糖代谢异常孕妇胰岛素水平的变化机制相关影响因素研究∗

摘要

Objective: To investigate the influence factors of the changes of insulin level in pregnant women with abnormal glucose metabolism . Method:Pregnant women who came to our hospital for perinatal healthcare from Feb. 2011 to Jun. 2012 were chosen. According to GCT by 50g and OGTT, 86 women whose glucose metabolism was anomalous were taken into this experiment. At the same time, 50 healthy pregnant women were taken as control subjects. The levels of plasma glucose and insulin were tested at separate 4 mo-ments ( at fasting time, 60, 120 and 180 minutes after taking 75g glucose) respectively. Result: The pre-pregnancy weigh index, the amounts of weight gain in gestational period and family history positive ratio of pregnant women with GIGR were higher than the control group. In the group with abnormal glucose tolerance, the levels of insulin measured at 60 minutes and 120 minutes after OGTT were much higher than that of the normal group. About the results of the HOMA-IR, the group with GIGR were much higher than the normal group (5.1±1.4 vs. 2.3±0.6;P<0.05). The pregnant week of diagnosing GIGR in pregnant women with fam-ily history was earlier than those without family history. The results of GCT of women with family history were also higher than the group without family history. Conclusion: The women with anomalous glucose metabo-lism hold insulin resistance, pre-pregnancy obesity, excessive weight gain and family history. Thus, Islet function test should be timely and regularly taken for the people with high risks of GIGR, so as to detect the abnormality at early stage and take effective intervention.%目的：：探讨妊娠期糖代谢异常孕妇的胰岛素水平变化的影响因素。方法：选取2011年2月至2012年6月在妇产科围产保健孕妇,根据50克葡萄糖筛查( GCT)和口服75克葡萄糖耐量试验( OGTT)结果纳入妊娠期糖代谢异常患者86例,并随机选取GCT正常孕妇60例作为对照组。检测所有研究对象的空腹血糖和胰岛素水平,OGTT60min、120min和180min的血糖及胰岛素水平。结果：妊娠期葡萄糖代谢异常( GIGR)组孕前体重指数( BMI)、孕期体重增加量及家族史阳性率明显高于正常组孕妇。 GIGR组OGTT试验60min及120min的胰岛素水平明显高于正常组。 GIGR组胰岛素抵抗指数(HOMA-IR)明显高于正常组(分别为5.1±1.4vs.2.3±0.6；P<0.05)。在GIGR孕妇中,有家族史的孕妇确诊为GIGR的孕周明显早于无家族史孕妇,GCT血糖结果亦明显高于无家族史孕妇。结论：GIGR孕妇存在明显的胰岛素抵抗、孕前肥胖、孕期体重增长过多和糖尿病家族史高危因素,故对于GIGR的高危人群,应及时并定期行孕早期胰岛功能检查,做到及早发现异常并进行有效的干预。