GDM孕中、晚期及子代胰岛素抵抗与正常妊娠的对照研究  

Control study of insulin resistance between GDM and normal pregnancy in the mid and late pregnancy and offspring

作　　者：林穗青[1] 张丹[2] 彭咏梅[2] 程蔚蔚[1] 

机构地区：[1]上海交通大学医学院附属国际和平妇幼保健院产科,200030 [2]复旦大学附属儿科医院儿童保健科

出　　处：《中国妇产科临床杂志》2013年第5期417-420,共4页Chinese Journal of Clinical Obstetrics and Gynecology

基　　金：国家科技部十一五支撑计划项目(2009BAI80B03)

摘　　要：目的探讨妊娠期糖尿病（GMD）与正常妊娠孕中、晚期及子代胰岛素抵抗、胰岛β细胞功能及胎儿脐血流的差异。方法选择上海交通大学医学院附属国际和平妇幼保健院产检、分娩的70例GDM产妇及其子代为GDM组,同期产检、分娩的70例健康母子配对样本为对照组。两组孕妇孕24-28周OGTT筛查时行胰岛素释放试验、孕33-34周、孕37-38周检测空腹血糖、胰岛素及C肽;比较两组稳态模型评估的胰岛素抵抗指数（HOMA-IR）;B超测定孕晚期胎儿脐血流;分娩时检测脐血血糖、胰岛素及C肽值并获取胎儿出生体重、胎龄等资料;比较两组母子配对样本间各项指标的差异。结果 GDM组OGTT时胰岛素峰值较对照组延迟1h;GDM组孕33-34周母血空腹胰岛素、C肽高于对照组,差异有统计学意义（P〈0.05）;孕37-38周母血空腹胰岛素、C肽虽仍高于对照组,但差异无统计学意义（P〉0.05）;GDM组孕中、晚期HOMA-IR高于对照组,差异有统计学意义（P〈0.05）;GDM组新生儿脐血胰岛素、C肽高于对照组,差异有统计学意义（P〈0.05）;两组间孕晚期胎儿脐动脉S/D值、搏动指数（PI）、阻力指数（RI）比较差异无统计学意义（P〉0.05）。结论 GDM患者孕中、晚期胰岛素抵抗较正常孕妇增加,并出现胰岛β细胞功能下降,其胎儿在宫内已发生糖代谢异常,但脐血流未受到显著影响。Objective To investigate the differences of insulin resistance andβ-cell function and fetal umbilical blood flow in the mid and late pregnancy and offspring between GDM and normal pregnancy.Methods 70mothers diagnosed as gestational diabetes mellitus and their offspring were selected as group GDM,and 70normal mothers and their offspring were selected as normal group.All cases hospitalized in the department of Obstetrics,International Peace Maternity Child Health Hospital,Shanghai Jiao Tong University School of Medicine.All pregnant women in the two groups underwent OGTT screening and insulin release test at 24to 28pregnant weeks.Maternal baseline data was obtained;maternal fasting blood glucose,insulin and C-peptide levels ofpregnancy from 33to 34 weeks and 37-38weeks were detected;Homeostasis model assessment insulin resistance index（HOMA-IR）,fetal intrauterine umbilical blood flow,neonatal birth weight,gestational age,glucose,insulin and C-peptide levels of umbilical cord blood were compared in the two groups.Results OGTT insulin peak of GDM group delayed 1hcompared to control group.In the GDM group,levels of fasting insulin and C-peptide of maternal serum in 33-34pregnant weeks were significantly higher than the control group（P0.05）;similar result were observed in 37-38 pregnant weeks maternal,but the difference had no statistically significant（P0.05）.HOMA-IR of GDM group was significantly higher than that of control group（P0.05）.Umbilical cord blood insulin,C-peptide of GDM group were significantly higher than that of normal control group（P0.05）.No significant difference in the fetal umbilical artery S/D ratio,PI and RI was found between the two groups（P0.05）.Conclusions In the mid and late pregnancy,the insulin resistance of GDM is more than normal pregnant women,and the islet beta cell function has been declined.The fetus in GDM group would have abnormal glucose metabolism in uterus,but no significant abnormal in umbilical blood was found.

关 键 词：妊娠期糖尿病 脐动脉S D 糖代谢 母子配对研究 

分 类 号：R714.2[医药卫生—妇产科学]