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目的观察不同糖化血红蛋白水平的新诊断妊娠糖尿病患者胰岛β细胞功能变化情况。方法选取2013年1月-2015年1月辽宁医学院附属第一医院新诊断妊娠糖尿病患者61例,分别记录年龄,测量身高、体重、血脂、血压、空腹血糖(FPG)、空腹胰岛素(FINS)、空腹血清C-肽(FC-P)、糖化血红蛋白(Hb A1C),计算稳态模型胰岛β细胞功能指数(HOMA-β)、胰岛素抵抗指数(HOMA-IR),并以Hb A1C 7.5%(中位数)为界值,将61例患者分为高糖化血红蛋白组(HH组)和低糖化血红蛋白组(LH组)。结果 HH组HOMA-IR高于LH组,分别为6.04±1.39、4.67±0.64,差异有统计学意义(P=0.000);甘油三酯水平高于LH组,分别为4.54±2.64、3.07±1.71,差异有统计学意义(P=0.012);HOMA-β低于LH组,分别为65.60±15.57、117.17±15.59,差异有统计学意义(P=0.000)。Hb A1C与TG呈正相关(r=0.335,P=0.012),与HOMA-IR也呈正相关(r=0.763,P=0.000),与HOMA-β呈负相关(r=-0.950,P=0.000)。结论晚期妊娠糖尿病患者,随着糖化血红蛋白和甘油三酯水平的升高,胰岛素抵抗增加,胰岛β细胞分泌功能下降,因此糖化血红蛋白可作为妊娠糖尿病患者胰岛β细胞功能的初步判断指标。
Objective To observe the changes of islet β-cell function in newly diagnosed gestational diabetes patients with different glycated hemoglobin levels. Methods Sixty-one newly diagnosed gestational diabetes patients in the First Affiliated Hospital of Liaoning Medical College from January 2013 to January 2015 were selected and their age, height, weight, blood fat, blood pressure, fasting blood glucose (FPG), fasting insulin (FINS) , Fasting serum C-peptide (FC-P) and glycosylated hemoglobin (Hb A1C). The steady-state model of islet β cell function index (HOMA-β) and insulin resistance index (HOMA-IR) were calculated. Hb A1C 7.5% Median), 61 patients were divided into HH group and HbA1c group (LH group). Results The HOMA-IR in HH group was significantly higher than that in LH group (6.04 ± 1.39 and 4.67 ± 0.64, respectively, P = 0.000). The triglyceride level in HH group was 4.54 ± 2.64 and 3.07 ± 1.71 , The difference was statistically significant (P = 0.012); HOMA-β was lower than LH group, respectively 65.60 ± 15.57,117.17 ± 15.59, the difference was statistically significant (P = 0.000). There was a positive correlation between Hb A1C and TG (r = 0.335, P = 0.012) and HOMA-IR (r = 0.763, P = 0.000) . Conclusions Patients with advanced gestational diabetes mellitus, with the increase of HbA1c and triglyceride, increase of insulin resistance and the secretion of pancreatic β-cell. Therefore, HbA1c can be used as a preliminary diagnostic indicator of pancreatic β-cell function in patients with gestational diabetes mellitus.