妊娠期合并糖代谢异常对新生儿胰岛素敏感性的影响

目的探讨妊娠期合并糖代谢异常对子代新生儿期胰岛素敏感性的影响。方法选择2009年12月至2010年11月本院产科出生的新生儿,根据母亲妊娠期是否合并糖代谢异常分为糖代谢异常母亲的新生儿和糖代谢正常母亲的新生儿。所有研究对象均进行出生体格测量,并于生后 3 天内测定空腹血糖( FPG) 和空腹血清胰岛素( FINS) ,计算胰岛素敏感指数( ISI) ,采用胰岛素稳态模型( HOMA) 计算胰岛素抵抗指数( IR) ,即 HOMA-IR,其中 FINS、ISI 和 HOMA-IR 值为胰岛素敏感性的评价指标。以性别、胎龄、出生体重为协变量,分别在早产儿和足月儿中进行胰岛素敏感性的协方差分析。结果 89 例早产新生儿和 96 例足月新生儿纳入分析。糖代谢异常母亲新生儿的出生体重、出生身长和重量指数( PI) 与糖代谢正常母亲的新生儿相比,差异无统计学意义( P >0. 05) 。与糖代谢正常母亲的早产儿相比,糖代谢异常母亲的早产儿 FPG 降低、FINS 升高,差异有统计学意义[FPG( mmol/L) : ( 4. 00 ±0. 25) 比( 4. 82 ±0. 18) ,FINS( 经对数 Lg 转换) : ( 0. 69± 0. 06) 比( 0. 54 ± 0. 04) ,P < 0. 05],ISI 值降低、HOMA-IR 值升高,但差异无统计学意义[ISI( 经对数 Ln 转换) : ( -2. 89 ±0. 15) 比( -2. 78 ±0. 11) ,HOMA-IR 值( 经对数 Lg 转换) : ( -0. 10 ±0. 06)比( -0. 15 ±0. 05) ,P >0. 05]; 足月儿中糖代谢异常母亲的新生儿 FPG、FINS 和 HOMA-IR 值低,ISI 值高,但差异均无统计学意义[FPG( mmol / L) : ( 4. 68 ± 0. 23) 比( 5. 17 ± 0. 13) ,FINS( 经对数 Lg转换) : ( 0. 56 ±0. 06) 比( 0. 61 ±0. 03) ,HOMA-IR 值( 经对数 Lg 转换) : ( -0. 14 ±0. 06) 比( -0. 03± 0. 03) ,ISI( 经对数 Ln 转换) : ( - 2. 79 ± 0. 14) 比( - 3. 04 ± 0. 08) ,P > 0. 05]。结论母亲妊娠期合并糖代谢异常虽然对新生儿的出生体重没有影响,但血糖仍然呈现低水平趋势,且对早产儿胰岛素敏感性可能有一定的影响。

Effects of pregnancy complicated with abnormal glycometabolism on the offspring insulin sensitivity

Objective To study the effects of pregnancy complicated with abnormal glycometabolism on the insulin sensitivity in neonates. Methods The neonates were assigned into two groups according to their maternal glycometabolism status during pregnancy. Anthropometric measurements were noted at birth. Fasting plasma glucose ( FPG) and fasting serum insulin ( FINS) levels were measured within three days after birth and insulin sensitivity index ( ISI) was calculated. Insulin resistance ( IR ) was assessed by homeostasis model ( HOMA-IR ) . Insulin sensitivity was evaluated by FINS,ISI and HOMA-IR. Using covariance analysis method with gender,gestational ageand birth weight as covariances,the differences of insulin sensitivity between preterm / term infants born to mothers with and without abnormal glycometabolism were examined separately. Results Eighty-nine preterm infants and ninety-six term infants were recruited. There were no differences in birth weight, birth height and Ponderal index between the two groups( P > 0. 05) . The preterm infants born to mothers with abnormal glycometabolism had significantly lower glucose levels and significantly higher insulin levels than those born to mothers with normal glycometabolism [FPG ( mmol / L) : ( 4. 00 ± 0. 25 ) to ( 4. 82 ± 0. 18) ,FINS( logarithmically transformed) : ( 0. 69 ± 0. 06) to( 0. 54 ± 0. 04) ,P < 0. 05]. There were no statistically significant differences in ISI ( natural logarithmically transformed) and HOMA-IR between the two groups in preterm infants( P > 0. 05) There were no statistically significant differences between term infants born to mothers with abnormal glycometabolism and those with normal glycometabolism in the insulin,glucose and HOMA-IR levels( P > 0. 05) . Conclusions Pregnancy complicated with abnormal glycometabolism may not influence the birth weight of the neonates,but the plasma glucose of the neonates may be lower,and the pregnancy complicated with abnormal glycometabolism may have some influences on the insulin sensitivity of preterm infants.