中华妇幼临床医学杂志（电子版）
中華婦幼臨床醫學雜誌（電子版）
중화부유림상의학잡지（전자판）
CHINESE JOURNAL OF OBSTETRICS & GYNECOLOGY AND PEDIATRICS(ELECTRONIC VERSION)
2012年
2期
110-114
,共5页
王蕴慧%张留苗%王振花%刘玉昆%谭剑平%张建平
王蘊慧%張留苗%王振花%劉玉昆%譚劍平%張建平
왕온혜%장류묘%왕진화%류옥곤%담검평%장건평
糖尿病,妊娠%随访研究%胰岛素抵抗%胰岛β细胞功能
糖尿病,妊娠%隨訪研究%胰島素牴抗%胰島β細胞功能
당뇨병,임신%수방연구%이도소저항%이도β세포공능
diabetes,gestational%follow-up study%insulin resistances pancreatic β cell function
目的 了解妊娠期糖尿病(GDM)患者产后3～6个月糖代谢异常的转归情况及其相关影响因素,并分析GDM患者产后胰岛素水平、胰岛素抵抗(IR)及胰岛β细胞功能恢复情况.方法 选择2009年6月至2010年6月在中山大学孙逸仙纪念医院确诊为GDM并分娩的82例患者为研究对象.对其于产后3～6个月时进行75 g葡萄糖耐量试验(OGTT)及相应时段胰岛素释放试验.根据82例患者的产后糖代谢状态分为产后糖代谢异常组(n=32)及糖代谢恢复正常组(n=50).采用多因素logistic回归模型对其进行糖代谢影响因素分析,了解产后糖代谢异常转归、相关影响因素及产后血糖、胰岛β细胞功能恢复情况(本研究遵循的程序符合本院人体试验委员会所制定的伦理学标准,得到该委员会批准,分组征得受试对象本人的知情同意,并与之签署临床研究知情同意书).结果 82例GDM患者中,①糖代谢异常检出率为39.02％(32/82),其中发展为糖尿病患者为4例(4.88％);葡萄糖耐量受损(IGT)为26例(31.71％),空腹血糖受损(IFG)为2例(2.44％).②logistic回归模型分析(经校正年龄后)显示,GDM诊断孕周早、OGTT2h血糖值高及胰岛素水平低是GDM患者产后持续糖代谢异常的危险因素(OR=0.951,95 ％CI:0.887～0.998;OR=1.464,95％CI:1.008～2.116;OR=0.981,95％CI:0.965～0.998).③GDM患者产后空腹血糖及空腹胰岛素水平与孕期比较,差异无统计学意义(P＞0.05);糖负荷后血糖及相应时段胰岛素水平及血糖与胰岛素曲线下面积(A UCGlu,A UCINs)、稳态模型的胰岛β细胞功能(HOMA-β),均较孕期显著下降,差异有统计学意义(P＜0.05);稳态模型胰岛素抵抗指数(HOMA- IR)较孕期略有下降,胰岛素敏感指数(IAD略有上升,但差异均无统计学意义(P＞0.05).④GDM患者中产后血糖持续异常组与恢复正常组比较,OGTT1h,2h血糖及2h胰岛素水平显著升高,差异有统计学意义(P＜0.05).结论GDM患者:①产后3～6个月存在较高糖代谢异常发生率,以IGT为主;②GDM诊断孕周早及孕早、中期OGTT2h 血糖水平高及胰岛素水平低,是GDM患者产后糖代谢异常的高危因素;③产后糖代谢恢复正常者AUCGlu及AUCINS基本恢复正常;而糖代谢异常者,则仍表现为明显胰岛素峰值后移.
目的 瞭解妊娠期糖尿病(GDM)患者產後3～6箇月糖代謝異常的轉歸情況及其相關影響因素,併分析GDM患者產後胰島素水平、胰島素牴抗(IR)及胰島β細胞功能恢複情況.方法 選擇2009年6月至2010年6月在中山大學孫逸仙紀唸醫院確診為GDM併分娩的82例患者為研究對象.對其于產後3～6箇月時進行75 g葡萄糖耐量試驗(OGTT)及相應時段胰島素釋放試驗.根據82例患者的產後糖代謝狀態分為產後糖代謝異常組(n=32)及糖代謝恢複正常組(n=50).採用多因素logistic迴歸模型對其進行糖代謝影響因素分析,瞭解產後糖代謝異常轉歸、相關影響因素及產後血糖、胰島β細胞功能恢複情況(本研究遵循的程序符閤本院人體試驗委員會所製定的倫理學標準,得到該委員會批準,分組徵得受試對象本人的知情同意,併與之籤署臨床研究知情同意書).結果 82例GDM患者中,①糖代謝異常檢齣率為39.02％(32/82),其中髮展為糖尿病患者為4例(4.88％);葡萄糖耐量受損(IGT)為26例(31.71％),空腹血糖受損(IFG)為2例(2.44％).②logistic迴歸模型分析(經校正年齡後)顯示,GDM診斷孕週早、OGTT2h血糖值高及胰島素水平低是GDM患者產後持續糖代謝異常的危險因素(OR=0.951,95 ％CI:0.887～0.998;OR=1.464,95％CI:1.008～2.116;OR=0.981,95％CI:0.965～0.998).③GDM患者產後空腹血糖及空腹胰島素水平與孕期比較,差異無統計學意義(P＞0.05);糖負荷後血糖及相應時段胰島素水平及血糖與胰島素麯線下麵積(A UCGlu,A UCINs)、穩態模型的胰島β細胞功能(HOMA-β),均較孕期顯著下降,差異有統計學意義(P＜0.05);穩態模型胰島素牴抗指數(HOMA- IR)較孕期略有下降,胰島素敏感指數(IAD略有上升,但差異均無統計學意義(P＞0.05).④GDM患者中產後血糖持續異常組與恢複正常組比較,OGTT1h,2h血糖及2h胰島素水平顯著升高,差異有統計學意義(P＜0.05).結論GDM患者:①產後3～6箇月存在較高糖代謝異常髮生率,以IGT為主;②GDM診斷孕週早及孕早、中期OGTT2h 血糖水平高及胰島素水平低,是GDM患者產後糖代謝異常的高危因素;③產後糖代謝恢複正常者AUCGlu及AUCINS基本恢複正常;而糖代謝異常者,則仍錶現為明顯胰島素峰值後移.
목적 료해임신기당뇨병(GDM)환자산후3～6개월당대사이상적전귀정황급기상관영향인소,병분석GDM환자산후이도소수평、이도소저항(IR)급이도β세포공능회복정황.방법 선택2009년6월지2010년6월재중산대학손일선기념의원학진위GDM병분면적82례환자위연구대상.대기우산후3～6개월시진행75 g포도당내량시험(OGTT)급상응시단이도소석방시험.근거82례환자적산후당대사상태분위산후당대사이상조(n=32)급당대사회복정상조(n=50).채용다인소logistic회귀모형대기진행당대사영향인소분석,료해산후당대사이상전귀、상관영향인소급산후혈당、이도β세포공능회복정황(본연구준순적정서부합본원인체시험위원회소제정적윤리학표준,득도해위원회비준,분조정득수시대상본인적지정동의,병여지첨서림상연구지정동의서).결과 82례GDM환자중,①당대사이상검출솔위39.02％(32/82),기중발전위당뇨병환자위4례(4.88％);포도당내량수손(IGT)위26례(31.71％),공복혈당수손(IFG)위2례(2.44％).②logistic회귀모형분석(경교정년령후)현시,GDM진단잉주조、OGTT2h혈당치고급이도소수평저시GDM환자산후지속당대사이상적위험인소(OR=0.951,95 ％CI:0.887～0.998;OR=1.464,95％CI:1.008～2.116;OR=0.981,95％CI:0.965～0.998).③GDM환자산후공복혈당급공복이도소수평여잉기비교,차이무통계학의의(P＞0.05);당부하후혈당급상응시단이도소수평급혈당여이도소곡선하면적(A UCGlu,A UCINs)、은태모형적이도β세포공능(HOMA-β),균교잉기현저하강,차이유통계학의의(P＜0.05);은태모형이도소저항지수(HOMA- IR)교잉기략유하강,이도소민감지수(IAD략유상승,단차이균무통계학의의(P＞0.05).④GDM환자중산후혈당지속이상조여회복정상조비교,OGTT1h,2h혈당급2h이도소수평현저승고,차이유통계학의의(P＜0.05).결론GDM환자:①산후3～6개월존재교고당대사이상발생솔,이IGT위주;②GDM진단잉주조급잉조、중기OGTT2h 혈당수평고급이도소수평저,시GDM환자산후당대사이상적고위인소;③산후당대사회복정상자AUCGlu급AUCINS기본회복정상;이당대사이상자,칙잉표현위명현이도소봉치후이.
Objective ① To investigate the glucose metabolism after 3 ～ 6 months of delivery in women with gestational diabetes mellitus (GDM),and to find out factors associated with the prognosis of GDM.②To investigate the insulin level,insulin resistance(IR) and function of pancreatic β cells in 3～6 months postpartum.Methods Clinical data of 82 women with GDM who were delivered in SUN Yat-sen Memorial Hospital from June 2009 to June 2010 were collected.All patients underwent 75 g oral glucose tolerance test(OGTT) in 3～6 months after delivery.They were divided into back to normal group (n=32)and continuous abnormal group (n=50)according to the postnatal status of glucose.Multivariate logistic regression model was used to analyze the factors affected glucose,and explore the insulin level,IR and function of pancreatic β cells.The study protocol was approved by the Ethical Review Board of Investigation in Human Being of SUN Yat - sen Memorial Hospital,SUN Yat-sen University.Informed consent was obtained from all participants.Results Among 82 women with GDM:① 32(39.02％) were reported with abnormal glucose metabolism,including 26 (31.71 ％ ) with impaired glucose tolerance (IGT),4 ( 4.88 ％ )with diabetes mellitus and 2 (2.44％) with impaired fasting glucose (IFG).② Logistic regression model showed that early diagnosis (OR=0.951,95％CI:0.887-0.998),elevated 2nd hour plasma glucose level (OR=1.464,95％CI:1.008-2.116) and lower 2nd hour insulin level(OR=0.981,95％CI:0.965-0.998) in OGTT were risk factors for postpartum abnormal glucose metabolism.③There were no statistical differences in fasting glucose and fasting insulin levels after delivery(P＞0.05),but the glucose and insulin levels after glucose loaded and AUCGlu,AUCINS and (homeostasis model assessment)HOMA-β were lower than those of pregnancy,the differences had statistical significance (P ＜ 0.05).Homeostasis model assessment insulin resistance index (HOMA-IR) had slightly lower and insulin sensitivity index (ISI) were slightly elevated,but the differences had no statistical difference (P＞0.05).④Compared the back to normal group with the continuous abnormal group,The first and second hour plasma glucose levels and the 2nd hour insulin levels in OGTT were significantly increased in the back to abnormal group,the differences had statistical significance(P＜0.05).Conclusions ①Women with GDM are more likely to present with abnormal glucose metabolism and mainly manifest in elevated glucose after glucose loaded.② Early diagnosis,elevated 2nd hour plasma glucose level and lower 2nd hour insulin level in OGTT were risk factors for postpartum abnormal glucose metabolism.③The glucose and insulin release curve was back to normal in women with normal glucose metabolism but in women with abnormal glucose metabolism the curve manifest in peak moved backwards.
