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目的探讨糖代谢正常的复发性流产(recurrent spontaneous abortion,RSA)患者妊娠早期胰岛素抵抗的发生状况。方法收集2007年1月至2011年6月在我院首次就诊的626例孕早期妇女:有RSA病史且孕前经口服葡萄糖耐量试验(oral glucose tolerance test,OGTT)排除糖代谢异常的161例(RSA组),其中患有多囊卵巢综合征(polycysticovarian syndrome,PCOS)者26例;无不良孕产史的465例(对照组),其中患有PCOS者45例。回顾性分析血β-HCG、雌二醇、孕酮(progesterone,P)、空腹血糖及空腹胰岛素等临床资料,并计算胰岛素稳态模型指数(HOMA-IR)和空腹血糖/胰岛素比值(G/I),比较两组胰岛素抵抗水平。结果两组的年龄、BMI、平均孕期、雌二醇相比无统计学差异(P>0.05),RSA组的血清β-HCG、孕酮水平明显低于对照组(P<0.05,P<0.01);与对照组相比,伴有PCOS的RSA患者FPG、FIN及HOMA-IR均明显升高,而G/I比值明显降低(P<0.05),且非PCOS的RSA患者中也有相同的趋势;在本研究总体人群中,β-HCG及P水平与HOMA-IR呈负相关,而与G/I比值呈正相关,在控制BMI的影响后,β-HCG及P水平与HOMA-IR及G/I比值仍呈现显著相关性(r分别为-0.205、-0.191、0.196、0.205,P<0.05);RSA患者妊娠早期自然流产率较对照组明显增高(18.6%vs 6.7%,P<0.01)。结论无论其是否患有PCOS,糖代谢正常的RSA妇女再次妊娠早期均具有显著增高的IR趋势,可能是导致其反复流产的原因之一,建议对所有RSA患者(包括孕前糖代谢正常及非PCOS者)查空腹血糖和胰岛素来评价IR,以指导临床治疗。
Objective To investigate the occurrence of insulin resistance during early pregnancy in recurrent spontaneous abortion (RSA) patients with normal glucose metabolism. Methods A total of 626 pregnant women with first trimester visit in our hospital from January 2007 to June 2011 were enrolled: 161 patients with RSA history and oral glucose tolerance test (OGTT) before pregnancy excluded the abnormal glucose metabolism Group), including 26 cases with polycysticovarian syndrome (PCOS); 465 cases without adverse pregnancy history (control group), of which 45 cases had PCOS. The clinical data of β-HCG, estradiol, progesterone (P), fasting blood glucose and fasting insulin in blood were retrospectively analyzed. The HOMA-IR and G / I), comparing the two groups of insulin resistance. Results The serum levels of β-HCG and progesterone in RSA group were significantly lower than those in control group (P <0.05, P <0.01), there was no significant difference in age, BMI, average gestational age and estradiol between the two groups ); Compared with the control group, the FPG, FIN and HOMA-IR of RSA patients with PCOS were significantly increased, while the G / I ratio was significantly lower (P <0.05), and the same trends were observed in RSA patients without PCOS ; In the overall population of our study, β-HCG and P levels were negatively correlated with HOMA-IR and positively correlated with G / I ratio. After control of BMI, the levels of β-HCG and P were positively correlated with HOMA-IR and G (R = -0.205, -0.191,0.196,0.205, P <0.05, respectively). The rate of spontaneous abortion in early pregnancy in RSA patients was significantly higher than that in the control group (18.6% vs 6.7%, P <0.01) . Conclusions RSA women with normal glucose metabolism have significantly increased IR tendency again in the first trimester of pregnancy, which may be one of the causes of recurrent miscarriage, regardless of whether they have PCOS or not. It is suggested that all RSA patients (including normal glucose metabolism before pregnancy and non-PCOS ) Check fasting blood glucose and insulin to evaluate IR, to guide clinical treatment.