妊娠合并糖尿病对子代婴幼儿期胰岛素敏感性的影响  

Effects of pregnancy complicated with diabetes on insulin sensitivity of offspring during their early childhood

作　　者：刘慧[1] 王新利[1] 关育红[1] 张淑丽[1] 齐婧[1] 童笑梅[1] 王雪梅[1] 

机构地区：[1]北京大学第三医院新生儿科,100191

出　　处：《中华围产医学杂志》2011年第4期215-220,共6页Chinese Journal of Perinatal Medicine

摘　　要：目的探讨妊娠合并糖尿病对子代婴幼儿期胰岛素敏感性的影响。方法本研究为前瞻性队列研究，在2、4、6、8、10、12、18和24月龄测量糖尿病母亲的子代和非糖尿病母亲的子代的体重、身长，计算体重指数。在6、12和24月龄随访当日测定空腹血浆血糖和空腹血清胰岛素（fasting serum insulin，FINS），计算胰岛素敏感指数（insulin sensitivity index，ISI），采用胰岛素稳态模型（homeostasis model assessment，HOMA）计算胰岛素抵抗（insulin resistence，IR）指数，即HOMAIR，将FINS、ISI和HOMAIR作为胰岛素敏感性评价指标。采用协方差分析比较2组间胰岛素敏感性的差异。结果最初纳入研究的婴幼儿共605例，其中糖尿病母亲的子代94例，非糖尿病母亲的子代511例。糖尿病母亲的子代在2、4和6月龄时体重、身长均大于非糖尿病母亲的子代，2和4月龄时体重指数也大于非糖尿病母亲的子代，差异均有统计学意义（P〈0．05）。在6、12和24月龄测定空腹血浆血糖和FINS的婴幼儿分别有276例、273例和56例。糖尿病母亲的子代在6、12和24月龄时的FINS[经对数（Lg）转换]分别为0．954±0．30、0．894±0．34和0．90±0．27，HOMAIR值[经对数（Lg）转换]分别为0．34±0．33、0．274±0．36和0．27±0．31，ISI[经对数（Ln）转换]分别为-3．874±0．75、-3．734±0．81和一3．734±0．71；FINS和HOMA—IR值高于非糖尿病母亲的子代（FINS分别为0．70±0．45、0．73±0．35和0．67±0．30，HOMAIR分别为0．08±0．46、0．10±0．36和0．03±0．33），差异有统计学意义（T=9．58、5．01、6．11、9．55、4．79和5．06，P均〈0．05）；ISI低于非糖尿病母亲的子代（分别为-3．29±1．05、-3．35±0．84和-3．18±0．77），差异有统计学意义（T=9．20、4．90和5．06，P均〈0．05）。糖尿病母亲的子代胰岛素敏感者22例，其中母乳喂养9例（40．91％），混合�Objective To investigate the effects of pregnancy complicated with diabetes on the insulin sensitivity of offspring during their early childhood. Methods Offspring of diabetic mothers （ODM） and of non-diabetic mothers（ONDM） aged 1 month to 24 months were recruited into this prospective cohort study and followed up for two years. Body weight and body length were measured at 2, 4, 6, 8, 10, 12, 18 and 24 months of age respectively, and body mass index （BMI） were calculated. Fasting plasma glucose and fasting serum insulin levels were measured on the following up day at 6, 12 and 24 months of age and insulin sensitivity index （ISI） was calculated. Homeostasis model assessment was used to calculate the insulin resistance （HOMA-IR）. Insulin sensitivity was evaluated by fasting serum insulin, ISI and HOMA-IR. The difference of insulin sensitivity between ODM and ONDM group were examined by analysis of covariance adjusted by gender, gestational age, birth weight and BMI. Results Six hundred and five babies including ninety ODM and five hundred and eleven ONDM met the inclusion criteria. There were no differences in gender, gestational age, birth-weight/height between the two groups（P〉0.05）. ODM were heavier and higher than ONDM at each measure point during early childhood, but there were statistical differences at the age of 2, 4 and 6 months only （P〈0. 05）. And the BMI at age of 2 and 4 months of ODM were higher than those of ONDM（P〈0.05）. The number of baby who accepted the measurement of fasting plasma glucose and fasting serum insulin levels at 6, 12 and 24 months of age was 276 cases, 273 cases and 56 cases respectively. The fasting serum insulin of ODM （logarithmically transformed） were 0.95 -＋- 0.30, 0. 89±0. 34 and 0. 90±0. 27, which were higher than those of ONDM （0.70±0.45, 0.73±0.35 and 0.67±0.30） （t= 9.58, 5.01 and 6.11, P〈0.05） ; HOMA-IR （logarithmically transformed） were o. 34±0.33, 0. 27±0.36 and 0. 27±0.31, which were higher than those of

关 键 词：糖尿病 妊娠 婴儿 胰岛素抗药性 母乳喂养 

分 类 号：R714[医药卫生—妇产科学]