妊娠期糖尿病患者胰岛素抵抗的危险因素分析

目的:探讨妊娠期糖尿病(GDM)患者胰岛素抵抗(IR)的危险因素,为防治GDM的发生、发展提供理论依据。方法:分析106例GDM患者和80例正常孕妇年龄、孕周、收缩压(SBP)、舒张压(DBP)、体质指数(BMI)、丙氨酸氨基转移酶(ALT)、天冬氨酸氨基转移酶(AST)、γ谷氨酸转移酶(GGT)、总胆固醇(TC)、甘油三酯(TG)、高密度脂蛋白胆固醇(HDL-C)、低密度脂蛋白胆固醇(LDL-C)、C反应蛋白(CRP)、空腹血糖(FBG)、空腹胰岛素(FIns),用稳态模型法计算胰岛素抵抗指数(HOMA-IR)评估IR程度,采用单因素分析及多元线性逐步回归分析,探讨各因素与胰岛素抵抗的关系。结果:GDM组BMI、ALT、GGT、TC、TG、LDL-C、FBG、FIns、HOMA-IR、CRP水平明显高于对照组(P0.05),HDL-C水平低于对照组(P0.05)。以HOMA-IR为因变量,进行多元线性逐步回归分析显示HOMA-IR与BMI、ALT、GGT、TG、CRP呈正相关(P0.05)。结论:BMI、ALT、GGT、TG、CRP水平与IR密切相关,是影响GDM发生、发展的危险因素,提示有效控制体重,监测血脂、肝酶及血清CRP指标,有望缓解IR的严重程度。

Risk factors of Insulin resistance in women with gestational diabetes mellitus

Objective:To identify risk factors of insulin resistance in women with gestational diabetes mellitus(GDM).Methods:A case-control study was performed in 106 women with GDM and 80 cases controls.Univariate and multivariate stepwise regression was used to identify risk factors of insulin resistance.Results:Body mass index(BMI) and the concentration of serum alanine aminotransferase(ALT),γ-glutamyltansferase(GGT),total cholesterol(TC),total triglycerides(TG),low density lipoprotein-cholesterol(LDL-C),fasting blood glucose(FBG),fasting serum insulin(FIns),HOMA-IR,C reactive protein(CRP)in GDM group were significantly higher than in normal control group(P<0.05).Multiple stepwise regression analysis showed that BMI,ALT,GGT,TG and CRP were positively correlated with insulin resistance.Conclusion:BMI,ALT,GGT and TG are the risk factors for insulin resistance in patients of GDM. They are useful additional measures in identifying those at high risk of GDM.