妊娠粮尿病代谢特征与产后粮代谢异常关系分析

目的研究妊娠糖尿病（GDM）患者临床代谢特征与产后早期持续糖代谢异常之间的关系。方法选取孕24～36周妊娠糖尿病患者63例，同期糖代谢正常孕妇30例作对照。分别测定两组空腹及75g葡萄糖负荷后血糖、胰岛素和血游离脂肪酸水平（FFA），同时测定空腹状态下血超敏C反应蛋白（Hs-CRP）、血脂谱、糖化血红蛋白等指标，计算孕前体重指数、新稳态模型胰岛素抵抗指数（HOMA2-IR）、新稳态模型胰岛B细胞功能指数（HOMA2-％B）、早期胰岛素分泌指数（△130／AG30）、早期FFA降低比率（△FFA30／△FFA0）、FFA曲线下面积（AUCFFA），并记录糖尿病家族史；同时于产后6～8周，对所有妊娠糖尿病患者再次行75g葡萄糖负荷试验以判定产后糖代谢情况，并分为正常对照组（NC）、产后糖调节正常组（NGR）和产后糖调节异常组（AGR）。结果17例GDM患者于产后6～8周仍持续存在糖代谢异常。占总随访例数的29％。对比NC组和NGR组孕期各项临床代谢指标，显示AGR组有明显升高的孕前BMI、HbA1C、空腹血糖、Hs-CRP。3组间血脂谱及糖尿病家族史分布的差异无统计学意义。AGR组胰岛素抵抗明显升高、13细胞功能减退。AGR组空腹、OGTT2h后血FFA及AUCFFA明显高于NC组和NGR组。NC组的△FFA30／AFFA0为25％，高于NGR组的18％和AGR组的15％（均P〈0．05）。Logistic回归分析显示：孕前BMI升高、AUCFFA升高和HOMA2一％B下降是妊娠糖尿病患者产后持续血糖异常的危险因素。结论有相当部分的GDM患者产后持续存在糖代谢异常。孕前BMI、胰岛B细胞功能缺陷和血FFA水平升高可能是GDM患者产后持续血糖升高的主要危险因素。

Metabolic features and their associations with postpartum abnormal glucose regulation among women with previous gestational diabetes mellitus

To analyze metabolic features and their associations with early postpartum consistent abnormal glucose regulation among women with previous gestational diabetes mellitus （GDM）. Methods A total of 63 GDM between the weeks 24 to 36 and 30 normal controls were recruited. Serum glucose, insulin and FFA levels were measured at fasting and two hours after 75g glucose challenge. Serum Hs-CRP, lipid spectrum and HbAlc were measured as well. Pre-pregnancy BMI, HOMA2-1R, HOMA2-%B, insulinogenic index at 30min （A 130/A G30）, A FFA30/FFA0 and AUCFFA were calculated. Family history of diabetes was recorded. Another 75g OGTT was performed at 6-8 weeks after delivery in all women diagnosed with GDM before. Those with GDM were divided into the normal controls （NC）, normal glucose regulation after delivery （NGR） and abnormal glucose regulation after delivery AGR） according to the second 75g OGTT. Results A total of 17 women with prior GDM had abnormal glucose level （12IFG, 141GT and 2DM）.Compared to the women with resuming NC and NGR, women of AGR showed higher pre-pregnancy BMI, HbAlc, fasting blood glucose level. Hs-CRP was increased in the NGR and AGR groups. There were no difference in the lipid spectrum and family history of diabetes among these three groups. AGR group showed significantly lower insulin sensitivity, IowerA 130/A G30 as well as lower HOMA2-%B. Fasting FFA, OGTT 2h FFA and AUCFFA were increased in the AGR group. In NC group, the A FFA30/A FFA0 was 25%, witch was higher than NGR group （18% P〈0.05） and AGR group （15% P〈0.05）.Logistic analysis showed that the increase of pre-pregnancy BMI, AUCFFA level and β cell dysfunction may be the risk factors to the consistent early postpartum abnormal glucose regulation. Conclusions There is a high incidence of early postpartum abnormal glucose regulation among women with prior GDM. Increased pre-pregnancy BMI, FFA level and β cell dysfunction may be the risk contributors to the consistent AGR after delivery.