乙型肝炎病毒携带者合并妊娠期糖尿病64例临床分析

摘要

Objective To investigate the condition of glucose metabolism in hepatitis B virus (HBV) carrier complicated with gestational diabetes mellitus (GDM) during pregnancy and postpartum, and to analyze the effects of HBVcarrying on the outcomes of GDM.Methods Clinical data of 64 HBV carrier complicated with GDM were collected and analyzed, retrospectively. All patients completed their prenatal examination and delivery in Beijing Ditan Hospital, Capital Medical University from January 2013 to July 2014. Fasting plasma glucose (FPG), 2 hour plasma glucose (2hPG) and fasting insulin (FINS) were examined in 24~28 weeks of pregnancy, 6~8 weeks and 1 year after delivery. The homeostasis model assessment of insulinresistance (Homa-IR), homeostasis model assessment of insulin sensitivity (Homa-ISI), homeostasis model assessment of percent β cell function (Homa-β) were calculated by homeostasis model assessment (HOMA). The changes of glucose, insulin, insulin sensitivity and function of pancreatic β cell were compared at different times.Results The FPG, 2hPG and FINS of 6~8 weeks and 1 year after delivery were lower than those of 24~28 weeks of pregnancy(P< 0.05). But there was no statistical difference between 6~8 weeks and 1 year after delivery[95%CI:(-0.319, 0.163), (-3.137, -2.143), (0.075, 3.143);P = 0.523,0.333, 0.245]. The Homa-β of 6~8 weeks and 1 year after delivery, and Homa-ISI of 6~8 weeks after delivery were higher than those of 24~28 weeks of pregnancy (Z = -4.4484, -3.965;P< 0.001). There were no statistical differences of Homa-IR among three groups (Z = -2.049,P< 0.001), and there were also no statistical differences of Homa-ISI and Homa-β between 6~8 weeks and 1 year after delivery (P> 0.005). Conclusions The secreted function of pancreatic β cell in HBV carrier complicated with GDM recovered gradually and the level of insulin increased after delivery, but insulin resistance still existed.The rate of new abnormal glucose metabolism after delivery is increasing as time going on.%目的：调查乙型肝炎病毒（HBV）携带者合并妊娠期糖尿病（GDM）孕24～28周及产后的糖代谢情况，分析HBV感染对GDM转归的影响。方法回顾性分析2013年1月至2014年7月于首都医科大学附属北京地坛医院产检并分娩的64例HBV携带者合并GDM孕24～28周、产后6～8周和产后1年口服葡萄糖糖耐量试验（OGTT）中空腹血糖（FPG）、2小时血糖（2hPG）及空腹胰岛素（FINS）情况。利用稳态模型（HOMA）计算胰岛素抵抗指数（Homa-IR）、胰岛素敏感指数（Homa-ISI）及胰岛β细胞功能（Homa-β）。比较HBV携带合并GDM患者不同时期血糖和胰岛素的变化，评价该类患者孕24～28周及产后胰岛素敏感性、胰岛β细胞功能及产后糖代谢复常情况。结果产后6～8周和产后1年FPG、2hPG及FINS水平均较孕24～28周下降，差异均有统计学意义（P均＜0.05），但产后6～8周和产后1年相比上述指标无统计学差异[95%CI分别为（-0.319，0.163）、（-3.137，-2.143）、（0.075，3.143），P值分别为0.523、0.333、0.245]。产后6～8周和产后1年Homa-β均显著高于孕24～28周（Z值分别为-4.4484、-3.965，P均＜0.001），产后6～8周Homa-ISI显著高于孕24～28周，差异有统计学意义（Z =-2.049，P＜0.001），但产后6～8周和产后1年间Homa-ISI和Homa-β的差异无统计学意义（P均＞0.005）。结论 HBV携带合并GDM患者产后胰岛素的分泌功能逐渐恢复，胰岛素分泌增加，但产后仍存在胰岛素抵抗。产后糖代谢异常发病率随产后时间的推移逐渐升高。