妊娠期糖尿病孕妇的胰岛素抵抗和胰岛β细胞功能与巨大儿的相关性研究  

Association of insulin resistance and β-cell function with macrosomia among pregnant women with gestational diabetes mellitus

作　　者：赵明[1] 李光辉[2] Zhao Ming;Li Guanghui(Department of Nutrition,Peking University Shougang Hospital,Beijing 100144,China;Department of Endocrinology and Metabolism,Beijing Obstetrics and Gynecology Hospital,Capital Medical University,Beijing 100026,China)

机构地区：[1]北京大学首钢医院营养科,100144 [2]首都医科大学附属北京妇产医院围产内分泌代谢科,100026

出　　处：《中华内分泌代谢杂志》2019年第10期848-852,共5页Chinese Journal of Endocrinology and Metabolism

基　　金：国家自然科学基金(81671477)。

摘　　要：目的探讨妊娠期糖尿病(GDM)孕妇的胰岛素抵抗和胰岛β细胞功能障碍与巨大儿发生风险的关系。方法选择2017年1月至2017年6月在北京妇产医院营养门诊就诊的165例妊娠期糖尿病孕妇为研究对象,随访直至分娩,按照新生儿的出生体重分为巨大儿组(出生体重≥4 000 g)和对照组(出生体重为2 500~3 999 g)。使用稳态模型评估胰岛素抵抗指数(HOMA-IR)和胰岛β细胞功能指数(HOMA-β)。采用多因素logistic回归分析巨大儿发生的危险因素。结果巨大儿组的分娩孕周、孕前体重指数(BMI)、孕期增重、妊娠24~28周和妊娠28~32周的空腹血糖和HOMA-IR都高于对照组(P<0.05)。多因素logistic回归结果显示,巨大儿的发生风险与孕前BMI(OR=1.41,95%CI 1.14~1.75,P<0.01)、孕期增重(OR=1.50,95%CI 1.26~1.79,P<0.01)和妊娠28~32周的空腹血糖(OR=6.56,95%CI 1.15~37.27,P<0.05)显著相关。此外,孕前BMI与新生儿的出生体重(r=0.21,P<0.01)、HOMA-IR(r=0.46,P<0.01)和HOMA-β(r=0.26,P<0.01)皆呈正相关关系。结论妊娠28~32周的空腹血糖独立于孕前BMI和孕期增重与GDM孕妇分娩巨大儿的风险显著相关。Objective To investigate the associations of insulin resistance andβ-cell function with macrosomia among pregnant women with gestational diabetes mellitus(GDM).Methods Totally 165 women with GDM were enrolled from January 2017 to June 2017 in the Nutrition Clinic of Beijing Obstetrics and Gynecology Hospitals of Capital Medical University,and they were followed-up until delivery.These GDM women were divided into macrosomia group(birth weight≥4 000 g)and control group(birth weight 2 500-3 999 g)according to their infants′birth weight.Homeostasis model assessment of insulin resistance(HOMA-IR)andβ-cell function(HOMA-β)were estimated.Multivariable logistic regression was conducted to analyze the risk factors of macrosomia.Results Compared to control group,macrosomia group had higher gestational weeks and body mass index(BMI)before pregnancy,gestational weight gain,fasting plasma glucose levels during both 24-28 and 28-32 weeks of gestation,and HOMA-IR.Multivariable logistic regression showed that the risk of macrosomia was associated with BMI before pregnancy(OR=1.41,95%CI 1.14-1.75,P<0.01),gestational weight gain(OR=1.50,95%CI 1.26-1.79,P<0.01)and fasting blood glucose during the 28-32 week period of gestation(OR=6.56,95%CI 1.15-37.27,P<0.05).In addition,BMI before pregnancy was positively correlated to birth weight(r=0.21,P<0.01),HOMA-IR(r=0.46,P<0.01),and HOMA-β(r=0.26,P<0.01).Conclusion Fasting plasma glucose levels during 28-32 weeks of gestation are associated with the risk of giving birth to macrosomia in pregnant women with GDM independent of maternal BMI before pregnancy as well as gestational weight gain.

关 键 词：妊娠期糖尿病 胰岛素抵抗 胰岛Β细胞功能 巨大儿 

分 类 号：R71[医药卫生—妇产科学]