糖代谢正常的复发性流产患者妊娠早期的胰岛素抵抗水平

目的探讨糖代谢正常的复发性流产(recurrent spontaneous abortion,RSA)患者妊娠早期胰岛素抵抗的发生状况。方法收集2007年1月至2011年6月在我院首次就诊的626例孕早期妇女:有RSA病史且孕前经口服葡萄糖耐量试验(oral glucose tolerance test,OGTT)排除糖代谢异常的161例(RSA组),其中患有多囊卵巢综合征(polycysticovarian syndrome,PCOS)者26例;无不良孕产史的465例(对照组),其中患有PCOS者45例。回顾性分析血β-HCG、雌二醇、孕酮(progesterone,P)、空腹血糖及空腹胰岛素等临床资料,并计算胰岛素稳态模型指数(HOMA-IR)和空腹血糖/胰岛素比值(G/I),比较两组胰岛素抵抗水平。结果两组的年龄、BMI、平均孕期、雌二醇相比无统计学差异(P>0.05),RSA组的血清β-HCG、孕酮水平明显低于对照组(P<0.05,P<0.01);与对照组相比,伴有PCOS的RSA患者FPG、FIN及HOMA-IR均明显升高,而G/I比值明显降低(P<0.05),且非PCOS的RSA患者中也有相同的趋势;在本研究总体人群中,β-HCG及P水平与HOMA-IR呈负相关,而与G/I比值呈正相关,在控制BMI的影响后,β-HCG及P水平与HOMA-IR及G/I比值仍呈现显著相关性(r分别为-0.205、-0.191、0.196、0.205,P<0.05);RSA患者妊娠早期自然流产率较对照组明显增高(18.6%vs 6.7%,P<0.01)。结论无论其是否患有PCOS,糖代谢正常的RSA妇女再次妊娠早期均具有显著增高的IR趋势,可能是导致其反复流产的原因之一,建议对所有RSA患者(包括孕前糖代谢正常及非PCOS者)查空腹血糖和胰岛素来评价IR,以指导临床治疗。

Insulin resistance within first-trimester pregnancy in women with normal pre-pregnant glucose metabolism and history of recurrent spontaneous abortion

Objective To investigate the status of insulin resistance within first-trimester pregnancy in patients with normal pre-pregnant glucose metabolism and history of recurrent spontaneous abortion(RSA).Methods A total of 626 pregnant women who first visited our hospital within their first-trimester pregnancy were enrolled.The patients with a history of RSA and normal pre-pregnant glucose metabolism diagnosed by oral glucose tolerance test(OGTT) were assigned in a RSA group(n=161) including 26 patients with polycystic ovarian syndrome(PCOS),while those without abnormal pregnancy history were assigned in a control group(n=465) including 45 PCOS patients.The status of insulin resistance were retrospectively analyzed by comparing the serum levels of β-HCG,estradiol,progesterone,fasting plasma glucose and fasting plasma insulin as well as the homeostasis model assessment of insulin resistance index(HOMA-IR) and fasting plasma glucose/fasting plasma insulin(G/I) ratio between the two groups of patients.Results The serum levels of β-HCG and progesterone were significantly lower in the RSA group than in the control group(P<0.05,P<0.01),but age,body mass index(BMI),gestational age and serum level of estradiol showed no significant difference between the two groups(P>0.05).The HOMA-IR was higher and the G/I ratio was lower in the RSA group than in the control group(P<0.05).The serum levels of β-HCG and progesterone were negatively correlated with the HOMA-IR(r=-0.205,-0.191,respectively),and were positively correlated with the G/I ratio(r=0.196,0.205,respectively) even after adjustment for BMI(all P<0.05).The spontaneous abortion rate within first-trimester pregnancy of the RSA group was significantly higher than that of the control group(18.6% vs 6.7%,P<0.01).Conclusion The RSA women with normal pre-pregnant glucose metabolism tend to have a high insulin resistance within their first-trimester pregnancy no matter whether they have PCOS or not.Insulin resistance may be one of the reasons for recurrent abortion.It is recommended to screen both fasting plasma glucose and fasting plasma insulin in all RSA patients to evaluate their insulin resistance status for guiding the clinical treatment.