妊娠期糖尿病性激素结合球蛋白与胰岛素抵抗的相关性研究

目的比较妊娠期糖尿病（GDM）与正常孕妇胰岛素抵抗情况及性激素结合球蛋白（SHBG）水平，探讨SHBG与胰岛素抵抗、胰岛素敏感性的关系。方法用放射免疫法或酶法检测27例GDM孕妇及27例正常孕妇血清SHBG水平，并同时检测其胰岛素、C肽释放曲线、游离睾酮（FT）、空腹血糖（FBG）和糖化血红蛋白（HbA1c）水平，计算胰岛素抵抗指数（HOMA—IR）及胰岛素敏感性指数（ISI）。结果（1）两组孕妇空腹及糖负荷后120min、180min时的胰岛素值间差异均有显著性意义（P〈0．05）；与正常对照组比较，GDM组孕妇胰岛素释放曲线表现为分泌峰后移（120min），峰值增高，下降延缓。（2）两组孕妇糖负荷后180min时的C肽值间差异有显著性意义（P〈0．01）；与正常对照组比较，GDM组孕妇C肽释放曲线也表现为分泌峰下降延缓。（3）两组孕妇sHBG、HOMA—IR、ISI、FT、FBG、HbA1c间差异均有显著性意义（P〈0.01）。（4）SHBG／空腹胰岛素（FINS）值与FINS、C肽及HOMA—IR呈显著负相关（P〈0．01），与ISI呈显著正相关（P〈0．01）。结论GDM孕妇存在明显的胰岛素抵抗和胰岛素敏感性下降；SHBG水平明显降低并且与胰岛素水平、胰岛素抵抗、胰岛素敏感性有相关关系，检测SHBG水平变化有助于了解GDM孕妇胰岛素抵抗情况及病情的进展，指导疾病的治疗。

Correlation Study between Sex Hormone-binding Globulin and Insulin Resistance in Gestational Diabetes Mellitus

Objective To compare the insulin resistance and sex hormone-binding globulin(SHBG) level between gestational diabetes mellitus(GDM) and normal women,explore the relationships between insulin resistance,insulin sensitivity and SHBG.Methods Serum SHBG concentrations were measured in 27 women with GDM and 27 normal women(control group).Insulin and C-peptide release curve,serum free testosterone(FT),fasting blood glucose(FBG) and glycosylated hemoglobin(HbA1c) were measured in two groups by radioimmunoassy or enzyme assay methods.Insulin resistance index(HOMA-IR) and insulin sensitivity index(ISI)were calculated.Results (1)The insulin levels at fasting and 120 min,180 min after glucose intolerance were significantly different between the two groups (P<0.05);The peak times of insulin release curves were prolonged,the peak values were higher and recovered slower in GDM group than those in control group.(2)The C-peptide levels at 180 min after glucose intolerance were significantly different between the two groups (P<0.01);The peak values of C-peptide release curves were also recovered slower in GDM group than those in control group.(3)The levels of SHBG,HOMA-IR,ISI,FT,FBG and HbA1c were significantly different between the two groups (P<0.01).(4)The ratio of SHBG/ fasting insulin were negatively correlated with fasting insulin,C-peptide,insulin resistance index(P<0.01),and positively correlated with ISI(P<0.01).Conclusion Insulin resistance exists in GDM women,their insulin sensitivity and SHBG concentrations are significantly low,SHBG is correlated with insulin level,insulin resistance and insulin sensitivity.The detection of SHBG can help us to evaluate the insulin resistance and to improve the treatment level of GDM women.