胰岛素抵抗与胰岛素分泌在妊娠期糖代谢异常发病中的作用

目的探讨胰岛素抵抗和胰岛素分泌在孕晚期糖代谢异常发病中的相互作用。方法在孕晚期测定36例妊娠期糖尿病(GDM)妇女、34例妊娠期糖耐量减低(G IGT)妇女和52名糖代谢正常(NGT)妇女的空腹胰岛素和空腹血糖。计算胰岛素敏感指数(ISI)和胰岛素分泌功能指数(IFI),比较3组胰岛素抵抗和胰岛素分泌能力的差别。结果⑴反映胰岛素抵抗的ISI,由NGT组、G IGT组到GDM组逐渐升高(P<0.01);反映胰岛素分泌能力的IFI和空腹胰岛素在GDM和G IGT组均高于NGT组(P<0.01)。⑵以各自的ISI均数将GDM和G IGT组进一步分组,高ISI的GDM和G IGT妇女,其胰岛素抵抗和胰岛素分泌能力均高于NGT组(P<0.01),低ISI的GDM妇女,其胰岛素抵抗也高于NGT组,但胰岛素分泌能力与NGT组相比差异无统计学意义(P>0.05);而低ISI的G IGT妇女,其胰岛素抵抗和胰岛素分泌能力与NGT组相比差异均无统计学意义(P>0.05)。结论与糖代谢正常孕妇相比,孕晚期糖代谢异常妇女存在胰岛素抵抗增强和胰岛素分泌相对不足,且GDM较G IGT具有更强的胰岛素抵抗。

The influence of insulin resistance and insulin secretion in women with glucose intolerance during late pregnancy

Objective To investigate the relationship of insulin resistance and secretion during late pregnancy in women with glucose intolerance.Methods Immunoenzymetric assay was used to measure the fasting serum insulin levels in 122 pregnant women which including of 36 pregnant women with gestational diabetes mellitus(GDM),34 pregnant women with gestational impaired glucose tolerance(GIGT),and 52 pregnant women with normal glucose tolerance(NGT).The fasting plasma glucose levels were measured by glucose oxidase method.The insulin sensitivity index(ISI) and islet secretive function index(IFI) were compared between the three groups.Results ISI had an increasing trend from NGT group,GIGT group to GDM group(P<0.01). The IFI and the level of fasting serum insulin in the groups of GDM and GIGT were higher than those in the NGT group(P<0.01).The women in the GDM and GIGT groups with high level of ISI had a higher capacity of insulin resistance and secretion than those of the NGT group(P<0.01).The insulin resistance in GDM women with low level of ISI was higher than that of the NGT group,with not significant difference.Conclusion The insulin resistance and insulin secretion have increased in women with glucose intolerance during late pregnancy compared with those of the NGT pregnant women,and the insulin resistance in women with GDM is higher than that of GIGT.