【摘要】 目的　了解体重指数 (BMI)正常、糖耐量异常的晚期妊娠妇女与糖耐量正常的晚期妊娠妇女胰岛素分泌与胰岛素抵抗是否存在差异 ,同时探讨妊娠期糖尿病与胰岛素抵抗综合征的关系。方法　选择我院孕 2 4～ 2 8周常规 5 0g葡萄糖筛查血糖≥ 7 2mmol/L ,且妊娠前BMI正常无合并症的妊娠妇女 10 3例 ,行 75g葡萄糖耐量试验 (OGTT)的同时 ,测定其各时点胰岛素水平及反映脂代谢的相关指标。根据OGTT结果分为 3组 :妊娠期糖尿病 (GDM)组 (32例 ) ,妊娠期糖耐量低减 (GIGT)组(2 1例 )及妊娠期糖耐量正常 (NGT)组 (5 0例 )。分别计算 3组妊娠妇女血糖曲线下面积 (GAUC)、胰岛素曲线下面积 (IAUC)、IAUC/GAUC比值及胰岛素敏感指数 (ISI)等指标。结果　GDM组妊娠妇女GAUC、IAUC、ISI及甘油三酯 (TG)均值分别为 2 6 3mmol/L·h-1、2 76 5mU/L·h-1、4 2及 3 2mmol/L ,明显高于NGT组妊娠妇女 (P <0 0 5 )。而IAUC/GAUC比值由GDM组、GIGT组到NGT组呈上升趋势 (分别为 10 5、11 4、及 11 7)。除TG外 ,GIGT组与NGT组妊娠妇女比较以上指标 ,差异均无显著性 (P>0 0 5 ) ;ISI与GAUC、IAUC、TG呈正相关关系 (P <0 0 1)。结论　GDM妇女存在胰岛素分泌相对不足、胰岛素抵抗增强及脂代谢紊乱等 ;GDM是胰岛素抵抗综合征的早期?更多还原

【Abstract】 Objective To investigate whether insulin secretion and resistance are different in glucose tolerant and intolerant women with normal pre-pregnant body mass index (BMI) during late pregnancy and to find out if there is association between gestational diabetes and insulin resistance syndrome. Methods On the basis of a 4-hour oral glucose tolerance test (OGTT), 32 gestational diabetes mellitus (GDM) patients, 21 gestational impaired glucose tolerant (GIGT) patients, and 50 normal glucose tolerant (NGT) cases were selected from uncomplicated pregnant women. Those had normal pre-pregnant BMI who had a 1-hour 50-g glucose-screening test (≥7 2 mmol/L), performed between 24～28 weeks of gestation. During the OGTT, several indexes of insulin resistance, insulin secretion, lipid metabolism were measured in addition to the standard glucose measurements. Results Glucose area under curve (GAUC), insulin area under curve (IAUC), insulin sensitivity index (ISI) transformed to natural logarithm and triglycerides (TG) are all significantly higher ( P <0 05) in GDM women. The means of these indexes in GDM group are 26 3 mmol/L·h -1 , 276 5 mU/L·h -1 , 4 2 and 3 2 mmol/L, respeetively. On the other hand, however, the differences of these indexes (except TG) between GIGT and NGT women are not statistically significant. The ratio of IAUC/GAUC has an increasing trend from GDM group, GIGT group to NGT group (10 5, 11 4 and 11 7, respectively), but the difference is not statistically significant. Multiple correlation coefficient study demonstrated that ISI is significantly positively correlated with GAUC, IAUC and TG ( P <0 01). Conclusions Compared with NGT women, GDM women has impaired insulin secretion, abnormally increased insulin resistance, and relatively dyslipidemia. GDM seems to be a component of the syndrome of insulin resistance that provides an excellent model for study and prevention in a relatively young aged group.更多还原