妊娠合并糖尿病对子代婴幼儿期胰岛素敏感性的影响
임신합병당뇨병대자대영유인기이도소민감성적영향
Effects of pregnancy complicated with diabetes on insulin sensitivity of offspring during their early childhood
  • 万方数据
    中华围产医学杂志 중화위산의학잡지
    CHINESE JOURNAL OF PERINATAL MEDICINE
    2011年 4期 215-220 ,共6页

    刘慧%王新利%关育红%张淑丽%齐婧%童笑梅%王雪梅

    류혜%왕신리%관육홍%장숙려%제청%동소매%왕설매

    糖尿病,妊娠%婴儿%胰岛素抗药性%母乳喂养 糖尿病,妊娠%嬰兒%胰島素抗藥性%母乳餵養
    당뇨병,임신%영인%이도소항약성%모유위양
    Diabetes,gestational%Infant%Insulin resistance%Breast feeding
    目的 探讨妊娠合并糖尿病对子代婴幼儿期胰岛素敏感性的影响.方法 本研究为前瞻性队列研究,在2、4、6、8、10、12、18和24月龄测量糖尿病母亲的子代和非糖尿病母亲的子代的体重、身长,计算体重指数.在6、12和24月龄随访当日测定空腹血浆血糖和空腹血清胰岛素(fasting seruminsulin,FINS),计算胰岛素敏感指数(insulin sensitivityindex,ISI),采用胰岛素稳态模型(homeostasis model assessment,HOMA)计算胰岛素抵抗(insulin resistence,IR)指数,即HOMA-IR,将FINS、ISI和HOMA-IR作为胰岛素敏感性评价指标.采用协方差分析比较2组间胰岛素敏感性的差异.结果 最初纳入研究的婴幼儿共605例,其中糖尿病母亲的子代94例,非糖尿病母亲的子代511例.糖尿病母亲的子代在2、4和6月龄时体重、身长均大于非糖尿病母亲的子代,2和4月龄时体重指数也大于非糖尿病母亲的子代,差异均有统计学意义(P＜0.05).在6、12和24月龄测定空腹血浆血糖和FINS的婴幼儿分别有276例、273例和56例.糖尿病母亲的子代在6、12和24月龄时的FINS[经对数(Lg)转换]分别为0.95±0.30、0.89±0.34和0.90±0.27,HOMA-IR值[经对数(Lg)转换]分别为0.34±0.33、0.27士0.36和0.27±0.31,ISI[经对数(Ln)转换]分别为-3.87±0.75、-3.73±0.81和-3.73±0.71;FINS和HOMA-IR值高于非糖尿病母亲的子代(FINS分别为0.70±0.45、0.73±0.35和0.67±0.30,HOMA-IR分别为0.08±0.46、0.10±0.36和0.03±0.33),差异有统计学意义(t=9.58、5.01、6.11、9.55、4.79和5.06,P均＜0.05);ISI低于非糖尿病母亲的子代(分别为-3.29±1.05、-3.35±0.84和-3.18±0.77),差异有统计学意义(t=9.20、4.90和5.06,P均＜0.05).糖尿病母亲的子代胰岛素敏感者22例,其中母乳喂养9例(40.91%),混合喂养7例(31.82%),配方乳喂养6例(27.27%);胰岛素不敏感者72例,其中母乳喂养12例(16.67%),混合喂养21例(29.17%)、配方乳喂养39例(54.17%),差异有统计学意义(x2=7.02,P=0.03).结论 妊娠合并糖尿病对子代婴幼儿期的胰岛素敏感性有不良影响,并且影响婴儿早期的生长发育,而母乳喂养可能有助于减少婴幼儿期胰岛素抵抗.
    목적 탐토임신합병당뇨병대자대영유인기이도소민감성적영향.방법 본연구위전첨성대렬연구,재2、4、6、8、10、12、18화24월령측량당뇨병모친적자대화비당뇨병모친적자대적체중、신장,계산체중지수.재6、12화24월령수방당일측정공복혈장혈당화공복혈청이도소(fasting seruminsulin,FINS),계산이도소민감지수(insulin sensitivityindex,ISI),채용이도소은태모형(homeostasis model assessment,HOMA)계산이도소저항(insulin resistence,IR)지수,즉HOMA-IR,장FINS、ISI화HOMA-IR작위이도소민감성평개지표.채용협방차분석비교2조간이도소민감성적차이.결과 최초납입연구적영유인공605례,기중당뇨병모친적자대94례,비당뇨병모친적자대511례.당뇨병모친적자대재2、4화6월령시체중、신장균대우비당뇨병모친적자대,2화4월령시체중지수야대우비당뇨병모친적자대,차이균유통계학의의(P＜0.05).재6、12화24월령측정공복혈장혈당화FINS적영유인분별유276례、273례화56례.당뇨병모친적자대재6、12화24월령시적FINS[경대수(Lg)전환]분별위0.95±0.30、0.89±0.34화0.90±0.27,HOMA-IR치[경대수(Lg)전환]분별위0.34±0.33、0.27사0.36화0.27±0.31,ISI[경대수(Ln)전환]분별위-3.87±0.75、-3.73±0.81화-3.73±0.71;FINS화HOMA-IR치고우비당뇨병모친적자대(FINS분별위0.70±0.45、0.73±0.35화0.67±0.30,HOMA-IR분별위0.08±0.46、0.10±0.36화0.03±0.33),차이유통계학의의(t=9.58、5.01、6.11、9.55、4.79화5.06,P균＜0.05);ISI저우비당뇨병모친적자대(분별위-3.29±1.05、-3.35±0.84화-3.18±0.77),차이유통계학의의(t=9.20、4.90화5.06,P균＜0.05).당뇨병모친적자대이도소민감자22례,기중모유위양9례(40.91%),혼합위양7례(31.82%),배방유위양6례(27.27%);이도소불민감자72례,기중모유위양12례(16.67%),혼합위양21례(29.17%)、배방유위양39례(54.17%),차이유통계학의의(x2=7.02,P=0.03).결론 임신합병당뇨병대자대영유인기적이도소민감성유불량영향,병차영향영인조기적생장발육,이모유위양가능유조우감소영유인기이도소저항.
    Objective To investigate the effects of pregnancy complicated with diabetes on the insulin sensitivity of offspring during their early childhood. Methods Offspring of diabetic mothers(ODM) and of non-diabetic mothers(ONDM) aged 1 month to 24 months were recruited into this prospective cohort study and followed up for two years. Body weight and body length were measured at 2, 4, 6, 8, 10, 12, 18 and 24 months of age respectively, and body mass index (BMI) were calculated. Fasting plasma glucose and fasting serum insulin levels were measured on the following-up day at 6, 12 and 24 months of age and insulin sensitivity index (ISI) was calculated. Homeostasis model assessment was used to calculate the insulin resistance (HOMA-IR). Insulin sensitivity was evaluated by fasting serum insulin, ISI and HOMA-IR. The difference of insulin sensitivity between ODM and ONDM group were examined by analysis of covariance adjusted by gender, gestational age,birth weight and BMI. Results Six hundred and five babies including ninety ODM and five hundred and eleven ONDM met the inclusion criteria. There were no differences in gender, gestational age,birth-weight/height between the two groups(P＞0. 05). ODM were heavier and higher than ONDM at each measure point during early childhood, but there were statistical differences at the age of 2, 4 and 6 months only (P＜0. 05). And the BMI at age of 2 and 4 months of ODM were higher than those of ONDM(P＜0.05). The number of baby who accepted the measurement of fasting plasma glucose and fasting serum insulin levels at 6, 12 and 24 months of age was 276 cases, 273 cases and 56 cases respectively. The fasting serum insulin of ODM (logarithmically transformed) were 0. 95±0. 30,0. 89±0. 34 and 0. 90±0. 27, which were higher than those of ONDM (0. 70±0. 45, 0. 73±0. 35 and 0. 67±0. 30) (t=9. 58, 5.01 and 6. 11, P＜0.05); HOMA-IR (logarithmically transformed) were 0. 34±0. 33, 0. 27±0. 36 and 0. 27±0. 31, which were higher than those of ONDM also(0.08±0. 46,0. 10±0. 36 and 0. 03 ± 0.33) (t= 9. 55, 4. 79 and 5. 06, P＜0.05); ISI(natural logarithmically transformed) were -3.87±0. 75, -3.73±0. 81 and -3. 73±0. 71, which were lower than those of ONDM(-3.29±1.05, -3.35±0.84 and -3.18±0. 77) (t=9.20, 4. 90 and 5.06, P＜0.05).There were differences in feeding characteristics of ODM between insulin sensitive subgroup [40. 9%(9/22) breast-feeding] and insulin insensitive subgroup [16.67 % (12/72) breast-feeding] (x2 = 7.02,P=0. 03). Conclusions Pregnancy complicated with diabetes has adverse effects on the offspring insulin sensitivity during their early childhood, and affects the early growth and development of them.Breast-feeding might decrease insulin resistance in babies.
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