妊娠期糖尿病孕妇胰岛素分泌特点及母婴结局
|
摘要
目的:分析妊娠期糖尿病(GDM)孕妇胰岛素分泌特点及母婴结局。方法:回顾性选择本院住院分娩孕妇,根据OGTT及服糖后胰岛素水平分组,分析各组间胰岛素分泌特点、胰岛素抵抗及胰岛■细胞功能指标,比较不同胰岛素分泌特点及母婴结局。结果:GDM各组在不同时点G0、G60及G120血糖值均高于血糖正常组,且GDM1、GDM2、GDM3组间水平呈递增趋势(P<0.05);GDM各组I120胰岛素水平高于血糖正常组,且GDM1、GDM2、GDM3组间水平呈递增趋势(P<0.05);GDM各组I0、I180胰岛素水平高于血糖正常组,其中GDM3组最高(P<0.05);与血糖正常组比较,GDM各组HOMA-IR升高,ISIcomp、MBCI及ΔI30/ΔG30降低(P<0.05),在GDM1、GDM2、GDM3组HOMA-IR呈递增趋势,ISIcomp、MBCI及ΔI30/ΔG30呈递减趋势(P<0.05);服糖后120min达峰值组巨大儿发生率最高(P<0.05),羊水过多、胎膜早破、早产及新生儿低血糖的发生率在不同峰值组无差异(P>0.05)。结论:GDM孕妇胰岛素水平升高且峰值延迟至糖负荷后120min,且峰值胰岛素水平与胰岛素抵抗及胰岛■细胞下降趋势一致,均与病情程度有关,胰岛素峰值延迟可能增加巨大儿的发生风险。
Objective: To analyze the characteristics of insulin secretion in pregnant women with gestational diabetes mellitus(GDM), and to analyze the influence on the maternal and infant outcomes. Methods: The data of pregnant women were retrospective analyzed. According to OGTT results and insulin levels, the included women were divided into different groups. The characteristics of insulin secretion, insulin resistance, and islet beta cell function indexes of all women were analyzed, and the characteristics of insulin secretion, and maternal and infant outcomes were compared among the groups. Results: The blood glucose value and insulin levels, and HOMA-IR of women with GDM at G0, G60 and G120 time were significant higher than those of women with normal blood glucose(P<0.05), but the ISIcomp, MBCI and ΔI30/ΔG30 were significant lower(P<0.05). The incidence of macrosomia of women with their blood glucose level increased to peak at 120 min after OGTT was highest(P<0.05). There were no statistically significant differences in the incidence of hyperhydramnios, premature rupture of membranes, preterm delivery, and neonatal hypoglycemia among the three groups(P>0.05). Conclusion: The pregnant women with GDM whose insulin level increase to the peak and delay until 120 min after glucose load, and the peak of insulin level is consistent with the trend of insulin resistance and decline of islet beta cells, which are all related to the degree of GDM. The delayed peak of insulin level may also increase the risk of macrosomia.
Objective: To analyze the characteristics of insulin secretion in pregnant women with gestational diabetes mellitus(GDM), and to analyze the influence on the maternal and infant outcomes. Methods: The data of pregnant women were retrospective analyzed. According to OGTT results and insulin levels, the included women were divided into different groups. The characteristics of insulin secretion, insulin resistance, and islet beta cell function indexes of all women were analyzed, and the characteristics of insulin secretion, and maternal and infant outcomes were compared among the groups. Results: The blood glucose value and insulin levels, and HOMA-IR of women with GDM at G0, G60 and G120 time were significant higher than those of women with normal blood glucose(P<0.05), but the ISIcomp, MBCI and ΔI30/ΔG30 were significant lower(P<0.05). The incidence of macrosomia of women with their blood glucose level increased to peak at 120 min after OGTT was highest(P<0.05). There were no statistically significant differences in the incidence of hyperhydramnios, premature rupture of membranes, preterm delivery, and neonatal hypoglycemia among the three groups(P>0.05). Conclusion: The pregnant women with GDM whose insulin level increase to the peak and delay until 120 min after glucose load, and the peak of insulin level is consistent with the trend of insulin resistance and decline of islet beta cells, which are all related to the degree of GDM. The delayed peak of insulin level may also increase the risk of macrosomia.
引文
[1] 符琳鑫,陈秀芹.孕妇糖耐量状态与胰岛素抵抗、胰岛细胞功能情况及妊娠结局分析[J].中国计划生育学杂志,2017,25(8):533-535.
[2] Powe CE,Allard C,Battista MC,et al.Heterogeneous Contribution of Insulin Sensitivity and Secretion Defects to Gestational Diabetes Mellitus[J].Diabetes Care,2016,39(6):1052-1055.
[3] 中华医学会妇产科学分会产科学组.中华医学会围产分会妊娠合并糖尿病协作组:妊娠合并糖尿病诊治指南(2014)[J],中华围产医学杂志,2014,17(8) :537-545.
[4] 张旋.妊娠期糖尿病患者与血糖正常孕妇胰岛B细胞分泌功能及胰岛素抵抗的对比研究[J].齐齐哈尔医学院学报,2017(9):9-10.
[5] 王凤环,李华萍.妊娠期糖尿病患者胰岛素抵抗及胰岛素分泌功能的评估[J].上海交通大学学报(医学版),2015,35(3):364-368.
[6] 陈晓燕,周俐琼.妊娠晚期糖尿病患者胰岛素抵抗与胰岛素分泌的临床研究[J].医学综述,2014,20(18):3429-3430.
[7] 张宁娟,李华萍,赵芳.妊娠期糖尿病胰岛素分泌模式与胰岛功能评估的探讨[J].中国实用妇科与产科杂志,2018,34(11):1261-1266.
[8] 李梅菊.妊娠期糖尿病孕妇胰岛素测定的临床意义[J].宁夏医科大学学报,2016,38(1):108-110.
[9] 贺彤.妊娠期糖尿病患者胰岛素抵抗与胰岛素分泌功能的变化及其对妊娠结局的影响[J].医学临床研究,2013,30(9):1765-1767.
[10] 陆蓓亦,朱自强,虞斌.妊娠期糖尿病妊娠中晚期胰岛素抵抗及胰岛B细胞功能的研究[J].中国妇幼保健,2015,30(36):6455-6458.
[11] 朱小玉,栾金倩,方勤,陈丹青.妊娠期糖尿病孕妇OGTT时胰岛素值测定及意义[J].中国妇幼保健,2011,26(21):3223-3225.
[12] 沈小雅.孕期糖耐量不同变化与妊娠结局及胰岛素分泌水平的相关性研究[D].广州:南方医科大学,2017.
[2] Powe CE,Allard C,Battista MC,et al.Heterogeneous Contribution of Insulin Sensitivity and Secretion Defects to Gestational Diabetes Mellitus[J].Diabetes Care,2016,39(6):1052-1055.
[3] 中华医学会妇产科学分会产科学组.中华医学会围产分会妊娠合并糖尿病协作组:妊娠合并糖尿病诊治指南(2014)[J],中华围产医学杂志,2014,17(8) :537-545.
[4] 张旋.妊娠期糖尿病患者与血糖正常孕妇胰岛B细胞分泌功能及胰岛素抵抗的对比研究[J].齐齐哈尔医学院学报,2017(9):9-10.
[5] 王凤环,李华萍.妊娠期糖尿病患者胰岛素抵抗及胰岛素分泌功能的评估[J].上海交通大学学报(医学版),2015,35(3):364-368.
[6] 陈晓燕,周俐琼.妊娠晚期糖尿病患者胰岛素抵抗与胰岛素分泌的临床研究[J].医学综述,2014,20(18):3429-3430.
[7] 张宁娟,李华萍,赵芳.妊娠期糖尿病胰岛素分泌模式与胰岛功能评估的探讨[J].中国实用妇科与产科杂志,2018,34(11):1261-1266.
[8] 李梅菊.妊娠期糖尿病孕妇胰岛素测定的临床意义[J].宁夏医科大学学报,2016,38(1):108-110.
[9] 贺彤.妊娠期糖尿病患者胰岛素抵抗与胰岛素分泌功能的变化及其对妊娠结局的影响[J].医学临床研究,2013,30(9):1765-1767.
[10] 陆蓓亦,朱自强,虞斌.妊娠期糖尿病妊娠中晚期胰岛素抵抗及胰岛B细胞功能的研究[J].中国妇幼保健,2015,30(36):6455-6458.
[11] 朱小玉,栾金倩,方勤,陈丹青.妊娠期糖尿病孕妇OGTT时胰岛素值测定及意义[J].中国妇幼保健,2011,26(21):3223-3225.
[12] 沈小雅.孕期糖耐量不同变化与妊娠结局及胰岛素分泌水平的相关性研究[D].广州:南方医科大学,2017.