糖代谢异常孕妇血中胰岛素和C肽水平变化

目的探讨正常妊娠妇女，妊娠期糖尿病（GDM）及妊娠合并糖耐量减低（GIGT）患者孕期及产后胰岛素、C肽水平的变化。了解其胰岛B细胞功能状况。方法用放射免疫法测定GDM患者20例（Ⅰ组）；GIGT患者20例（Ⅱ组）；正常孕妇20例（Ⅲ组）的胰岛素水平及C肽水平。结果Ⅰ、Ⅱ组于孕24～28周时，胰岛素水平明显高于Ⅲ组（P〈0．05、P〈0．01），孕32．40周时略有下降，产时有峰式分泌，但Ⅲ组比较无差异性。Ⅰ组C肽水平于孕期明显高于Ⅱ、Ⅲ两组（P〈0．05），产时明显低于Ⅲ组（P〈0．05），Ⅰ．Ⅲ组产后6周胰岛素，C肽水平均下降，Ⅰ、Ⅱ组仍明显高于Ⅲ组（P〈0．01），Ⅲ组孕妇在孕24～28周OGTT胰岛素及C肽水平在不同时点比较无明显差异。结论GDM、GIGT孕妇血中胰岛素、C肽水平均随孕周不同而发生不同变化。可能和较强的胰岛素抵抗有关，Ⅰ-Ⅲ组产时胰岛素和C肽的峰式分泌，可能与精神、心脑等应力因素有关，且产后6周两者水平高于正常水平，需进行长期随诊。

Changes of insulin and C-peptide in pregnancy of gestational diabetes mellitus

Objective To observe the different changes of plasma insulin and c-peptide in patients with gestational diabetes mellitus（GDM）, gestational impaired glucose tolerance（GITG）, normal pregnant women during duration of pregnancy and after parturition, and to detect the function of β-cell in patients with gestational impaired glucose metabolism. Methods Test the plasma insulin, c-peptide in 20 cases of GDM（group Ⅰ ）, 20 cases of GIGT（group Ⅱ ）, 20 cases of normal pregnant women （group Ⅲ ） by immunoluminescence. Results Insulin levels of group Ⅰ and group Ⅱ were higher than those of group Ⅲ during 24-28weeks （P〈0.05.P〈0.01）, but tended to decrease during 32-40weeks and peaked during delivery. During delivery, there were no significant differences among the three groups. During druation of pregnancy, c-peptide of group Ⅰ was significanfly higher than those in group Ⅱ and Ⅲ （P〈0.05） and was lower than that in group Ⅲ during delivery （P〈0.05）. Insulin and c-peptide of these 3 groups dropped gradually within 6 weeks after delivery but in group Ⅰ and Ⅱ they were significantly higher than those of group Ⅲ （P〈0.01）, During 24-28 weeks, ther were no significant differences among 3 groups of the levels of Insulin and c-peptide compared in different times of OGTT. Conclusions The levels of Insulin and c-peptide of GDM and GIGT were changed followed with gestational weeks, the reason maybe associated with insulin resistance. The three groups had the same peaking secretion during delivery, this maybe due to the stress during delivery. Insulin, c-peptide levels of most GDM and GIGT were still higher than normal after 6 weeks postpartum, and should be followed up carefully.