetes mellitus (GDM).Methods GAD-Ab,IA-2A,insulin and glucose metabolism index were measured in 82subjects with normal glucose tolerance (control group) and 84 patients with GDM(GDM group) during 24 to 28 weeks in pregnancy,postpartum 6 to 12 weeks and 2 years.GDM group was divided into antibodies positive group (GAD-Ah or IA-2A were positive) with 18 cases and antibodies negative group (GAD-Ab and IA-2A was negative) with 66 cases.Results Homeostasis model insulin resistance index (HOMA-IR) in GDM group was higher than that in control group (3.87 ± 2.17 vs.2.31 ± 0.52,P ＜ 0.05 ).Homeostasis β -cell function index (HBCI) and 30 min net increment of insulin/30 min net increment of glucose ( △ I30/△ G30) in GDM group were lower than those in control group [206.38 ± 138.06 vs.422.43 ± 228.93 and (20.16 ±11.38) mU/mmol vs.(26.54 ±24.30) mU/mmol,P ＜0.05].The numbers who had the family history of diabetes mellitus and the used of insulin for treatment in antibodies positive group were higher than those in antibodies negative group [ 83.3％ (15/18) vs.28.8％ (19/66) and 77.8％ ( 14/18 ) vs.30.3％ (20/66) ],HOMA-IR,△ I30/ △ G30 and HBCI in antibodies positive group were lower than those in antibodies negative group [3.20±0.84 vs.4.02±0.36,(16.81 ±2.91) mU/mmol vs.(21.55± 11.11) mU/mmol and 124.95 ± 5.03 vs.217.43 ± 115.64,P＜ 0.01 ].Fasting plasma glucose (FPG),2 hours postprandial glucose (2hPG)and glycosylated hemoglobin (HbA1c) in antibodies positive group were higher than those in antibodies negative group during postpartum 6 to 12 weeks and 2 years [postpartum 6 to 12 weeks: (8.20 ±3.11)mmol/L vs.(5.39 ±0.76) mmol/L,(15.22 ±7.29) mmol/L vs.(8.15 ± 1.93) mmol/L,(7.26 ± 1.04)％ vs.(5.88 ±0.41)％ ;postpartum 2 years: (8.91 ±2.80) mmol/L vs.(4.93 ±0.66) mmol/L,(15.75 ±7.87)mmol/L vs.(7.85 ± 1.79) mtmol/L,(7.18 ± 1.22)％ vs.(5.64 ± 0.32 )％,P ＜ 0.01].△ I30/ △ G30 and HBCI were significantly decreased in antibodies positive group postpartum 2 years.No change of the above parameters in antibodies negative group was found.The occurrence rate of type 1 diabetes mellitus (T1DM) was 16.7％(3/18) and 33.3％(6/18) postpartum 6 to 12 weeks and 2 years in antibodies positive group,there was no T1DM in antibodies negative group.Conclusions Women with GDM are partly associated with T1DM.Requiring insulin therapy during pregnancy and GAD-Ab or IA-2A positive have considerable risk for developing T1DM.It is also an important predictor to GDM after parturition.
