妊高征患者胰岛素抵抗的初步研究

研究妊高征患者糖耐量和胰岛素分泌情况，从代谢角度探讨其病因。对妊娠３７～４１周的妊高征３０例（妊高征组）、正常妊娠３０例（妊娠对照组）及未孕妇女１２例（未孕对照组）进行糖耐量试验；应用放射免疫分析法，同时测定胰岛素、Ｃ－肽水平，计算其曲线下面积。结果：三组血糖水平相近（Ｐ＞０．０５）。胰岛素峰值及曲线下面积不同，妊高征组分别为６１．４２±４８．７２ｍＩＵ／Ｌ，１３７．１２±８１．１２ｍＩＵ／Ｌ，妊娠对照组分别为７０．４６±５８．４２ｍＩＵ／Ｌ，１５０．３７±１０４．７６ｍＩＵ／Ｌ，均较未孕对照组１７．１２±１１．０３ｍＩＵ／Ｌ，３４．３８±１６．０１ｍＩＵ／Ｌ，升高（Ｐ＜０．０１）；妊高征组血压水平与胰岛素无相关性。提示：妊娠晚期存在高胰岛素血症和胰岛素抵抗，妊高征者胰岛素抵抗性无显著改变，好高征血压升高，与胰岛素抵抗间无明确的因果关系。     

妊高征患者糖、脂质代谢及胰岛素抗性

妊高征患者糖、脂质代谢及胰岛素抗性张金玉，陈丽芬，李文玲（广州军区广州总医院）近年的研究表明，高血压与高胰岛素血症密切相关，高血压患者存在胰岛素抗性。我们通过口服葡萄糖耐量试验、胰岛素反应及测定脂质和脂蛋白，探讨了妊高症患者的糖及脂质代谢。１材料与方...     

妊高征与一氧化氮

妊高征与一氧化氮同济医科大学附属协和医院（４３００２２）王泽华妊高征的病因至今尚未完全阐明，但近年来研究发现血管内皮细胞损伤及其功能失调在妊高征发病机制中起重要作用，其中内皮细胞释放的一氧化氮（ＮＯ）被认为是影响妊高征病理生理变化的关键因素。现将ＮＯ...     

妊高征与脂代谢

妊高征与脂代谢北京医科大学第一医院（１０００３４）章小维董悦目前认为，妊高征病理生理变化中，内皮细胞损伤，内皮细胞功能异常起了重要作用。妊高征时子宫胎盘血管床存在急性动脉粥样硬化的改变，表现为内膜细胞脂肪变和血管壁坏死，血管管腔狭窄。心血管领域研究显...     

妊高征与营养

妊高征与营养沈阳市妇婴医院（１１００１４）曲文玉刘文翰妊高征孕妇的饮食是一个复杂且争论颇多的问题。它主要涉及两个方面，一方面是妊高征的发生发展是否与饮食有关，另一方面是妊高征的饮食疗法问题。１营养缺乏或失调与妊高征的关系目前认为妊高征与膳食有关，有人...     

钙与妊高征

选择１５０例孕妇，于妊娠２０～２４周查血钙、磷值，并将病例分为Ａ、Ｂ、Ｃ三组，各５０例。Ａ组补钙元素１ｇ／日，Ｂ组２ｇ／日，Ｃ组不补钙。妊高征的发生率依次为８％，４％及１８％。Ｂ组效果最佳。产前门诊对２００例孕妇由２０～２８周始，至分娩期每日补钙元素２ｇ，另２００例不补钙，妊高征发生率分别为７．５％和１６．５％。补钙２ｇ／日，对母儿无不良影响。本文讨论了正常妊娠和妊高征的钙代谢。妊娠期补钙可降低妊     

胰岛素抵抗与妊高征发病及围产儿预后的关系

目的探讨胰岛素抵抗与妊高征发病及围产儿预后的关系。方法选择妊高征孕妇１１１例为妊高征组,正常妊娠妇女１５５例为对照组;分别于孕３２周前和３２周后取母血,分娩后取脐血,测定胰岛素和Ｃ肽浓度;比较新生儿出生体重、Ａｐｇａｒ评分和羊水状况。结果妊高征组Ｃ肽和胰岛素的浓度在孕３２周前、后均明显高于对照组（Ｐ＜０．００１和Ｐ＜０．０１）。在妊高征组,宫内发育迟缓、新生儿窒息和羊水异常时,母儿Ｃ肽和胰岛素浓度均有上升的趋势,并且发生在妊娠３２周之前;在对照组,宫内发育迟缓时,孕妇Ｃ肽和胰岛素浓度有下降的趋势。结论胰岛素抵抗在妊高征的发生、发展,以及围产儿预后不良等方面均有重要意义。     

Maternal serum fructosamine and maternofetal glucose and insulin homeostasis in normal pregnancy

Summary Well-defined normal values are necessary to identify pregnancies complicated by gestational diabetes (GD) and thus further reduce perinatal morbidity and mortality from this condition. The present study defined the range for the oral glucose tolerance test (oGTT) in 2578 pregnancies. After exclusion of abnormal results 822 randomized patients were used to define normal values for fructosamine, HbA1c, insulin, glucose and C-peptide in the maternal serum; insulin, glucose and fructosamine in the amniotic fluid; and insulin, glucose, C-peptide and fructosamine in the cord blood.     

妊高征孕妇的脂质代谢

对３４例妊高征孕妇、３０例健康未妊娠妇女及３５例正常孕妇的血脂代谢进行了检测，分别测定了胆固醇（ＴＣ）、甘油三酯（ＴＧ）、低密度脂蛋白－胆固醇（ＬＤＬ－Ｃ）和高密度脂蛋白－胆固醇（ＨＤＬ－Ｃ），并计算ＬＤＬ－Ｃ／ＨＤＬ－Ｃ比值及动脉粥样硬化指数（ＡＩ）。结果：正常妊娠中期血脂水平与非孕妇血脂水平差异无显著性（Ｐ＞０．０５），妊娠晚期与非孕妇血脂水平及妊高征轻、中度与妊娠晚期血脂水平比较，差异均无显著性，Ｐ均＞０．０５，但重度妊高征ＴＧ和ＡＩ明显增高，其平均值加一个标准差＞３小于４。血脂水平与急性动脉粥样硬化及胎婴儿预后无明显相关。提示：（１）高脂血症分Ⅳ型，重度妊高征属Ⅳ型高脂血症。（２）妊娠期脂质代谢为妊娠晚期有大量胎肪积留，妊娠晚期血脂水平高于妊娠中期，可能为正常生理变化或与易发妊高征有关。（３）妊高征脂质代谢为重度妊高征ＴＧ和Ａｌ水平明显增高，胎盘血管粥祥硬化与ＴＧ增高导致脂质过氧化物增多或与免疫反应有关，其原因不明可能是多种因素的作用。     

The influence of ritodrine on glucose and insulin blood levels after oral glucose loading in the last three months of normal pregnancy

By a t-test for paired observations the influence of ritodrine, a β-sympathicomimetic drug which is administered as a tocolytic, on the blood glucose concentrations and the insulin secretion of women in their last 3 months of pregnancy, whose metabolism was normal, was demonstrated by means of the oral glucose tolerance test. Upon administration of ritodrine, the insulin levels as well as the mean glucose values significantly exceed the results obtained from the standard glucose tolerance test. In 12 out of 21 patients abnormally high blood glucose levels were encountered following additional administration of ritodrine.     

Insulin pumps and diabetes technologies in pregnancy: an overview for the obstetrician

The use of technologies to support self-management of type 1 diabetes is growing, including in women pursuing pregnancy. Women with type 1 diabetes might use a variety of technologies to manage their diabetes before, during and after pregnancy. Innovations range from sensors that allow real-time monitoring of glucose to insulin pump therapy and to even more sophisticated technologies used by a smaller number of pioneers. Using these technologies during pregnancy requires a working knowledge of some key principles to ensure the safety of the woman and the best possible outcome for her and the baby. In this review, we discuss some of these newer technologies, principles behind their use, common issues encountered in everyday practice and how to resolve these.     

Comparison of postprandial (lunch tolerance) and postglucose (oral glucose tolerance) blood sugar values in pregnancy

The diagnosis of diabetes mellitus in pregnancy is generally made by means of an oral glucose tolerance test (oGTT). As this test can be unpleasant for pregnant women because of morning sickness, especially when frequent repetitions are necessary (in cases of suspected diabetes whereby a normal glucose tolerance can change into glucose intolerance as pregnancy progresses), we investigated whether the blood sugar values around lunch time, which we make use of in gestational diabetics to check the effect of treatment on the blood sugar level, could be used for diagnostic purposes.The normal upper limits of the capillary blood sugar values 30 min before and 60 and 90 min after a normal lunch (lunch tolerance test, LTT) were determined. They were found to be 5.6, 7.6 and 7.2 mmol/l, respectively, for true blood sugar (Nelson Somogyi method) and 5.1, 6.6 and 6.4 mmol/l, respectively, for true blood glucose (glucose oxidase method). The normal upper limit of the sum of the component LTT values (ΣLTT) was 19.0 mmol/l for blood sugar and 17.1 mmol/l for blood glucose. It did not appear necessary to standardize the lunch, as the height of the blood sugar level after the lunch or ΣLTT was not influenced by the size or composition of the lunch.The use of the LTT for diagnostic purposes appeared to be warranted, since the reproducibility and the sensitivity of the LTT were at least as good as those of the oGTT. The diagnosis of diabetes mellitus in pregnancy is made when the normal upper limit of ΣLTT or of one of the 3 LTT values is exceeded on two successive occasions within 3 wk, in order to avoid possible errors.     

胰岛素抵抗与妊娠高血压综合征发病的关系

目的　探讨胰岛素抵抗与妊娠高血压综合征 (妊高征 )发病的关系。方法　选取 1998年在上海市第一人民医院进行产前妊娠期糖尿病筛选异常的 199例孕妇为研究对象 ,进行 75g葡萄糖耐量试验 ,同时进行胰岛素释放试验 ,计算胰岛素曲线下面积及胰岛素敏感性指数 ,并随访至妊娠晚期发生妊高征的情况 ,比较 199例孕妇中 ,发生妊高征者和血压正常者胰岛素敏感性的差异。结果　 (1)妊高征发病有 39例 ,空腹血糖为 (4 .2± 0 .7)mmol/L ,空腹胰岛素为 (10 7.8± 48.8)pmol/L ,胰岛素敏感性指数为 - 3.2 5± 0 .2 7。血压正常的孕妇 16 0例 ,空腹血糖为 (3.8± 0 .7)mmol/L ,空腹胰岛素为 (5 0 .4± 40 .5 )pmol/L ,胰岛素敏感性指数为 - 2 .5 8± 0 .6 6 (P <0 .0 5 )。 (2 )胰岛素曲线下面积 ,妊高征患者为 112 5 .6± 331.0 ,血压正常孕妇为 10 5 7.6± 44 2 .2 ,两者比较 ,差异无显著性 (P >0 .0 5 )。结论　孕中期胰岛素抵抗可能是妊高征发病的原因之一。妊娠中期存在胰岛素抵抗可以作为一项预测妊高征的指标     

妊娠期糖尿病75g OGTT不同时点血糖异常孕妇的临床特点与妊娠结局分析

目的:分析妊娠期糖尿病(GDM)75g葡萄糖耐量试验(75g OGTT)不同时点血糖异常孕妇的临床特点与妊娠结局。方法:选取2013年1月至2015年3月在华北理工大学附属医院行产前检查并住院分娩的妊娠期糖尿病孕妇150例,孕24~28周均直接行75g OGTT,检测结果中仅其中1项时点血糖异常为GDMⅠ组、2项时点血糖异常为GDMⅡ组、3项时点血糖均异常为GDMⅢ组。结果:(1)GDMⅢ组的孕前体重指数(BMI)高于GDMⅡ组和GDMⅠ组,两两比较差异均有统计学意义(P0.05);(2)GDMⅢ组的胰岛素使用率高于GDMⅡ组和GDMⅠ组(P0.05),GDMⅡ组与GDMⅠ组比较,差异无统计学意义(P0.05)。GDMⅢ组使用胰岛素的风险是GDMⅠ组的23.05倍(OR=23.05,95%CI 2.61~203.18);(3)GDMⅢ组的OGTT结果 3项时点血糖水平、FINS和胰岛素抵抗指数均高于GDMⅡ组和GDMⅠ组,两两比较差异均有统计学意义(P0.05);(4)GDMⅢ组的巨大儿发生率高于GDMⅡ组和GDMⅠ组(P0.05),GDMⅡ组与GDMⅠ组比较,差异无统计学意义(P0.05)。GDMⅢ组发生巨大儿的风险是GDMⅠ组的5.029倍(OR=5.029,95%CI 1.789~14.132)。结论:OGTT结果 3项时点均异常的GDM孕妇的孕前体重指数、胰岛素使用率、胰岛素抵抗水平均明显升高,也是发生巨大儿的高危人群。此类高危GDM孕妇临床应高度重视并积极干预。     

糖耐量异常的晚期妊娠妇女胰岛素分泌与胰岛素抵抗的研究

OBJECTIVE: To investigate whether insulin secretion and resistance are different in glucose tolerant and intolerant women with normal pre-pregnant body mass index (BMI) during late pregnancy and to find out if there is association between gestational diabetes and insulin resistance syndrome. METHODS: On the basis of a 4-hour oral glucose tolerance test (OGTT), 32 gestational diabetes mellitus (GDM) patients, 21 gestational impaired glucose tolerant (GIGT) patients, and 50 normal glucose tolerant (NGT) cases were selected from uncomplicated pregnant women. Those had normal pre-pregnant BMI who had a 1-hour 50-g glucose-screening test (> or = 7.2 mmol/L), performed between 24-28 weeks of gestation. During the OGTT, several indexes of insulin resistance, insulin secretion, lipid metabolism were measured in addition to the standard glucose measurements. RESULTS: Glucose area under curve (GAUC), insulin area under curve (IAUC), insulin sensitivity index (ISI) transformed to natural logarithm and triglycerides (TG) are all significantly higher (P < 0.05) in GDM women. The means of these indexes in GDM group are 26.3 mmol/L.h-1, 276.5 mU/L.h-1, 4.2 and 3.2 mmol/L, respeetively. On the other hand, however, the differences of these indexes (except TG) between GIGT and NGT women are not statistically significant. The ratio of IAUC/GAUC has an increasing trend from GDM group, GIGT group to NGT group (10.5, 11.4 and 11.7, respectively), but the difference is not statistically significant. Multiple correlation coefficient study demonstrated that ISI is significantly positively correlated with GAUC, IAUC and TG (P < 0.01). CONCLUSIONS: Compared with NGT women, GDM women has impaired insulin secretion, abnormally increased insulin resistance, and relatively dyslipidemia. GDM seems to be a component of the syndrome of insulin resistance that provides an excellent model for study and prevention in a relatively young aged group.