妊娠糖耐量低减患者胰岛素抵抗和胰岛β细胞分泌功能

目的:探讨妊娠糖耐量低减(GIGT)患者胰岛素抵抗和胰岛β细胞分泌功能的变化。方法:分析125例糖耐量正常(NGT)孕妇、61例GIGT孕妇和59例妊娠糖尿病(GDM)孕妇的胰岛素抵抗(IR)和胰岛β细胞分泌功能,采用稳态模式胰岛素抵抗指数(HOMA-IR)评价胰岛素抵抗,稳态模式胰岛β细胞功能指数(HBCI)、30min净增胰岛素/30min净增血糖(ΔⅠ30/ΔG30)和ΔⅠ30评价胰岛β细胞分泌功能。结果:GIGT组和GDM组HOMA-IR高于NGT组,GDM组的HOMA-IR高于GIGT组,差异均有统计学意义(P<0.05);GIGT组和GDM组ΔⅠ30/ΔG30和HBCI低于NGT组,差异有统计学意义(P<0.05～0.01),GDM组的HBCI低于GIGT组,差异有统计学意义(P<0.05),GIGT组与GDM组的ΔⅠ30/ΔG30和ΔⅠ30比较无统计学差异。结论:GIGT的发病机制为胰岛素抵抗增强和胰岛β细胞分泌功能缺陷,且胰岛素早期分泌功能受损;GIGT应被视作病理状态,应该与GDM患者采取类似的防治方法。

Changes of insulin resistance and function of islet βcell in subjects with gestational impaired glucose tolerance

Objective:To investigate the changes of insulin resistance(IR) and function of islet β cell in subjects with gestational impaired glucose tolerance(GIGT).Methods:125 subjects with normal glucose tolerance(NGT),61 GIGT and 59 gestational diabetes mellitus(GDM) were observed.Homeostasis model insulin resistance index(HOMA-IR) was applied to assess the status of insulin resistance,Homeostasis β-cell function index(HBCI),30min net increment of insulin/30min net increment of glucose(ΔⅠ30/ΔG30) andΔⅠ30 were used to evaluate the basic function of islet β cells.Results:HOMA-IR in GIGT and GDM were higher than in NGT,HOMA-IR in GDM was higher than in GIGT,there were significant difference(all P<0.05);Compared with NGT,HBCI and ΔI30/ΔG30 were significantly decreased(P<0.05～0.01),HBCI in GDM was lower than in GIGT(P<0.05).There were no significant difference in ΔI30/ΔG30 and ΔI30 in GDM and GIGT.Conclusion:The increase of insulin resistance and decrease of islet β cell function may result in subjects with GIGT,and show a defect of the early phase of insulin secretion.GIGT should be regarded as a pathologic states and be treaded similarly to the patient with GDM.