孕晚期妊娠期糖尿病胰岛素抵抗和分泌关系的探讨

目的 :探讨孕晚期妊娠期糖尿病 (GDM)胰岛素抵抗和胰岛素分泌能力的相互关系 ,并研究不同空腹血糖水平与胰岛素抵抗和胰岛素分泌的关系。方法 :利用胰岛素敏感指数 (ISI)和胰岛素分泌指数 (FBCI)分析空腹血糖 (FPG)、胰岛素抵抗和胰岛素分泌水平之间的关系。结果 :(1)GDM孕妇的ISI比正常孕妇 (NP)高 (P <0 .0 0 1) ,胰岛素分泌能力差异则不显著 (P >0 .0 5 ) ;(2 )正常妊娠组ISI与FBCI呈负相关 (P <0 .0 0 1) ;(3)以GDM的ISI中位数为分界点 :ISI高于中位数时 ,GDM的FBCI高于正常孕妇 (P <0 .0 5 ) ,FBCI也与ISI呈正相关 (P <0 .0 5 ) ;(4)正常妊娠组和GDM组FPG与ISI和FBCI相关 (P<0 .0 5 )。以FPG 5 .0mmol/L和 5 .8mmol/L为分界点对GDM分组 :FPG≤ 5 .0mmol/L时 ,FPG与ISI和FBCI相关 (P <0 .0 5 ) ;5 .0 5 .8mmol/L时 ,FPG与ISI和FBCI不相关 (P >0 .0 5 )。结论 :与正常妊娠相比 ,胰岛素抵抗程度较低的GDM ,胰岛素分泌能力未增加 ;胰岛素抵抗程度较高的GDM ,胰岛素分泌增加不能抵偿胰岛素抵抗增加 ;FPG低于 5 .0mmol/L时更能反映机体GDM的病情。

Study of insulin resistance and secretion durin g late pregnancy in gestational diabetes mellitus.

Objective:To investigate the relationship of insulin resistance and insulin secretion and to find out whether there was assocication between various levels of plasma glucose and insulin resistance or insulin secretion during late pregnancy in gestational diabetes mellitus (GDM).Methods:To analyse the relationships of fasting plasma glucose (FPG),insulin resistance and insulin secretion by insulin sensitivity index (ISI) and fasting β cell function index (FBCI).Results: (1)ISI was higher in GDM,but there was no significant difference of FBCI between normal pregnancy (NP) and GDM.(2)ISI was negatively correlated with FBCI in NP,but it did not exist in GDM.(3)FBCI and ISI of GDM were higher than those of NP (P<0.05,P<0.001),when ISI was above the median of ISI in GDM.(4)FPG was positively related with FBCI or ISI in GDM with FPG ≤ 5.0mmol/L(P<0.05),but not with FPG>5.0mmol/L(P>0.05). Conclusions:The capacity of B cell in women of GDM with lower ISI does not enhance although insulin action is more resistant than that of normal pregnancy.The degree of insulin secretion and insulin resistance both increase in women of GDM with higher ISI,but the increased degree of capacity of insulin secretion does not compensate for the impaired insulin action.FPG below 5.0mmol/L is a more excellent index with the degree of GDM.