妊娠期糖尿病患者产后内脏脂肪面积与胰岛素抵抗的关系  

Relationship between visceral fat area and insulin resistance in postpartum women with gestational diabetes mellitus

作　　者：庞天骄[1] 张萍[1] 蓝海云[1] 梁慧[1] 唐超燕 PANG Tianjiao;ZHANG Ping;LAN Haiyun;LIANG Hui;TANG Chaoyan(Department of Endocrinology,Yulin Municipal First People's Hospital,Guangxi Yulin 5370o0,China)

机构地区：[1]玉林市第一人民医院内分泌科,广西玉林537000

出　　处：《中国妇幼健康研究》2023年第11期54-60,共7页Chinese Journal of Woman and Child Health Research

基　　金：玉林市科学研究与技术开发计划项目(201934047)。

摘　　要：目的分析妊娠期糖尿病(GDM)患者产后1年的内脏脂肪面积(VFA)与胰岛素抵抗(IR)的关系。方法选取2018年1月至2019年12月在玉林市第一人民医院分娩并完成产后1年随访的102例GDM患者为研究对象,记录其产后1年的一般情况、血脂指标、口服葡萄糖耐量-胰岛素释放试验、VFA和皮下脂肪面积(SFA)。根据患者是否存在IR[胰岛素抵抗指数(HOMA-IR)≥2.69)],将其分为IR组(n=39)与非IR组(NIR组,n=63);根据患者的VFA进行三分位数法分组,由低到高将其分为T1组(VFA≤48cm^(2),n=36)、T2组(VFA为>48cm^(2)~≤59cm^(2),n=33)、T3组(VFA>59cm^(2),n=33),分别比较IR组与NIR组,以及T1、T2、T3三组间的临床资料。采用多因素Logistic回归分析影响GDM患者产后1年IR的相关因素。结果产后1年GDM患者的2型糖尿病(T2DM)发病率为2.94%(3/102),糖代谢异常发病率为36.27%(37/102)。IR组的收缩压(SBP)、空腹血糖(FPG)、口服葡萄糖耐量试验2h血糖(OGTT 2hPG)、空腹胰岛素(FINS)、OGTT 2h胰岛素(2hINS)、甘油三酯(TG)、体质量指数(BMI)、腰围(WC)、臀围(HC)、VFA、SFA均高于NIR组,差异均有统计学意义(t值分别为2.950、3.256、2.626、2.051、4.081、3.078、4.584、3.134、4.075、4.525、3.348,P<0.05)。在T1、T2、T3组中,随着VFA的升高,2hINS、BMI、腰臀比(WHR)、SFA、VFA与SFA比率(VSR)、HOMA-IR逐渐升高,而高密度脂蛋白胆固醇(HDL-C)逐渐降低,三组比较差异均有统计学意义(F值分别为3.171、16.274、5.937、19.513、6.111、13.669、5.144,P<0.05);T2组和T3组的SBP均高于T1组,T1组和T3组的总胆固醇(TC)、TG均高于T2组,三组比较差异均有统计学意义(F值分别为3.240、3.801、9.190,P<0.05)。多因素Logistic回归分析显示,VFA是IR的独立影响因素(OR=1.045,95%CI:1.006~1.085,P<0.05)。结论GDM患者产后1年IR组的VFA显著高于NIR组,VFA是影响GDM患者产后1年IR的危险因素。Objective To analyze relationship between visceral fat area(VFA)and insulin resistance(IR)at one year after delivery in postpartum women who once had gestational diabetes mellitus(GDM)during their pregnancy.Methods 102 postpartum women with GDM who once delivered in our hospital and received follow up at one year after delivery from January 2018 to December 2019 were selected as research subjects,and their clinical data such as general information,serum levels of blood lipid indexes,results of oral glucose tolerance-insulin release test,visceral fat area(VFA)and subcutaneous fat area(SFA)were recorded at one year after delivery.The postpartum women with GDM were divided into IR group(n=39)and non-IR group(NIR group,n=63)according to whether they had IR[homeostasis model assessment of insulin resistance(HOMA-IR)≥2.69].Again,in triple quantile grouping method,they were divided into group T1(VFA≤48cm^(2),n=36),group T2(VFA>48cm^(2)≤59cm^(2),n=33)and group T3(VFA>59cm^(2),n=33),and the clinical data of the postpartum women with GDM were compared between the IR group and the NIR group,and among groups T1,T2 and T3.The multiple Logistic regression analysis was used to analyse correlation between IR and related factors that affect IR at one year after delivery of the postpartum women with GDM.Results At one year after delivery,the incidence rate of type 2 DM(T2DM)in the GDM patients was 2.94%(3/102)and the incidence rate of glycometabolism disorder was 36.27%(37/1020).The systolic blood pressure(SBP),fasting plasma glucose(FPG)level,2h plasma glucose in oral glucose tolerance test(OGTT)(2h PG),fasting insulin(FINS),2h insulin in OGTT(2hINS),triglyceride(TG),body mass index (BMI),waist circumference(WC),hip circumference(HC),VFA and SFA of the postpartum women with GDM in the IR group were all higher than those in the NIR group,and the differences were significant(t=2.950,3.256,2.626,2.051,4.081,3.078,4.584,3.134,4.075,4.525 and 3.348 respectively,all P<0.05).In groups T1,T2 and T3,with increase in VFA,2hINS,BMI,wa

关 键 词：妊娠期糖尿病 产后 胰岛素抵抗 内脏脂肪面积 

分 类 号：R173[医药卫生—妇幼卫生保健]