妊娠期糖尿病胰岛素分泌模式与胰岛功能评估的探讨  

Research on patterns of insulin secretion and evaluation of islet function in gestational diabetes mellitus

作　　者：张宁娟 李华萍 赵芳[2] ZHANGNing-juan;LI Hua-ping;ZHAO Fang(Department of Obstetrics and Gynecology,Shanghai Jiao Tong University Affiliated Sixth People＇s Hospital,Shanghai 200233,China)

机构地区：[1]上海交通大学附属上海市第六人民医院妇产科,上海200233 [2]上海健康医学院,上海200051

出　　处：《中国实用妇科与产科杂志》2018年第11期1261-1266,共6页Chinese Journal of Practical Gynecology and Obstetrics

摘　　要：目的建立妊娠期胰岛素分泌模式,探讨不同胰岛素分泌模式与胰岛功能的关系。方法回顾性分析从2010年12月至2017年1月在上海交通大学附属上海市第六人民医院正规产检并住院分娩的2432例孕妇资料,按75g葡萄糖耐量试验(OGTT)及胰岛素分泌试验结果分为两组:妊娠期糖尿病(GDM)组及糖耐量正常(NGT)组;据胰岛素分泌试验结果建立胰岛素分泌模式曲线。利用稳态模型计算胰岛素抵抗指标:胰岛素抵抗指数(HOMA-IR)、混合胰岛素敏感度(ISIcomp)及胰岛素分泌指标:即刻胰岛B细胞功能(HOMA-β)、修正的胰岛B细胞功能指数(MBCI)、第一时相胰岛素分泌指数(Stumvoll1)、第二时相胰岛素分泌指数(Stumvoll2)、即刻胰岛素分泌指数(ΔI30/ΔG30)进行统计学分析。结果 (1)建立了P1～P6 6种胰岛素分泌模式曲线。(2)NGT组胰岛素分泌模式主要表现为P3(51.45%),而GDM组为P4(51.83%)。GDM为P4、P5模式时,主要表现为服糖后1h及2h血糖均异常。(3)NGT中,P3、P4、P5的ISIcomp、MBCI均较P1降低(P<0.05),不同胰岛素分泌模式下HOMA-β差异无统计学意义。GDM中,P3、P4和P5的MBCI、Stumvoll1、Stumvoll2均小于P1和P2模式(P<0.05),各分泌模式的ISIcomp差异无统计学意义。结论 GDM患者的胰岛素分泌模式主要表现为峰值延迟至服糖后2h。随着胰岛素分泌延迟,胰岛素分泌功能降低,餐后血糖异常增加。Objective To establish patterns of insulin secretion during pregnancy and to study the relationship between different patterns of insulin secretion and the assessment of islet function.Methods Retrospectively analyze the general information of 2432 cases of pregnant women in Shanghai Jiao Tong University Affiliated Sixth People＇s Hospital from December 2010 to January 2017.According to the results of 75 g oral glucose tolerance tes（tOGTT）and insulin secretion test,divide pregnant women into two groups：normal glucose tolerance group（NGT）and gestational diabetes mellitus group（GDM）.Establish patterns of insulin secretion based on the results of insulin secretion test.Insulin sensitivity was estimated by homeostasis model assessment of insulin resistance（HOMA-IR）and ISIcomp.Insulin secretion was estimated by the HOMA-β,MBCI,Stumvoll1,Stumvoll2 and ΔI30/ΔG30,and make statistical analysis.Results（1）Six patterns of insulin secretion（P1-P6）was established（.2）The pattern was mainly P3（51.45%）and P4（51.83%）in NGT and GDM,respectively.When insulin secretion pattern in GDM group was P4 or P5,the blood glucose in 1 h or 2 h was abnormal（.3）In NGT,the ISIcomp and MBCI were lower in P3,P4 and P5 than in P1（P〈0.05）,and there was no statistical significance in HOMA-β in different patterns.In GDM,MBCI,Stumvoll1,Stumvoll2 and ΔI30/ΔG30 in P1 and P2 were greater than in P3,P4 and P5（P〈0.05）,and there was no statistical significance in ISIcomp in different patterns.Conclusion In GDM patients,the peak of insulin secretion in GDM is mainly delayed to 2 h after glucose loaded.With the delay of the peak of insulin secretion,the insulin secretion is reduced and the number of abnormal postprandial blood glucose is increased.

关 键 词：妊娠期糖尿病 口服葡萄糖耐量试验 胰岛素抵抗 胰岛素分泌 

分 类 号：R714.256[医药卫生—妇产科学]