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目的:探讨BMI正常的糖代谢异常孕妇胰岛素抵抗与分泌的关系。方法:选择2005年1月1日至2007年1月1日在我院进行正规产检、孕前BMI正常孕妇538例。于孕24~28周行50g葡萄糖筛查和75g葡萄糖耐量试验(oral glucose tolerance test,OGTT),根据检查结果将产妇分为:血糖正常孕妇组(NGT)178例、50g葡萄糖筛查(glucose challengetest,GCT)(+)组94例、妊娠期糖耐量减低(gestational impaired glucose tolerance,GIGT)组100例、妊娠期糖尿病(gestational diabetes mellitus,GDM)166例,同期测定空腹血胰岛素及空腹血糖。用稳态模型评估法(HOMA)计算各组胰岛素抵抗指数(HOMA-IR)和胰岛素β细胞功能指数(HBCI),比较各组胰岛素抵抗和胰岛素分泌能力的差别。结果:(1)GDM组与NGT、GCT(+)、GIGT组孕妇相比,空腹血糖、空腹胰岛素、HBCI差异有统计学意义(P<0.01)。HOMA-IR在各组间差异无统计学意义(P>0.05)。(2)NGT、GIGT组孕妇的HOMA-IR与HBCI呈正相关关系(P<0.01)。GCT(+)、GDM组孕妇的HOMA-IR则与HBCI无关(r=0.123,P>0.05)。结论:孕中期BMI正常的GDM妇女胰岛素抵抗与NGT、GCT(+)、GIGT孕妇相比无增高,但胰岛β细胞分泌能力明显降低。
Objective: To investigate the relationship between insulin resistance and secretion in pregnant women with abnormal glucose metabolism. Methods: January 1, 2005 to January 1, 2007 in our hospital for regular birth control, pre-pregnancy BMI normal pregnant women 538 cases. The pregnant women were divided into two groups: normal glucose test group (178 cases), glucose challenge test (glucose challenge test group) , 94 cases of GCT (+) group, 100 cases of gestational impaired glucose tolerance (GIGT) group and 166 cases of gestational diabetes mellitus (GDM). Fasting plasma insulin and fasting blood glucose were measured at the same period. The homeostasis model assessment (HOMA) was used to calculate the insulin resistance index (HOMA-IR) and insulin beta-cell function index (HBCI), and the differences of insulin resistance and insulin secretion ability between groups were compared. Results: (1) There were significant differences in fasting blood glucose, fasting insulin and HBCI between GDM group and NGT, GCT (+) and GIGT group (P <0.01). There was no significant difference in HOMA-IR between groups (P> 0.05). (2) There was a positive correlation between HOMA-IR and HBCI in NGT and GIGT pregnant women (P <0.01). HOMA-IR in pregnant women with GCT (+) and GDM was unrelated to HBCI (r = 0.123, P> 0.05). CONCLUSION: Insulin resistance in GDM women with normal BMI at the second trimester is not increased compared with that of NGT, GCT (+) and GIGT pregnant women, but the secretion of pancreatic islet β cells is significantly reduced.