影响妊娠期糖尿病产后血糖转归的相关因素  

Related factors of postpartum glucose metabolism in gestational diabetes

作　　者：卫梦南[1] 刘建[1] 吴彦丽[1] 饶明礼[1] 王一清[1] 

机构地区：[1]重庆医科大学附属第二医院产科,重庆400010

出　　处：《重庆医科大学学报》2013年第2期182-185,共4页Journal of Chongqing Medical University

摘　　要：目的:分析妊娠期糖尿病(gestational diabetes mellitus,GDM)孕妇产后42 d 75 g葡萄糖耐量实验(oral glucose tolerancetest,OGTT)结果,探讨其与脂肪因子间关系,同时分析GDM患者孕期相关资料与产后6周的OGTT结果的相关性。方法:收集2011年4-11月我院产科36例GDM孕妇的临床资料,根据产后42 d 75 g OGTT结果分2组[血糖浓度正常组(Ⅰ组)和不正常组(Ⅱ组)]。分析孕期相关资料,检测空腹胰岛素、脂联素(adiponectin,ADP)、瘦素(leptin,LEP),进行统计分析。结果:孕期相关指标比较发现,Ⅰ组,糖尿病(diabetes mellitus,DM)家族史明显低于Ⅱ组,确诊GDM孕周明显晚于Ⅱ组(P<0.05),怀孕年龄、孕期体质量、确诊时空腹血糖水平无明显差异(P>0.05);临床检测指标比较发现,Ⅰ组产后空腹血糖明显低于Ⅱ组(P<0.05),LEP水平明显高于Ⅱ组(P<0.05);2组间年龄、体质指数(body mass index,BMI)、空腹胰岛素、ADP、胰岛素抵抗指数稳态模型评估法(homeostasis model assessment-insulin resistance,HOMA-IR)无明显差异(P>0.05)。相关性分析结果表明:LEP与空腹血糖存在明显负相关性(R=-0.51,P=0.02),与HOMA-IR存在明显正相关性(R=0.7,P=0.003)。BMI、年龄、ADP等与空腹血糖、HOMA-IR均没有显著相关性。结论:(1)产后血糖恢复正常组的空腹血糖明显低于血糖未恢复组,而LEP水平明显高于血糖未恢复组。(2)LEP水平与空腹血糖水平明显负相关,与HOMA-IR存在明显正相关,LEP在GDM产后空腹血糖恢复中发挥的作用可能通过对HOMA-IR的影响来实现,提高GDM患者产后血清中LEP水平,将来可能可以作为GDM产后干预血糖恢复的切入点。(3)组间OGTT结果:1、2、3 h血糖值无明显差异,ADP与空腹血糖、HOMA-IR无显著相关性。(4)有DM家族史,孕期确诊时间早均是GDM产后发生糖代谢紊乱的危险因素。Objective ：To analyze the results of the 75 g oral glucose tolerance test（OGTT） in gestational diabetes mellitus （GDM） at 6 weeks after delivering and to investigate the relationships between the results of 0GTT and adiponectin,pregnancy related index. Methods：Clinical data of 36 women with GDM in our hospital from 2011 April to 2011 November were collected and retrospectively analyzed. According to the results of 75 g OGTT at 6 weeks after delivering, the patients were reclassified into two groups：normal group （ I group） and abnormal group（ II group）. Levels of leptin, adiponectin and fasting insulin were detected and pregnancy related index and 6 weeks postpartum glucose metabolism were analyzed. Results：According to the results of pregnancy related index,incidence of family diabetes history was lower in I group than in II group（P〈0.05） and the mean GDM diagnosing time was significantly later in I group than in II group（P〈0.05）. There was no significant difference in pregnant age,pregnant BMI,fasting blood glucose level when making definite diagnosis between two groups（P〉0.05）. Based on the clinical indicators,level of postpartum fasting blood glucose was much lower in I group than in II group（P〈0.05） and the mean leptin concentration was significantly higher in I group than in II gTOup（P〈0.05）. There was no significant difference in age, BMI, fasting insulin level, adiponectin and homeostasis model assessmentinsulin resistance（HOMA-IR） between two groups （P〉0.05）. Multiple Logistic regression model showed that the leptin concentration was negatively correlated with fasting blood glucose（R=-0.51 ,P=0.02） and was positively correlated with HOMA-IR（R=0.7,P=0.003）. There was no significant correlation between BMI, age, adiponectin and fasting blood glucose, HOMA- IR. Conclusions ： （ 1 ）Fasting blood glucose is much lower in I group than in 1] group while leptin concentration is significantly higher in ｜ group than in 11 group. （2

关 键 词：妊娠期糖尿病 产后 糖代谢 瘦素 脂联素 

分 类 号：R714.256[医药卫生—妇产科学]