不同糖调节状态孕妇产后1年胰岛素分泌和胰岛素抵抗的随访

doi:10.3877/cma.j.issn.1673-5250.2014.03.017

目的

比较不同糖调节状态孕妇产后1年胰岛素分泌和胰岛素抵抗的差异以及血脂、血压情况。

方法

选择2009年11月至2012年8月在江苏省常州市第二人民医院分别被诊断为妊娠期糖尿病(GDM)、妊娠期糖耐量异常(GIGT)及糖耐量正常(NGT)共计336例孕妇为随访对象，在其分娩1年后进行随访，排除了GDM诊断时由于血糖水平较高而接受药物治疗的患者，最后共纳入95例为研究对象。按照妊娠时糖耐量状态将其分为GDM组(n＝22)、GIGT组(n＝41)及NGT组(n＝32)，并按照妊娠时75 g口服葡萄糖耐量试验(OGTT)的结果将GIGT组分为3个亚组：1 h血糖异常亚组(GIGT1, n＝11)、2 h血糖异常亚组(GIGT2, n＝18)及3 h血糖异常亚组(GIGT3，n＝12)。对各组75 g OGTT、空腹血胰岛素(FINS)、空腹血糖(FPG)、总胆固醇(TCH)、三酰甘油(TG)、低密度脂蛋白-胆固醇(LDL-C)、高密度脂蛋白-胆固醇(HDL-C)、收缩压(SBP)、舒张压(DBP)、体质量指数(BMI)、胰岛素分泌指数(IFI)及胰岛素抵抗指数(HOMA-IR)进行统计学分析(本研究遵循的程序符合常州市第二人民医院人体试验委员会制定的伦理学标准，得到该委员会批准，分组征得受试对象知情同意，并与之签署临床研究知情同意书)。

结果

研究结果为：①GDM组FPG、75 g OGTT 2 h血糖、HOMA-IR、BMI、TCH、TG及LDL-C水平较GIGT组或NGT组均升高，且差异有统计学意义(P<0.05)；而IFI水平较GIGT组或NGT组均降低，且差异有统计学意义(P<0.05)；GIGT组75 g OGTT 2 h血糖及BMI水平较NGT组均升高，且差异有统计学意义(P<0.05)。②3组间SBP、DBP、HDL-C水平比较，差异均无统计学意义(P>0.05)；GIGT组及NGT组之间FPG、IFI、HOMA-IR、TCH、TG、LDL-C水平比较，差异均无统计学意义(P>0.05)。③3个亚组GIGT1组、GIGT2组、GIGT3组比较可见：GIGT1组IFI水平较GIGT2组或GIGT3组均降低，且差异有统计学意义(P<0.05)；而HOMA-IR水平均升高，且差异有统计学意义(P<0.05)。④3个亚组BMI、SBP、DBP、TG、TCH、LDL-C、HDL-C水平比较，差异均无统计学意义(P>0.05)；GIGT2组、GIGT3组的IFI及HOMA-IR水平比较，差异均无统计学意义(P>0.05)。

结论

GDM孕妇相比于GIGT或NGT孕妇，产后更易出现胰岛素分泌受损和胰岛素抵抗以及脂代谢紊乱。GIGT孕妇中，75 g OGTT 1 h血糖异常者较75 g OGTT 2 h血糖异常者或75 g OGTT 3 h血糖异常者产后更易出现胰岛素分泌受损和胰岛素抵抗。

关键词: 糖尿病，妊娠的, 葡萄糖耐量试验, 产后期, 胰岛素耐受性

Objective

To compare the insulin secretion, insulin resistance, blood fat and blood pressure differences of postpartum Chinese women with the history of different glucose tolerance.

Methods

A total of 336 gestational diabetes mellitus (GDM), gestational impair glucose tolerance(GIGT) and normal glucose tolerance(NGT) pregnant women diagnosed in the Second People's Hospital of Changzhou from November 2009 to August 2012 were observed, then an one year follow-up study was executed on those postpartum women with the history of different glucose tolerance but exclude those had been treated with drugs because of serious hyperglycemia in postpartum women with GDM history.We got a total of 95 cases as study subjects, according to glucose tolerance during pregnancy, they were divided into GDM group (n=22), GIGT group (n=41) and NGT group(n=32), then according to 75 g oral glucose tolerance test(OGTT) during pregnancy, GIGT group had been divided into three subgroups: 1-hour abnormal blood glucose subgroup(GIGT1, n=11), 2-hour abnormal blood glucose subgroup(GIGT2, n=18) and 3-hour abnormal blood glucose subgroup(GIGT3, n=12). Then the 75 g OGTT, fasting blood insulin(FINS), fasting plasma glucose(FPG), total cholesterol(TCH), triglyceride(TG), low-density lipoproteincholesterol(LDL-C), high-density lipoproteincholesterol(HDL-C) were detected and systolic blood pressure(SBP), diastolic blood pressure(DBP) were measured and body mass index (BMI), insulin secretion function index(IFI), homeostasis model assessment of insulin resistance(HOMA-IR) were calculated.The study protocol was approved by the Ethical Review Board of Investigation in Human Beings of Changzhou No.2 People's Hospital. Informed consent was obtained from each participating patient.

Results

The results were: ①The FPG, 75 g OGTT 2 h, HOMA-IR, BMI, TCH, TG and LDL-C levels of GDM group were statistically higher than those of GIGT group or NGT group(P<0.05); The IFI level of GDM group was statistically lower than those of GIGT group or NGT group(P<0.05); The 75 g OGTT 2 h and BMI levels of GIGT group were statistically higher than those of NGT group(P<0.05). ②There were no significant differences of SBP、DBP and HDL-C levels among three groups(P>0.05); There were no significant differences of FPG, IFI, HOMA-IR, TCH, TG and LDL-C levels between GIGT group and NGT group(P>0.05). ③The IFI level of GIGT1 subgroup was statistically lower than that of GIGT2 subgroup or GIGT3 subgroup(P<0.05), but the HOMA-IR level of GIGT1 subgroup was statistically higher than that of GIGT2 subgroup or GIGT3 subgroup(P<0.05). ④ There were no significant differences of BMI, SBP, DBP, TG, TCH, LDL-C and HDL-C levels among three subgroups(P>0.05); There were no significant differences of IFI and HOMA-IR levels between GIGT2 subgroup and GIGT3 subgroup(P>0.05).

Conclusions

Compared with postpartum women with GIGT history or NGT history, Chinese postpartum women with GDM history show easier of impairments of both insulin secretion and insulin sensitivity and lipid metabolic disorders.Compared with 2-hour or 3-hour abnormal blood glucose value postpartum women with GIGT history, 1-hour abnormal blood glucose value postpartum women with GIGT history show easier of impairments of both insulin secretion and insulin sensitivity.

Key words: Diabetes, gestational, Glucose tolerance test, Postpartum period, Insulin resistance

表1 3组孕妇产后1年随访结果比较(±s)

Table 1 Comparison of 1 year follow-up results among three groups of postpartum women(±s)

组别	n	FPG(mmol/L)	75 g OGTT 2 h血糖(mmol/L)	DBP(mmHg)	SBP(mmHg)	IFI	HOMA-IR	BMI (kg/m²)	TCH(mmol/L)	TG (mmol/L)	LDL-C(mmol/L)	HDL-C(mmol/L)
GDM组	22	6.20±1.40	9.70±2.60	66.00±7.00	108.00±9.00	2.08±0.43	5.78±1.58	22.50±3.50	5.04±0.92	3.58±1.90	2.81±0.54	1.33±0.28
GIGT组	41	5.10±1.00	7.20±1.90	67.00±6.00	108.00±9.00	3.52±0.45	2.62±0.82	19.60±3.40	3.72±0.77	1.77±0.57	2.01±0.35	1.32±0.29
NGT组	32	5.00±0.60	5.30±0.70	66.00±6.00	107.00±8.00	3.66±0.66	2.45±0.53	18.10±3.60	3.70±0.67	1.62±0.30	1.98±0.30	1.34±0.31
F		5.13	8.63	1.41	1.50	6.79	7.30	5.79	7.67	13.37	8.44	1.23
P		0.041	0.038	0.261	0.312	0.023	0.024	0.019	0.034	0.026	0.027	0.327

表1 3组孕妇产后1年随访结果比较(±s)

Table 1 Comparison of 1 year follow-up results among three groups of postpartum women(±s)

组别	n	FPG(mmol/L)	75 g OGTT 2 h血糖(mmol/L)	DBP(mmHg)	SBP(mmHg)	IFI	HOMA-IR	BMI (kg/m²)	TCH(mmol/L)	TG (mmol/L)	LDL-C(mmol/L)	HDL-C(mmol/L)
GDM组	22	6.20±1.40	9.70±2.60	66.00±7.00	108.00±9.00	2.08±0.43	5.78±1.58	22.50±3.50	5.04±0.92	3.58±1.90	2.81±0.54	1.33±0.28
GIGT组	41	5.10±1.00	7.20±1.90	67.00±6.00	108.00±9.00	3.52±0.45	2.62±0.82	19.60±3.40	3.72±0.77	1.77±0.57	2.01±0.35	1.32±0.29
NGT组	32	5.00±0.60	5.30±0.70	66.00±6.00	107.00±8.00	3.66±0.66	2.45±0.53	18.10±3.60	3.70±0.67	1.62±0.30	1.98±0.30	1.34±0.31
F		5.13	8.63	1.41	1.50	6.79	7.30	5.79	7.67	13.37	8.44	1.23
P		0.041	0.038	0.261	0.312	0.023	0.024	0.019	0.034	0.026	0.027	0.327

表2 3个GIGT亚组孕妇产后1年随访结果比较(±s)

Table 2 Comparison of 1 year follow-up results among three subgroups of postpartum women with GIGT history(±s)

组别	n	BMI(kg/m²)	SBP(mmHg)	DBP(mmHg)	IFI	HOMA-IR	TG(mmol/L)	TCH (mmol/L)	LDL-C (mmol/L)	HDL-C(mmol/L)
GIGT1组	11	19.50±3.30	107.00±8.00	66.00±5.00	3.09±0.02	3.42±0.02	1.77±0.57	3.70±0.75	2.01±0.35	1.32±0.28
GIGT2组	18	19.60±3.40	108.00±9.00	67.00±5.00	3.94±0.03	2.95±0.02	1.76±0.52	3.72±0.77	2.00±0.34	1.31±0.28
GIGT3组	12	19.60±3.30	108.00±8.00	67.00±6.00	3.95±0.02	2.95±0.03	1.75±0.53	3.71±0.72	2.02±0.32	1.32±0.29
F		1.29	1.35	1.32	5.69	5.37	1.81	2.05	1.82	1.62
P		0.152	0.234	0.325	0.032	0.033	0.254	0.315	0.216	0.234

表2 3个GIGT亚组孕妇产后1年随访结果比较(±s)

Table 2 Comparison of 1 year follow-up results among three subgroups of postpartum women with GIGT history(±s)

组别	n	BMI(kg/m²)	SBP(mmHg)	DBP(mmHg)	IFI	HOMA-IR	TG(mmol/L)	TCH (mmol/L)	LDL-C (mmol/L)	HDL-C(mmol/L)
GIGT1组	11	19.50±3.30	107.00±8.00	66.00±5.00	3.09±0.02	3.42±0.02	1.77±0.57	3.70±0.75	2.01±0.35	1.32±0.28
GIGT2组	18	19.60±3.40	108.00±9.00	67.00±5.00	3.94±0.03	2.95±0.02	1.76±0.52	3.72±0.77	2.00±0.34	1.31±0.28
GIGT3组	12	19.60±3.30	108.00±8.00	67.00±6.00	3.95±0.02	2.95±0.03	1.75±0.53	3.71±0.72	2.02±0.32	1.32±0.29
F		1.29	1.35	1.32	5.69	5.37	1.81	2.05	1.82	1.62
P		0.152	0.234	0.325	0.032	0.033	0.254	0.315	0.216	0.234

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One Year Follow-up Study of Insulin Secretion and Insulin Resistance of Postpartum Women with History of Different Glucose Tolerance

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One Year Follow-up Study of Insulin Secretion and Insulin Resistance of Postpartum Women with History of Different Glucose Tolerance