对妊娠期糖耐量受损妇女胰岛素抵抗和胰岛素生成的观察

目的:通过糖耐量实验后(OGTT)3h胰岛素反应,探讨妊娠期糖耐量受损(IGT)和妊娠期糖尿病(GDM)妇女的胰岛素水平和胰岛素抵抗。方法:选择24～28周孕妇75例进行OGTT试验。正常妊娠组30例(Ⅰ组),IGT组26例(Ⅱ组),GDM组25例(Ⅲ组)。应用胰岛素生成指数和平均胰岛素浓度反映胰岛素分泌水平,应用空腹胰岛素浓度和稳态模式HOMA-IR反映胰岛素抵抗。结果:正常妊娠组(NP)空腹胰岛素水平显著低于GDM组和IGT组(P<0.001和P<0.005)。GDM组胰岛素分泌指数显著低于NP组(P<0.05),在GDM组和IGT组之间,稳态模式HOMA-IR和早期胰岛素生成指数(IGT)无显著差异(P>0.05),总的胰岛素分泌在GDM组最高,其次IGT组,与NP组有显著差异(P<0.001和P<0.005)。结论:妊娠期糖尿病和糖耐量受损病人之间有显著相似之处,IGT妇女的空腹胰岛素和胰岛素抵抗指数与GDM无显著差异。由此得出,糖耐量减低应被视作病理状态,应该与GDM病人一样对待。

Observation on insulin resistance and secretion of women with impaired glucose tolerance in gestation

Objective:To explore the insulin level and resistance of gestational women with impaired glucose tolerance(IGT) and gestational diabetes mellitus(GDM) through insulin reaction 3 h after oral glucose tolerance test(OGTT).Methods:The women from 24 to 28 weeks of gestation were selected to accept OGTT and divided into 30 case of the normal pregnancy (groupⅠ),26 case of IGT(groupⅡ) and 25 case of GDM (groupⅢ).Insulin secretion was assessed by the early-phase insulinogenic index and mean insulin level ,insulin resistance was assessed by fasting insulin concentration and homeostasis model insulin resistance index.Results:The fasting insulin level in normal pregnancy group were significantly lower than that in GDM and IGT(P<0.001 and P<0.005 respectively). The insulin secretion index was significantly lower in GDM,compare with NP (P<0.05).The homeostasis model insulin resistance index and early insulinogenic index was no significant difference between GDM and IGT.Insulin secretion fuction were the highest in GDM ,followed by IGT,but significantly differed from that in the normal pregnancy.Conclusion:A striking similarity between GDM and IGT was found.The women with IGT were indistinguishable from patients with gestational diabetes in aspects of fasting insulin level and insulin resistance. IGT should be regarded as a pathologic states and be treated similarly to the patient with GDM.