妊娠早期25-羟维生素不足对妊娠期糖尿病的预测价值

摘要

目的:分析妊娠早期25-羟维生素D不足对妊娠期糖尿病(GDM)的预测价值.方法:选取妊娠早期于本院就诊的孕妇作为研究对象,于确诊妊娠时检测空腹血糖(FPG)、血清25-羟维生素D[25-(OH) D]及空腹胰岛素(FIns),于孕24～28周行75g口服葡萄糖耐量试验(OGTT),按照血清25-(OH)D水平分为25-(OH)D正常及不足组,比较GDM的发生率及胰岛素相关指标的差异;按照OGTT的血糖值,将GDM孕妇分为不同时间点血糖正常及异常组,分析血清25-(OH)D水平与OGTT血糖值的关系.结果:血清25-(OH)D不足组中的GDM发生率及HOMA-IR均高于25-(OH)D正常组,胰岛素分泌指数(HOMA)-β低于25-(OH)D正常组(P＜0.05);糖耐量指标中,服糖后1、2h血糖异常组的血清25-(OH)D水平低于血糖正常组(P＜0.05),而空腹血糖异常组与正常组间血清25-(OH)D水平无统计学差异(P＞0.05).结论:孕妇血清25-(OH)D不足可以降低机体胰岛素的敏感性,加重胰岛素抵抗,在妊娠早期检测,对GDM的发生可起到一定的预测作用.%Objective:To analyze the predictive value of deficiency of 25 hydroxy vitamin D for gestational diabetes mellitus (GDM) in early pregnancy.Methods:The pregnant women in early pregnancy from Haining City People's Hospital were collected.The fasting blood glucose (FPG),serum 25 hydroxy vitamin D (25 (OH) D) and fasting insulin (FIns) were tested when women were diagnosed of pregnancy.And 75g oral glucose tolerance test (OGTT) were conducted in 24 to 28 gestational weeks.All gravidas were divided into the 25 (OH) D normal group and 25 (OH) D deficiency group according to the level of 25 (OH) D.The rate of GDM and the indexes of insulin related were compared between the two groups.The gravidas with GDM were also divided into normal blood glucose group and abnormal blood glucose group based on blood glucose level at different time points of OGTT.And the relationship between the level of blood glucose and 25 (OH) D was analyzed.Results:The rate of GDM and the ln(HOMA IR)of women in 25 (OH) D deficiency group were significant higher than those of women in 25 (OH) D normal group,but the ln(HOMA β)of women in 25 (OH) D deficiency group was significant lower than that of women in 25 (OH)D normal group (P ＜0.05).The level of 25 (OH) D of women in abnormal blood glucose group were significant lower than that of women in normal blood glucose group at 1 hour and 2 hours after taking glucose(P＜0.05),but there were no statistical significant difference in FPG between the normal and abnormal blood glucose groups (P＞0.05).Conclusion:The deficiency of 25 (OH) D can reduce the sensitivity of insulin and increased the resistance of insulin.If the level 25 (OH) D is tested in early pregnancy,it can predict GDM.