中华糖尿病杂志
中華糖尿病雜誌
중화당뇨병잡지
CHINES JOURNAL OF DLABETES MELLITUS
2014年
9期
640-644
,共5页
任茜%马宇航%黄倩芳%陈苏%张佳荣%王育璠%彭永德
任茜%馬宇航%黃倩芳%陳囌%張佳榮%王育璠%彭永德
임천%마우항%황천방%진소%장가영%왕육번%팽영덕
糖尿病,妊娠%甘油三酯%胰岛素抵抗%胰岛β细胞功能
糖尿病,妊娠%甘油三酯%胰島素牴抗%胰島β細胞功能
당뇨병,임신%감유삼지%이도소저항%이도β세포공능
Diabetes,gestational%Triglycerides%Insulin resistance%Islet β cell function
目的 探讨血清甘油三酯(TG)水平对初诊妊娠期糖尿病(GDM)患者的胰岛β细胞功能及胰岛素抵抗的影响.方法 纳入2012年1月至2014年4月入住于上海交通大学附属第一人民医院产科病房,孕24～ 30周的439例初诊GDM患者.收集其一般资料、血脂,行75 g口服葡萄糖耐量试验和胰岛素释放试验,分别计算稳态模型评估β细胞功能指数(HOMA-β)、稳态模型评估胰岛素抵抗指数(HOMA-IR)和定量胰岛素敏感性检测指数(QUICKI),并将GDM患者以空腹血清甘油三酯(TG)水平分成下三分位T1(1.25 ～ 2.30 mmol/L,n=146)组、中三分位T2(＞2.30 ～ 3.10 mmol/L,n=146)组和上三分位T3(＞3.10 ～ 22.03 mmol/L,n=147)组.三组数据比较采用方差分析,并用逐步多因素线性回归模型分析影响初诊GDM患者HOMA-IR的相关因素.结果 与T1组相比,T2组和T3组GDM患者的体质指数(BMI)较高(均P＜0.05);T3组的总胆固醇(TC)明显升高(P＜0.05);T2组和T3组的TG水平明显升高(均P＜0.05);T3组的高密度脂蛋白胆固醇(HDL-C)水平明显降低(P＜0.05);T3组的空腹血糖(FPG)水平和服糖后1h血糖(1 hPG)水平较高(均P＜0.05);T2组和T3组的空腹胰岛素(FINS)水平明显升高(均P＜0.05);T3组的餐后1h胰岛素(1 hINS)水平较高(P＜0.05);T2组和T3组的服糖后2h胰岛素(2 hINS)水平明显升高(均P＜0.05).同时,与T1组相比,T2组和T3组HOMA-IR升高(分别为2.0±1.3、2.7±1.2、3.3±2.7),QUICKI指数降低(分别为1.5±0.5、1.2±0.4、1.1±0.4),差异均有统计学意义(F=16.745、21.110,均P＜O.05);而三组间的HOMA-β无明显差异.逐步多因素线性回归模型显示:BMI[标准化回归系数(β)=0.210]、TG(β=0.135)、2 hINS (β=0.394)和年龄(β=-0.118)与初诊GDM患者HOMA-IR显著相关(均P＜0.05).结论 随着空腹血清TG水平的升高,初诊GDM患者胰岛素抵抗加重,胰岛素敏感性降低.除了BMI增加、高2 hINS水平和低龄外,TG水平升高是初诊GDM患者胰岛素抵抗的独立相关因素.
目的 探討血清甘油三酯(TG)水平對初診妊娠期糖尿病(GDM)患者的胰島β細胞功能及胰島素牴抗的影響.方法 納入2012年1月至2014年4月入住于上海交通大學附屬第一人民醫院產科病房,孕24～ 30週的439例初診GDM患者.收集其一般資料、血脂,行75 g口服葡萄糖耐量試驗和胰島素釋放試驗,分彆計算穩態模型評估β細胞功能指數(HOMA-β)、穩態模型評估胰島素牴抗指數(HOMA-IR)和定量胰島素敏感性檢測指數(QUICKI),併將GDM患者以空腹血清甘油三酯(TG)水平分成下三分位T1(1.25 ～ 2.30 mmol/L,n=146)組、中三分位T2(＞2.30 ～ 3.10 mmol/L,n=146)組和上三分位T3(＞3.10 ～ 22.03 mmol/L,n=147)組.三組數據比較採用方差分析,併用逐步多因素線性迴歸模型分析影響初診GDM患者HOMA-IR的相關因素.結果 與T1組相比,T2組和T3組GDM患者的體質指數(BMI)較高(均P＜0.05);T3組的總膽固醇(TC)明顯升高(P＜0.05);T2組和T3組的TG水平明顯升高(均P＜0.05);T3組的高密度脂蛋白膽固醇(HDL-C)水平明顯降低(P＜0.05);T3組的空腹血糖(FPG)水平和服糖後1h血糖(1 hPG)水平較高(均P＜0.05);T2組和T3組的空腹胰島素(FINS)水平明顯升高(均P＜0.05);T3組的餐後1h胰島素(1 hINS)水平較高(P＜0.05);T2組和T3組的服糖後2h胰島素(2 hINS)水平明顯升高(均P＜0.05).同時,與T1組相比,T2組和T3組HOMA-IR升高(分彆為2.0±1.3、2.7±1.2、3.3±2.7),QUICKI指數降低(分彆為1.5±0.5、1.2±0.4、1.1±0.4),差異均有統計學意義(F=16.745、21.110,均P＜O.05);而三組間的HOMA-β無明顯差異.逐步多因素線性迴歸模型顯示:BMI[標準化迴歸繫數(β)=0.210]、TG(β=0.135)、2 hINS (β=0.394)和年齡(β=-0.118)與初診GDM患者HOMA-IR顯著相關(均P＜0.05).結論 隨著空腹血清TG水平的升高,初診GDM患者胰島素牴抗加重,胰島素敏感性降低.除瞭BMI增加、高2 hINS水平和低齡外,TG水平升高是初診GDM患者胰島素牴抗的獨立相關因素.
목적 탐토혈청감유삼지(TG)수평대초진임신기당뇨병(GDM)환자적이도β세포공능급이도소저항적영향.방법 납입2012년1월지2014년4월입주우상해교통대학부속제일인민의원산과병방,잉24～ 30주적439례초진GDM환자.수집기일반자료、혈지,행75 g구복포도당내량시험화이도소석방시험,분별계산은태모형평고β세포공능지수(HOMA-β)、은태모형평고이도소저항지수(HOMA-IR)화정량이도소민감성검측지수(QUICKI),병장GDM환자이공복혈청감유삼지(TG)수평분성하삼분위T1(1.25 ～ 2.30 mmol/L,n=146)조、중삼분위T2(＞2.30 ～ 3.10 mmol/L,n=146)조화상삼분위T3(＞3.10 ～ 22.03 mmol/L,n=147)조.삼조수거비교채용방차분석,병용축보다인소선성회귀모형분석영향초진GDM환자HOMA-IR적상관인소.결과 여T1조상비,T2조화T3조GDM환자적체질지수(BMI)교고(균P＜0.05);T3조적총담고순(TC)명현승고(P＜0.05);T2조화T3조적TG수평명현승고(균P＜0.05);T3조적고밀도지단백담고순(HDL-C)수평명현강저(P＜0.05);T3조적공복혈당(FPG)수평화복당후1h혈당(1 hPG)수평교고(균P＜0.05);T2조화T3조적공복이도소(FINS)수평명현승고(균P＜0.05);T3조적찬후1h이도소(1 hINS)수평교고(P＜0.05);T2조화T3조적복당후2h이도소(2 hINS)수평명현승고(균P＜0.05).동시,여T1조상비,T2조화T3조HOMA-IR승고(분별위2.0±1.3、2.7±1.2、3.3±2.7),QUICKI지수강저(분별위1.5±0.5、1.2±0.4、1.1±0.4),차이균유통계학의의(F=16.745、21.110,균P＜O.05);이삼조간적HOMA-β무명현차이.축보다인소선성회귀모형현시:BMI[표준화회귀계수(β)=0.210]、TG(β=0.135)、2 hINS (β=0.394)화년령(β=-0.118)여초진GDM환자HOMA-IR현저상관(균P＜0.05).결론 수착공복혈청TG수평적승고,초진GDM환자이도소저항가중,이도소민감성강저.제료BMI증가、고2 hINS수평화저령외,TG수평승고시초진GDM환자이도소저항적독립상관인소.
Objective To explore the effects of serum triglyceride on islet β cell function and insulin resistance in patients with newly diagnosed gestational diabetes mellitus (GDM).Methods Total of 439 newly diagnosed GDM patients at 24-30 weeks of gestation from maternity ward in First People's Hospital were recruited from January 2012 to April 2014.The demographic data,lipid profiles were collected and 75 g oral glucose tolerance test (OGTT)and insulin release test were performed.Homeostasis model assessment for β cell function index (HOMA-β),homeostasis model assessment for insulin resistance index (HOMA-IR)and quantitative insulin-sensitivity check index (QUICKI) were calculated respectively.The participants were divided into three groups based on the three tertiles of their fasting serum triglycerides:lowest tertile group (1.25-2.30 mmol/L,Group T1,n=146),medium tertile group (＞2.30-3.10 mmol/L,Group T2,n=146)and highest tertile group (＞3.10-22.03 mmol/L,Group T3,n=147).The data were analysed by one-way Anova method and multiple stepwise linear regression model was used to explore the risk factors which affected HOMA-IR in newly diagnosed GDM patients.Results Compared with that of Group T1,maternal body mass index (BMI)in Group T2 and T3 were signifcantly higher(both P＜0.05) ;total cholesterol (TC)level in Group T3 increased obviously and TG levels in Group T2 and Group T3 were significantly higher (all P＜0.05) ;High density lipoprotein-cholesterol (HDL-C)level in Group T3 was lower,fasting plasma glucose (FPG) level and 1 h postprandial plasma glucose (1 hPG) level in Group T3 were higher(all P＜0.05) ;fasting insulin (FINS)level in Group T2 and T3,1 bINS level in Group T3,2 h postprandial insulin (2 hINS)level in Group T2 and T3 were all elevated significantly (all P＜0.05).Meantime,compared with that of Group T1,maternal HOMA-IR in Group T2 and T3 were elevated obviously (2.0± 1.3,2.7± 1.2,3.3±2.7 respectively,F=16.745,P＜0.05),and maternal QUICKI in Group T2 and T3 decreased significantly (1.5 ±0.5,1.2 ±0.4,1.1 ±0.4 respectively,F=21.110,P＜0.05).However,HOMA-β of three groups were almost at the same level.The multiple stepwise linear regression analysis indicated that BMI (standardized coefficient β=0.210),TG (β=0.135),2 hINS (β=0.394) and age (β=-0.118) were significantly associated with HOMA-IR in newly diagnosed GDM patients (all P＜0.05).Conclusions For the newly diagnosed GDM patients,insulin resistance worsens and insulin sensitivity reduces following the elevated fasting serum levels of triglyceride.Except increased BMI,higher 2 hINS level and younger age,higher TG level is independent risk factor for insulin resistance in those patients.
