同型半胱氨酸与胰岛素抵抗对妊娠期糖尿病合并高血压的影响

目的:分析同型半胱氨酸(Hcy)与胰岛素抵抗对妊娠期糖尿病(GDM)合并妊娠期高血压疾病(PIH)的影响。方法:回顾性将本院2014年3月-2018年3月收治的孕妇资料按照孕期合并症分组,分别为GDM组42例、PIH组35例、GDM+PIH组29例及正常妊娠对照组56例。检测孕24~28周血清Hcy空腹血糖(FPG)、胰岛素(FINs)计算胰岛素抵抗指数(HOMA-IR),分析影响GDM患者合并PIH的相关因素。结果:GDM组、PIH组孕前体质指数(BMI)高于对照组但低于GDM+PIH组,GDM组FPG、FINs、HOMA-IR高于PIH组和对照组,但低于GDM+PIH组,PIH组收缩压、舒张压、Hcy高于GDM组和对照组,但低于GDM+PIH组(均P<0.05)。logistic回归分析示,BMI、HOMA-IR、Hcy均为影响GDM孕妇合并PIH的独立危险因素(P<0.05)。结论:Hcy与胰岛素抵抗均参与了GDM合并PIH的发病过程,且Hcy、胰岛素抵抗异常与GDM孕妇发生PIH有关。

The influence of homocysteine and insulin resistance on pregnancy induced hypertension occurrance of women with gestational diabetes mellitus

Objective:To analyze the influence of homocysteine(Hcy)and insulin resistance on the pregnancy induced hypertension(PIH)occurance of women with gestational diabetes mellitus(GDM).Methods:All included pregnant women were divided in group A(42 women with GDM),group B(35 women with PIH),group C(28 women with GDM and PIH),and group D(56 normal pregnant women)from March 2014 to March 2018.The serum Hcy level and insulin resistance index(HOMA-IR)of women during 24-28 gestational weeks in the four groups were measured.Logistic regression analysis was used to summarize the related factors affecting the PIH occurance of women with GDM.Results:Before pregnancy,BMI value of women in group A and B was significant higher than that of women in group D,but was significant lower than that of women in group C.The levels of fasting plasma glucose(FPG)and fasting insulin(FINs),and HOMA-IR value of women in group A were significant higher than those of women in group B and D,but were significant lower than those of women in group A.The systolic blood pressure,diastolic blood pressure and Hcy level of women in group B were significant higher than those of women in group A and D,but were significant lower than those of women in group A(all P<0.05).Logistic regression analysis showed that BMI,HOMA-IR value,and Hcy level were independent risk factors for PIH occurance of women with GDM(P<0.05).Conclusion:Both Hcy and insulin resistance are related to the pathogenesis of PIH,and abnormal Hcy level and insulin resistance are related to PIH occurance of pregnant women with GDM.