妊娠糖尿病患者产后血浆RBP4水平和代谢参数变化  

Changes of plasma retinol binding protein-4 and metabolic parameters in women with gestational diabetes mellitus after delivery

作　　者：林丽[1] 谢飞[1] 李海平[1] 李文翠[1] 张吉才[1] 

机构地区：[1]湖北省十堰市太和医院(湖北医药学院附属医院),湖北十堰442000

出　　处：《现代中西医结合杂志》2017年第8期813-815,共3页Modern Journal of Integrated Traditional Chinese and Western Medicine

基　　金：国家高科技研究发展计划"863"计划项目(2014AA022304)

摘　　要：目的探讨产后2个月糖耐量恢复正常的妊娠期糖尿病(GDM)患者产后1年血浆视黄醇结合蛋白4(RBP4)水平以及代谢参数变化。方法选择产后2个月血糖恢复正常GDM妇女120例,进行产后1年OGTT检查,根据结果分为糖代谢正常组和糖代谢异常组,检测2组RBP4水平和糖类、脂类代谢指标水平。结果糖代谢正常组84例;糖代谢异常组36例(30%),其中产后2型糖尿病4例(11%),空腹血糖受损8例(22%),糖耐量减低24例(67%)。2组年龄、BMI、腰围、血压、空腹胰岛素水平比较差异均无统计学意义(P均>0.05),糖代谢异常组血浆RBP4水平、胰岛素抵抗指数、空腹血糖、OGTT餐后2 h血糖、TG水平均明显高于糖代谢正常组(P均<0.05),HDL-C水平明显低于糖代谢正常组(P<0.05),2组TC、LDL-C比较差异均无统计学意义(P均>0.05);糖代谢异常组中代谢综合征发生率(28%)明显高于糖代谢正常组(5%)(P<0.05)。结论即使GDM患者产后2个月糖耐量恢复正常,依然有30%患者在产后1年存在慢性胰岛素抵抗和高RBP4水平,并出现糖代谢紊乱,有更高的风险出现产后2型糖尿病和代谢综合征。不能放松每年对GDM妇女的随访,早期干预则有可能阻止疾病进一步恶化为糖尿病和代谢综合征。Objective It is to investigate the changes of retinol binding protein 4（RBP4） and metabolic parameters in women with gestational diabetes mellitus（GDM） at 1 year after delivery,who exhibited normal glucose tolerance at 2 months after delivery. Methods 120 women with GDM who exhibited normal glucose tolerance at 2 months after delivery,were given OGTT examination at 1 year after delivery. The plasma concentrations of RBP4 and metabolic parameters were determined in two groups of women who exhibited normal glucose metabolism（B group,n = 84）,and abnormal glucose metabolism（A group,n = 36） according to their examination results. Results Among women with GDM could restore normal glucose tolerance at 2 months postpartum,there were 36（30%） subjects with abnormal glucose metabolism at 1 year postpartum,in which4（11%） of type 2 diabetes mellitus,24（67%） of impaired glucose tolerance（IGT）,and 8（22%） of impaired fasting glucose（IFG）. The mean age,BMI,waist circumference and blood pressure were not different between the two groups. In comparison to the B group,women in the A group had higher plasma RBP4 concentration,HOMA-IR,the fasting plasma glucose（FPG） concentration,2 h post-OGTT glucose concentration and triglyceride concentration. And the levels of high-density lipoprotein cholesterol（HDL-C） was lower（P〈 0. 05）. The prevalence of metabolic syndrome（MS） was also higher in the A group. Conclusion Among women with GDM could restore normal glucose tolerance at 2 months after delivery,30% women exhibited abnormal glucose tolerance at 1 year after delivery. They had higher plasma RBP4 concentration and HOMA-IR,and they were at high risk of developing type 2 diabetes mellitus and MS. So follow-up should start at 1 year postpartum.

关 键 词：妊娠期糖尿病 视黄醇结合蛋白4 胰岛素抵抗 产后糖尿病 

分 类 号：R714.256[医药卫生—妇产科学]