妊娠糖尿病患者孕中晚期血清GLP-1水平变化及临床意义

摘要

目的 探讨妊娠糖尿病(GDM)患者孕中晚期血清胰高血糖素样肽1(GLP-1)水平变化及临床意义.方法 选取规律产检孕妇82例,其中GDM患者40例(GDM组),糖耐量正常者42例(对照组).两组均于孕24~28周行75 g口服葡萄糖耐量试验(OGTT),分别于糖负荷后0、30、60、120 min时检测血清GLP-1及GLP-1曲线下面积(AUCGLP-1),分别计算糖负荷后0、30、60、120 min时胰岛素(INS)/GLP-1及胰岛素曲线下面积(AUCINS)/AUCGLP-1.分析GDM患者血清GLP-1、AUCGLP-1与血糖(GLU)、血糖曲线下面积(AUCGLU)、INS及AUCINS的相关性.结果 GDM组糖负荷后30 min时INS/GLP-1低于对照组(P<0.05),两组各时间点血清GLP-1水平及AUCGLP-1、AUCINS/AUCGLP-1比较差异均无统计学意义(P均>0.05).GDM患者血清GLP-1与糖负荷后0、30、60、120 min时GLU、INS及AUCGLU均不相关(P均>0.05),GLP-1及AUCGLP-1均与AUCINS呈正相关(r分别为0.243、0.270,P均<0.05),糖负荷后60、120 min时AUCGLP-1与INS呈正相关(r分别为0.013、0.041,P均<0.05).结论 与糖耐量正常孕妇相比,GDM患者血清GLP-1水平存在峰值延后倾向,在75 g OGTT糖负荷后30 min可能存在GLP-1分泌相对不足,提示GDM患者可能存在GLP-1抵抗.%Objective To investigate the changes in levels of serum glucagon-like peptide 1 (GLP-1) in the second and third trimesters of pregnant women with gestational diabetes mellitus (GDM) and its clinical significance.Methods A total of 82 pregnant women receiving antenatal care regularly were enrolled, including 40 cases of GDM patients (GDM group) and 42 cases of normal glucose tolerance subjects (control group).The pregnant women in both groups received oral glucose tolerance test (OGTT) after taking 75 g glucose during the 24-28 weeks of gestation.The serum GLP-1 and area under the GLP-1 curve (AUCGLP-1), the serum insulin (INS)/GLP-1 and area under the insulin curve (AUCINS)/area under the blood glucose curve (AUCGL)-1 were measured at 0, 30, 60, and 120 min after glucose administration.We analyzed the correlations between serum GLP-1, AUCGLP-1, blood glucose, AUCGLU, INS, and AUCINS in GDM patients.Results The level of INS/GLP-1 in the GDM group at 30 min was lower than that of the control group (P<0.05).However, there were no statistically significant differences in the levels of serum GLP-1, AUCGLP-1, and AUCINS/AUCGLP-1 between these two groups (all P>0.05).For GDM patients, the level of serum GLP-1 was not correlated with GLU, INS, and AUCGLU at 0, 30, 60, and 120 min after glucose administration (all P>0.05), but GLP-1 was positively correlated with AUCGLP-1 (r=0.243, P<0.05) and AUCINS (r=0.270, P<0.05).There was a positive correlation between AUCGLP-1 and INS at 60 min (r=0.013, P<0.05) and 120 min (r=0.041, P<0.05).Conclusion Compared with normal glucose tolerance subjects, the level of serum GLP-1 in GDM patients does not change significantly, but exists the tendency of peak delay.There may be a relative deficiency of GLP-1 secretion at 30 min after 75 g OGTT, which indicates that GDM patients may have GLP-1 resistance.