BMI正常的糖代谢异常孕妇胰岛素抵抗与分泌的研究

目的:探讨BMI正常的糖代谢异常孕妇胰岛素抵抗与分泌的关系。方法:选择2005年1月1日至2007年1月1日在我院进行正规产检、孕前BMI正常孕妇538例。于孕24~28周行50g葡萄糖筛查和75g葡萄糖耐量试验(oral glucose tolerance test,OGTT),根据检查结果将产妇分为:血糖正常孕妇组(NGT)178例、50g葡萄糖筛查(glucose challengetest,GCT)(+)组94例、妊娠期糖耐量减低(gestational impaired glucose tolerance,GIGT)组100例、妊娠期糖尿病(gestational diabetes mellitus,GDM)166例,同期测定空腹血胰岛素及空腹血糖。用稳态模型评估法(HOMA)计算各组胰岛素抵抗指数(HOMA-IR)和胰岛素β细胞功能指数(HBCI),比较各组胰岛素抵抗和胰岛素分泌能力的差别。结果:(1)GDM组与NGT、GCT(+)、GIGT组孕妇相比,空腹血糖、空腹胰岛素、HBCI差异有统计学意义(P<0.01)。HOMA-IR在各组间差异无统计学意义(P>0.05)。(2)NGT、GIGT组孕妇的HOMA-IR与HBCI呈正相关关系(P<0.01)。GCT(+)、GDM组孕妇的HOMA-IR则与HBCI无关(r=0.123,P>0.05)。结论:孕中期BMI正常的GDM妇女胰岛素抵抗与NGT、GCT(+)、GIGT孕妇相比无增高,但胰岛β细胞分泌能力明显降低。

Insulin resistance and insulin secretion in normal body mass index pregnant women with abnormal glucose metabolism

Objective:To study insulin resistance and insulin secretion in normal body mass index pregnant women with abnormal glucose metabolism.Methods:Pregnant women who had antenatal care and delivered in the department of obstetrics and gynecology of first people's hospital of shanghai from Jan.1,2005 to Jan.1,2007 were analysed.Only those pregnant women who had normal body mass index(BMI) were chosen.Glucose challenge test(50g) and oral glucose tolerance test(75g) were performed at 24~28th gestational week.According to the results,538 pregnant women were divided into four groups:normal glucose test(NGT) 178,GCT(+) 94,GIGT 100,GDM 166.Fasting serum glucose and insulin levels were measured in those pregnant women.Insulin resistance index(HOMA-IR) and β-cell function index(HBCI) were calculated by HOMA model.Results:(1)There was significant difference in the mean of fasting serum glucose and insulin level and HBCI in GDM group compared with any other group(P<0.01),but HOMA-IR showed differences in the four groups(P>0.05).(2)There was significant correlation between HOMA-IR and HBCI in NGT and GIGT group(P<0.01),but no significant correlation in GDM and GCT(+) group.Conclusion:At 24~28th gestational week,HOMA-IR has no difference,but β-cell function impairment is evident in GDM group compared with any other group whose BMI is normal.