CAJ | 학술논문

目的观察正常孕妇及糖代谢异常孕妇在妊娠早、中、晚期胰岛素抵抗及胰岛β细胞功能的变化规律,比较不同糖代谢状态相应孕期胰岛素抵抗及胰岛β细胞功能的差别,探讨妊娠期糖尿病(GDM)早期诊断的可行性.方法 2009年2月至2010年3月在中山大学孙逸仙纪念医院进行早孕安胎、优生咨询及定期产检的507例孕妇,排除妊娠前患有糖尿病、甲状腺功能亢进症等内分泌疾病者,进行前瞻性研究.对受试者给予75 g口服葡萄糖耐量试验(OGTF)及胰岛素释放试验,根据血糖是否异常分为GDM早孕组(58例),早孕对照组(72例),GDM中孕组(81例),中孕对照组(164例),GDM晚孕组(66例),晚孕对照组(66例).分别比较各组稳态模型评估的胰岛素抵抗指数(HOMA-IR)、稳态模型评估的胰岛β细胞功能指数(HOMA-β)、血糖曲线下面积(AUCG)、胰岛素曲线下面积(AUCI)、早期胰岛素分泌指数( △I30/△G30)、混合胰岛素敏感度(ISIcomp).结果 (1)GDM早孕组AUCG、AUCI均高于早孕对照组,AI30/△G30及ISIcomp低于早孕对照组(P＜0.05),而HOMA-IR差异无统计学意义(P＞0.05);GDM中孕组及GDM晚孕组HOMA-IR、AUCG均高于相应对照组,△I30/△G30及ISIcomp均低于相应对照组(P＜0.05),各组的HOMA-β差异均无统计学意义(P＞0.05).(2)血糖及胰岛素释放曲线显示,早、中、晚孕正常对照组服糖后0.5h血糖水平达峰值,服糖后0.5～1h胰岛素水平达峰值,而GDM早、中、晚孕组服糖后1h血糖水平达峰值,服糖后2h血胰岛素水平达到峰值.结论早期妊娠与中、晚期妊娠诊断的GDM患者胰岛素抵抗均较相应孕期正常妇女增高,且OGTT后血糖及胰岛素峰值延迟,GDM患者妊娠早期即出现了胰岛素早期分泌功能受损.对高危人群在早期妊娠行OGTT可及早发现糖代谢异常.
목적 관찰정상잉부급당대사이상잉부재임신조、중、만기이도소저항급이도β세포공능적변화규률,비교불동당대사상태상응잉기이도소저항급이도β세포공능적차별,탐토임신기당뇨병(GDM)조기진단적가행성.방법 2009년2월지2010년3월재중산대학손일선기념의원진행조잉안태、우생자순급정기산검적507례잉부,배제임신전환유당뇨병、갑상선공능항진증등내분비질병자,진행전첨성연구.대수시자급여75 g구복포도당내량시험(OGTF)급이도소석방시험,근거혈당시부이상분위GDM조잉조(58례),조잉대조조(72례),GDM중잉조(81례),중잉대조조(164례),GDM만잉조(66례),만잉대조조(66례).분별비교각조은태모형평고적이도소저항지수(HOMA-IR)、은태모형평고적이도β세포공능지수(HOMA-β)、혈당곡선하면적(AUCG)、이도소곡선하면적(AUCI)、조기이도소분비지수( △I30/△G30)、혼합이도소민감도(ISIcomp).결과 (1)GDM조잉조AUCG、AUCI균고우조잉대조조,AI30/△G30급ISIcomp저우조잉대조조(P＜0.05),이HOMA-IR차이무통계학의의(P＞0.05);GDM중잉조급GDM만잉조HOMA-IR、AUCG균고우상응대조조,△I30/△G30급ISIcomp균저우상응대조조(P＜0.05),각조적HOMA-β차이균무통계학의의(P＞0.05).(2)혈당급이도소석방곡선현시,조、중、만잉정상대조조복당후0.5h혈당수평체봉치,복당후0.5～1h이도소수평체봉치,이GDM조、중、만잉조복당후1h혈당수평체봉치,복당후2h혈이도소수평체도봉치.결론조기임신여중、만기임신진단적GDM환자이도소저항균교상응잉기정상부녀증고,차OGTT후혈당급이도소봉치연지,GDM환자임신조기즉출현료이도소조기분비공능수손.대고위인군재조기임신행OGTT가급조발현당대사이상.
Objective To observe and compare the variation of insulin resistance and pancreatic β-cell function in pregnant women with abnormal and normal glucose metabolism during the first,second,and third trimesters,and to explore the feasibility of early diagnosis of gestational diabetes mellitus(GDM).Methods This is a prospective study.507 pregnant women with regular antenatal care from February 2009 to March 2010 were included in the study.Based on the results of oral glucose tolerance test,the patients with GDM consisted of 58,86,and 66 subjects respectively in the first,second,and third trimesters.The control group included 72,164,and 66 subjects respectively in the first,second,and third trimesters.Homeostasis model assessment insulin resistance index( HOMA-IR),homeostasis model assessment β-cell function (HOMA-β),area under curve of glucose (AUCG),area under curve of insulin ( AUCI ),30-minute insulin increase to 30-minute glucose increase ( △I30/△G30 ),and insulin sensitivity index composite(ISIcomp) were calculated for the evaluation of insulin resistance and pancreatic β-cell function.Results ( 1 ) AUCG and AUCI in the GDM group were statistically higher than those in control group while △I30/△G30and ISlcomp in the GDM group were statistically lower than those in the control group during the first trimester(P＜0.05),but HOMA-IR showed no statistically significant difference between two groups.In the GDM groups HOMA-IR,AUCG,and AUCI were statistically higher,whereas △I30/△G30 and ISIcomp were statistically lower than those in the control groups during the second and third trimesters (P ＜ 0.05 ). HOMA-β showed no statistically significant differences between the GDM groups and control groups during 3 trimesters.( 2 ) During thefirst,second,and third trimesters,blood glucose reached its peak by 0.5 h in the oral glucose tolerance test,and insulin reached its peak by 0.5-1 h in the control groups; while in the GDM groups the respective figures were 1 h and 2 h.Conclusions The insulin resistance in GDM patients diagnosed during the first,second,and third trimesters was higher than in pregnant women with normal glucose metabolism,and the peaks of blood glucose and insulin reached in oral glucose tolerance test were respectively delayed.The impaired pancreatic β-cell insulin secretion in GDM patients was present from early pregnancy.Thus for high-risk groups,oral glucose tolerance test during early pregnancy will be helpful for screening abnormal glucose metabolism.