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目的研究不同糖耐量状态孕妇胰岛素敏感性(IS)、胰岛β细胞分泌功能及产后转归情况。方法 376例50g葡萄糖负荷试验(GCT)阳性者,再行75g OGTT。采用胰岛素敏感指数(ISIMatsuda)、胰岛β细胞代偿胰岛素抵抗的分泌能力(ISSI)对糖耐量正常组(GNGT,298名)、妊娠期糖耐量减低(GIGT,47例)组及妊娠期糖尿病(GDM,31例)组进行评价,分析影响因素,追踪产后转归情况。结果 ISI-Matsuda在GNGT组、GDM组及GIGT组依次递减[(93.98±24.66)vs(71.41±33.75)vs(57.36±23.26),P均<0.01];ISSI在GNGT组、GIGT组及GDM组依次降低[(132233.10±26049.05)vs(74736.81±11163.93)vs(53099.99±20380.48),P均<0.01]。Pearson相关分析显示,LDL-C、TG、高敏C反应蛋白(hsC-RP)与ISI-Matsuda及ISSI呈负相关(P<0.01)。糖耐量异常孕妇产后34.3%仍存在糖代谢异常,转为T2DM者ISSI下降最明显。结论 GIGT以IR为主,GDM以胰岛素分泌缺陷为主。胰岛素分泌功能受损孕妇产后易发生T2DM。
Objective To study insulin sensitivity (IS), pancreatic β-cell secretion and postpartum outcomes of pregnant women with different glucose tolerance status. Methods 376 cases of 50g glucose load test (GCT) were positive, and then 75g OGTT. ISIMatsuda and ISSI were used to evaluate the effects of ISIG on the normal glucose tolerance group (GNGT, 298), GIGT (47) and gestational diabetes mellitus GDM, 31 cases) group were evaluated, the influencing factors were analyzed and the postpartum outcomes were tracked. Results Compared with GNGT group, GDM group and GIGT group, ISI-Matsuda decreased ([93.98 ± 24.66] vs (71.41 ± 33.75) vs (57.36 ± 23.26), P <0.01] (132233.10 ± 26049.05) vs (74736.81 ± 11163.93) vs (53099.99 ± 20380.48), P <0.01, respectively. Pearson correlation analysis showed that LDL-C, TG and hsC-RP were negatively correlated with ISI-Matsuda and ISSI (P <0.01). Impaired glucose tolerance in postpartum 34.3% of pregnant women still have abnormal glucose metabolism, ISSI decreased to T2DM was the most obvious. Conclusion GIGT is predominantly IR and GDM is predominantly deficient in insulin secretion. Impaired insulin secretion Pregnant women prone to postpartum T2DM.