了解妊娠期糖尿病(GDM)患者产后3～6个月糖代谢异常的转归情况及其相关影响因素，并分析GDM患者产后胰岛素水平、胰岛素抵抗(IR)及胰岛β细胞功能恢复情况。

选择2009年6月至2010年6月在中山大学孙逸仙纪念医院确诊为GDM并分娩的82例患者为研究对象。对其于产后3～6个月时进行75 g葡萄糖耐量试验(OGTT)及相应时段胰岛素释放试验。根据82例患者的产后糖代谢状态分为产后糖代谢异常组(n＝32)及糖代谢恢复正常组(n＝50)。采用多因素logistic回归模型对其进行糖代谢影响因素分析，了解产后糖代谢异常转归、相关影响因素及产后血糖、胰岛β细胞功能恢复情况(本研究遵循的程序符合本院人体试验委员会所制定的伦理学标准，得到该委员会批准，分组征得受试对象本人的知情同意，并与之签署临床研究知情同意书)。

82例GDM患者中，①糖代谢异常检出率为39.02%(32/82)，其中发展为糖尿病患者为4例(4.88%)；葡萄糖耐量受损(IGT)为26例(31.71%)，空腹血糖受损(IFG)为2例(2.44%)。②logistic回归模型分析(经校正年龄后)显示，GDM诊断孕周早、OGTT 2 h血糖值高及胰岛素水平低是GDM患者产后持续糖代谢异常的危险因素(OR＝0.951, 95%CI：0.887～0.998；OR＝1.464, 95%CI：1.008～2.116；OR＝0.981，95%CI：0.965～0.998)。③GDM患者产后空腹血糖及空腹胰岛素水平与孕期比较，差异无统计学意义(P>0.05)；糖负荷后血糖及相应时段胰岛素水平及血糖与胰岛素曲线下面积(AUC_Glu，AUC_INS)、稳态模型的胰岛β细胞功能(HOMA－β)，均较孕期显著下降，差异有统计学意义(P<0.05)；稳态模型胰岛素抵抗指数(HOMA－IR)较孕期略有下降，胰岛素敏感指数(IAI)略有上升，但差异均无统计学意义(P>0.05)。④GDM患者中产后血糖持续异常组与恢复正常组比较，OGTT 1 h，2 h血糖及2 h胰岛素水平显著升高，差异有统计学意义(P<0.05)。

GDM患者：①产后3～6个月存在较高糖代谢异常发生率，以IGT为主；②GDM诊断孕周早及孕早、中期OGTT 2 h血糖水平高及胰岛素水平低，是GDM患者产后糖代谢异常的高危因素；③产后糖代谢恢复正常者AUC_Glu及AUC_INS基本恢复正常；而糖代谢异常者，则仍表现为明显胰岛素峰值后移。

①To investigate the glucose metabolism after 3~6 months of delivery in women with gestational diabetes mellitus (GDM), and to find out factors associated with the prognosis of GDM. ②To investigate the insulin level, insulin resistance(IR) and function of pancreatic β cells in 3~6 months postpartum.

Clinical data of 82 women with GDM who were delivered in SUN Yat-sen Memorial Hospital from June 2009 to June 2010 were collected. All patients underwent 75 g oral glucose tolerance test(OGTT) in 3~6 months after delivery. They were divided into back to normal group (n=32) and continuous abnormal group (n=50)according to the postnatal status of glucose. Multivariate logistic regression model was used to analyze the factors affected glucose, and explore the insulin level, IR and function of pancreatic β cells. The study protocol was approved by the Ethical Review Board of Investigation in Human Being of SUN Yat-sen Memorial Hospital, SUN Yat-sen University. Informed consent was obtained from all participants.

Among 82 women with GDM: ① 32(39.02%) were reported with abnormal glucose metabolism, including 26 (31.71%) with impaired glucose tolerance(IGT), 4(4.88%) with diabetes mellitus and 2(2.44%) with impaired fasting glucose(IFG). ② Logistic regression model showed that early diagnosis (OR=0.951, 95%CI: 0.887-0.998), elevated 2nd hour plasma glucose level (OR=1.464, 95%CI: 1.008-2.116) and lower 2nd hour insulin level(OR=0.981, 95%CI: 0.965-0.998) in OGTT were risk factors for postpartum abnormal glucose metabolism.③There were no statistical differences in fasting glucose and fasting insulin levels after delivery(P>0.05), but the glucose and insulin levels after glucose loaded and AUC_Glu, AUC_INS and (homeostasis model assessment)HOMA-β were lower than those of pregnancy, the differences had statistical significance(P<0.05). Homeostasis model assessment insulin resistance index (HOMA-IR) had slightly lower and insulin sensitivity index (ISI) were slightly elevated, but the differences had no statistical difference (P>0.05). ④Compared the back to normal group with the continuous abnormal group, The first and second hour plasma glucose levels and the 2nd hour insulin levels in OGTT were significantly increased in the back to abnormal group, the differences had statistical significance(P<0.05).

①Women with GDM are more likely to present with abnormal glucose metabolism and mainly manifest in elevated glucose after glucose loaded.② Early diagnosis, elevated 2nd hour plasma glucose level and lower 2nd hour insulin level in OGTT were risk factors for postpartum abnormal glucose metabolism.③The glucose and insulin release curve was back to normal in women with normal glucose metabolism but in women with abnormal glucose metabolism the curve manifest in peak moved backwards.