中华临床营养杂志
中華臨床營養雜誌
중화림상영양잡지
Chinese Journal of Clinical Nutrition
2015年
4期
195-202
,共8页
王相清%袁涛%赵维纲%付勇%董颖越%和洁
王相清%袁濤%趙維綱%付勇%董穎越%和潔
왕상청%원도%조유강%부용%동영월%화길
妊娠期糖尿病%胰岛素抵抗%胰高血糖素%胰高血糖素样肽1
妊娠期糖尿病%胰島素牴抗%胰高血糖素%胰高血糖素樣肽1
임신기당뇨병%이도소저항%이고혈당소%이고혈당소양태1
Gestational diabetes mellitus%Insulin resistance%Glucagon%Glucagon-like peptide-1
目的 评估不同糖耐量状态下孕妇临床及生化特征,以及糖负荷后胰岛素、胰高血糖素及胰高血糖素样肽1 (GLP-1)的分泌特点.方法 选取2009年1月至2012年6月北京协和医院定期规律随诊的孕妇,纳入妊娠24 ～ 28周50 g葡萄糖负荷试验(GCT)阳性者74例,进一步行100 g口服葡萄糖耐量试验(OGTT),将孕妇分为妊娠糖尿病(GDM)组(25例)、糖耐量异常(IGT)组(25例)和糖耐量正常(NGT)组(24例).比较3组孕妇的一般临床资料和生化指标,计算及评估胰岛素抵抗和胰岛β细胞分泌功能相关指数.OGTT中,同时测定血糖、胰岛素、胰高血糖素和GLP-1水平,评估各激素的分泌特点,分析其与其他指标的相关性.结果 GDM组孕妇的GCT血糖值、糖化血红蛋白高于NGT组[(9.21 ±0.75) mmol/L比(8.52±0.50) mmol/L, (5.39±0.34)％比(5.18±0.20)％,均P ＜0.05].OGTT中,GDM组血糖曲线下面积显著高于IGT组和NGT组[(26.58±2.02) mmol/ (L·h)比(23.20±1.51)、(19.84±1.95) mmol/ (L·h),均P＜0.05]. GDM和IGT两组的胰岛素分泌高峰延迟至糖负荷后2h,GDM组3h胰岛素水平显著高于NGT组(P＜0.05).与NGT组相比,GDM组和IGT组OGTT各点胰高血糖素水平及曲线下面积有降低趋势,但差异无统计学意义.各组胰高血糖素水平均在糖负荷后3h出现峰值.与NGT组相比,从IGT组至GDM组OGTT各点GLP-1水平有逐渐升高趋势,但差异无统计学意义.GLP-1分泌峰值在NGT组和IGT组出现于糖负荷后1h,在GDM组出现于糖负荷后2h,各组GLP-1水平均在糖负荷后3h达到谷值.GDM组1和2 h GLP-1与血糖比值(GLP/BG)显著低于NGT组(P＜0.05).OGTT胰高血糖素曲线下面积与空腹血糖(r=-0.287,P=0.013)及OGTT1 h血糖(r=-0.266,P=0.022)水平呈负相关,与胰岛素分泌敏感性指数(ISSI)(r=0.297,P=0.010)和稳态模型胰岛β细胞功能指数(r =0.236,P=0.043)呈正相关.OGTT中GLP-1曲线下面积与C反应蛋白水平呈负相关(r=-0.264,P=0.035).OGTT中GLP/BG曲线下面积与ISSI呈正相关(r=0.406,P＜0.001).结论 中孕期GDM和IGT患者均存在胰岛素抵抗和胰岛β细胞功能缺陷,GDM患者可能存在潜在的GLP-1抵抗和分泌不足,GLP/BG可能是评价妊娠期L细胞分泌功能的更佳指标,以及间接评价胰岛β细胞代偿分泌能力的有效指标.而胰高血糖素水平可能由于孕周不足尚未出现明显的变化.
目的 評估不同糖耐量狀態下孕婦臨床及生化特徵,以及糖負荷後胰島素、胰高血糖素及胰高血糖素樣肽1 (GLP-1)的分泌特點.方法 選取2009年1月至2012年6月北京協和醫院定期規律隨診的孕婦,納入妊娠24 ～ 28週50 g葡萄糖負荷試驗(GCT)暘性者74例,進一步行100 g口服葡萄糖耐量試驗(OGTT),將孕婦分為妊娠糖尿病(GDM)組(25例)、糖耐量異常(IGT)組(25例)和糖耐量正常(NGT)組(24例).比較3組孕婦的一般臨床資料和生化指標,計算及評估胰島素牴抗和胰島β細胞分泌功能相關指數.OGTT中,同時測定血糖、胰島素、胰高血糖素和GLP-1水平,評估各激素的分泌特點,分析其與其他指標的相關性.結果 GDM組孕婦的GCT血糖值、糖化血紅蛋白高于NGT組[(9.21 ±0.75) mmol/L比(8.52±0.50) mmol/L, (5.39±0.34)％比(5.18±0.20)％,均P ＜0.05].OGTT中,GDM組血糖麯線下麵積顯著高于IGT組和NGT組[(26.58±2.02) mmol/ (L·h)比(23.20±1.51)、(19.84±1.95) mmol/ (L·h),均P＜0.05]. GDM和IGT兩組的胰島素分泌高峰延遲至糖負荷後2h,GDM組3h胰島素水平顯著高于NGT組(P＜0.05).與NGT組相比,GDM組和IGT組OGTT各點胰高血糖素水平及麯線下麵積有降低趨勢,但差異無統計學意義.各組胰高血糖素水平均在糖負荷後3h齣現峰值.與NGT組相比,從IGT組至GDM組OGTT各點GLP-1水平有逐漸升高趨勢,但差異無統計學意義.GLP-1分泌峰值在NGT組和IGT組齣現于糖負荷後1h,在GDM組齣現于糖負荷後2h,各組GLP-1水平均在糖負荷後3h達到穀值.GDM組1和2 h GLP-1與血糖比值(GLP/BG)顯著低于NGT組(P＜0.05).OGTT胰高血糖素麯線下麵積與空腹血糖(r=-0.287,P=0.013)及OGTT1 h血糖(r=-0.266,P=0.022)水平呈負相關,與胰島素分泌敏感性指數(ISSI)(r=0.297,P=0.010)和穩態模型胰島β細胞功能指數(r =0.236,P=0.043)呈正相關.OGTT中GLP-1麯線下麵積與C反應蛋白水平呈負相關(r=-0.264,P=0.035).OGTT中GLP/BG麯線下麵積與ISSI呈正相關(r=0.406,P＜0.001).結論 中孕期GDM和IGT患者均存在胰島素牴抗和胰島β細胞功能缺陷,GDM患者可能存在潛在的GLP-1牴抗和分泌不足,GLP/BG可能是評價妊娠期L細胞分泌功能的更佳指標,以及間接評價胰島β細胞代償分泌能力的有效指標.而胰高血糖素水平可能由于孕週不足尚未齣現明顯的變化.
목적 평고불동당내량상태하잉부림상급생화특정,이급당부하후이도소、이고혈당소급이고혈당소양태1 (GLP-1)적분비특점.방법 선취2009년1월지2012년6월북경협화의원정기규률수진적잉부,납입임신24 ～ 28주50 g포도당부하시험(GCT)양성자74례,진일보행100 g구복포도당내량시험(OGTT),장잉부분위임신당뇨병(GDM)조(25례)、당내량이상(IGT)조(25례)화당내량정상(NGT)조(24례).비교3조잉부적일반림상자료화생화지표,계산급평고이도소저항화이도β세포분비공능상관지수.OGTT중,동시측정혈당、이도소、이고혈당소화GLP-1수평,평고각격소적분비특점,분석기여기타지표적상관성.결과 GDM조잉부적GCT혈당치、당화혈홍단백고우NGT조[(9.21 ±0.75) mmol/L비(8.52±0.50) mmol/L, (5.39±0.34)％비(5.18±0.20)％,균P ＜0.05].OGTT중,GDM조혈당곡선하면적현저고우IGT조화NGT조[(26.58±2.02) mmol/ (L·h)비(23.20±1.51)、(19.84±1.95) mmol/ (L·h),균P＜0.05]. GDM화IGT량조적이도소분비고봉연지지당부하후2h,GDM조3h이도소수평현저고우NGT조(P＜0.05).여NGT조상비,GDM조화IGT조OGTT각점이고혈당소수평급곡선하면적유강저추세,단차이무통계학의의.각조이고혈당소수평균재당부하후3h출현봉치.여NGT조상비,종IGT조지GDM조OGTT각점GLP-1수평유축점승고추세,단차이무통계학의의.GLP-1분비봉치재NGT조화IGT조출현우당부하후1h,재GDM조출현우당부하후2h,각조GLP-1수평균재당부하후3h체도곡치.GDM조1화2 h GLP-1여혈당비치(GLP/BG)현저저우NGT조(P＜0.05).OGTT이고혈당소곡선하면적여공복혈당(r=-0.287,P=0.013)급OGTT1 h혈당(r=-0.266,P=0.022)수평정부상관,여이도소분비민감성지수(ISSI)(r=0.297,P=0.010)화은태모형이도β세포공능지수(r =0.236,P=0.043)정정상관.OGTT중GLP-1곡선하면적여C반응단백수평정부상관(r=-0.264,P=0.035).OGTT중GLP/BG곡선하면적여ISSI정정상관(r=0.406,P＜0.001).결론 중잉기GDM화IGT환자균존재이도소저항화이도β세포공능결함,GDM환자가능존재잠재적GLP-1저항화분비불족,GLP/BG가능시평개임신기L세포분비공능적경가지표,이급간접평개이도β세포대상분비능력적유효지표.이이고혈당소수평가능유우잉주불족상미출현명현적변화.
Objective To evaluate the clinical and biochemical characteristics of pregnant women with different glucose tolerance status,and their secretion characteristics of insulin,glucagon and glucagon-like peptide-1 (GLP-1) after oral glucose challenge.Methods We analyzed 74 cases pregnant women with positive results of 50 g glucose challenge test in 24-28 gestational weeks,who received regular obstetrical follow-up in Peking Union Medical College Hospital from January 2009 to June 2012.A further 100 g oral glucose tolerance test (OGTT) was performed,based on which the included women were divided into three groups,namely gestational diabetes mellitus (GDM) group (n =25),impaired glucose tolerance (IGT) group (n =25) and normal glucose tolerance (NGT) group (n =24).The general clinical data and biochemical indexes of the three groups were compared,and the indexes about insulin resistance and the function of pancreatic islet beta cells were calculated.Glucose,insulin,glucagon and GLP-1 were measured in OGTT.The secretion characteristics of each of these hormones and their correlation with other indicators were evaluated.Results Compared with the NGT group,the GCT [(9.21 ±0.75) mmol/L vs.(8.52 ±0.50) mmol/L,P ＜0.05] and glycosylated hemoglobin A1c [(5.39±0.34)％ vs.(5.18 ±0.20)％,P＜0.05] were significantly higher in the GDM group.In OGTT,the area under curve (AUC) of glucose in the GDM group was significantly higher than that inthe IGT group and NGT group [(26.58 ±2.02) mmol/(L · h) vs.(23.20 ± 1.51) mmoL/(L · h),(26.58 ± 2.02) mmol/(L · h) vs.(19.84 ± 1.95) mmol/(L · h),both P ＜ 0.05].The peak values of insulin secretion in the GDM group and IGT group were delayed to 2 hours after OGTT.The 3-hour insulin level in the GDM group was significantly higher than that in the NGT group (P ＜ 0.05).Compared with the NGT group,the glucagon levels in each time point after OGTT and the AUC of glucagon levels were reduced in the GDM group and the IGT group,but with no significant differences.The peak glucagon levels in the 3 groups all appeared at 3 hours after OGTT.The GLP-1 levels in each time point of OGTT were gradually increased from the NGT group to the IGT group to the GDM group,but no significant differences were found.The peak value of GLP-1 level was presented at 1 hour after OGTT in the NGT group and the IGT group and at 2 hours after OGTT in the GDM group.The valley values of GLP-1 level in the 3 groups all appeared at 3 hours after OGTT.In comparison with the NGT group,the ratios of GLP-1 to blood glucose levels (GLP/BG) at 1-hour and 2-hour were significantly decreased in the GDM group (P ＜ 0.05).The AUC of glucagon levels in OGTT were negatively correlated with fasting blood glucose (r =-0.287,P =0.013) and 1-hour glucose levels (r =-0.266,P =0.022) in OGTT and positively correlated with insulin secretion sensitivity index (ISSI) (r =0.297,P =0.010) and HOMA-β (r =0.236,P =0.043).Moreover,the AUC of GLP-1 levels in OGTT was negatively correlated with the levels of C-reactive protein (r =-0.264,P =0.035).The AUC of GLP/BG in OGTT was positively correlated with ISSI (r=0.406,P＜0.001).Conclusions Pregnant women with GDM and IGT in the second trimester have insulin resistance and dysfunction of pancreatic islet β cells.Potential GLP-1 resistance and inadequate secretion may exist in GDM patients.GLP/BG may be a better parameter to evaluate the secretion function of L cells in pregnancy and an effective parameter to estimate the compensatory function of pancreatic β cells indirectly.Glucagon levels may not start to change obviously before 28 gestational weeks.
