糖尿病与妊娠

　　[摘要] 目的 研究不同糖耐量状态孕妇胰岛素敏感性(IS)、胰岛β细胞分泌能力及产后转归情况。方法 50 g葡萄糖负荷试验(GCT)阳性者376例，再行75 g OGTT。采用胰岛素敏感指数(ISI-Matsuda)、胰岛β细胞代偿胰岛素抵抗的分泌能力(ISSI)对糖耐量正常组(NGT，298名)、IGT组(47例)及妊娠糖尿病 (GDM，31例) 组进行评价，分析影响因素，追踪产后转归情况。结果 ISI-Matsuda在NGT组、GDM组及妊娠期糖耐量减低(GIGT)组依次递减[(93.98±24.66)vs(71.41±33.75)vs(57.36±23.26)，P均<0.01];ISSI在NGT组、GIGT组及GDM组依次降低[(132233.10±26049.05)vs(74736.81±11163.93)vs(53099.99±20380.48),P均<0.01]。Pearson相关分析显示，LDL-C、TG、hsC-RP与ISI-Matsuda及ISSI呈负相关(P<0.01)。糖耐量异常孕妇产后34.3%仍存在糖代谢异常，转为T2DM者ISSI下降最明显。结论 GIGT以IR为主，GDM以胰岛素分泌缺陷为主。胰岛素分泌功能差的孕妇产后易发生T2DM。

　　[关键词] 妊娠期糖尿病;胰岛β细胞功能;产后转归

　　[Abstract] Objective To study the correlation of insulin sensitivity and islet β-cell function with postpartum outcomes in pregnant women with different glucose tolerance status. Methods After 75 g-OGTT, 376 cases of pregnant women were divided into gestational diabetes mellitus (GDM, n=31) group, gestational impaired glucose test (IGT, n=47) group and normal glucose tolerance (NGT, n=298) group. Insulin sensitivity index(ISI-Matsuda), islet β-cell insulin secretion compensation ability (ISSI) and influence factors were analyzed, meanwhile, postpartum outcomes were recorded.Results From NGT group to GDM group to GIGT group, ISI-Matsuda were decreased successively(P<0.01). From NGT group to IGT group to GDM group, ISSI were decreased successively too(P< 0.01). Pearson correlation analysis showed that TG、LDL-C and hs-CRP were significantly negatively related to ISI-Matsuda and ISSI. 34% postpartum women with impaired glucose regulation presented with abnormal glycometabolism, ISSI were significantly lower in postpartum women who turned to type 2 diabetic mellitus. Conclusion IGT gives priority to insulin resistance , and GDM gave priority to insulin secretion defects. Postpartum women with worse insulin secretion function would be more likely to turn to 2 type diabetic mellitus.

　　【Key words】 Gestational diabetic mellitus;Islet β-cell function;Postpartum outcomes