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目的探讨谷氨酸脱羧酶抗体(GAD-Ab)阳性的妊娠糖尿病(GDM)患者胰岛素敏感性与β细胞功能变化。方法选取GDM孕妇84例(GDM组)和糖耐量正常孕妇82例作对照组(NGT组),孕期24~28周测定GAD-Ab和胰岛素水平及糖代谢指标,随访GDM产后6~12周和产后2年胰岛素水平及糖代谢指标。采用稳态模式胰岛素抵抗指数(HOMA-IR)评价胰岛素敏感性,稳态模式胰岛β细胞功能指数(HBCI)和30 min净增胰岛素/30 min净增血糖比值(ΔI30/ΔG30)评价胰岛β细胞分泌功能。结果⑴GDM组的HOMA-IR高于NGT组,差异有统计学意义(P<0.05);GDM组ΔI30/ΔG30和HBCI低于NGT组,差异有统计学意义(P<0.05);⑵GDM组中GAD-Ab阳性率17.0%,而NGT组中GAD-Ab阳性率1.0%,两组比较差异有统计学意义(P<0.01);⑶GAD-Ab阳性的GDM孕妇有糖尿病家族史、在孕期需胰岛素治疗者所占比例均高于抗体阴性组(P<0.05),GAD-Ab阳性的GDM孕妇HOMA-IR高于抗体阴性组,而ΔI30/ΔG30和HBCI均低于抗体阴性组,差异均有统计学意义(P<0.05);⑷GAD-Ab阳性GDM孕妇于产后6~12周和2年空腹血糖(FPG)、餐后血糖(2hPG)、糖化血红蛋白(HbA1c)均高于抗体阴性组(P<0.05~0.01),而产后2年ΔI30/ΔG30、HBCI明显下降,GAD-Ab阴性的GDM孕妇的胰岛功能在随访期间则无显著变化。结论 GAD-Ab阳性是胰岛β细胞功能损伤的一个预测指标;GDM孕妇中混有一些亚临床状态的1型糖尿病患者。
Objective To investigate the changes of insulin sensitivity and β-cell function in patients with GDM-G positive gestational diabetes mellitus (GDM). Methods Eighty-four pregnant women with GDM (GDM group) and 82 healthy pregnant women with normal glucose tolerance (GDM group) were selected as the control group (NGT group). GAD-Ab and insulin levels and glucose metabolism indexes were measured 24-24 weeks after pregnancy. Postpartum 2 years insulin level and glucose metabolism index. Insulin sensitivity, steady-state islet beta-cell function index (HBCI), and 30 min net insulin augmentation / 30 min net blood glucose increase (ΔI30 / ΔG30) were assessed using homeostasis model insulin resistance index (HOMA-IR) Secretion function. Results ① The HOMA-IR in GDM group was significantly higher than that in NGT group (P <0.05), and the levels of ΔI30 / ΔG30 and HBCI in GDM group were lower than those in NGT group (P <0.05). -Ab positive rate of 17.0%, while NGT group GAD-Ab positive rate of 1.0%, the difference between the two groups was statistically significant (P <0.01); GGAD-Ab positive GDM pregnant women have a family history of diabetes, insulin therapy during pregnancy (P <0.05). The HOMA-IR of GAD-Ab-positive GDM pregnant women was higher than that of antibody negative ones, but the values of ΔI30 / ΔG30 and HBCI were lower than those of antibody negative ones (P <0.05). (4) The fasting blood glucose (FPG), postprandial blood glucose (2hPG) and HbA1c of GAD-Ab positive GDM pregnant women were higher than those of antibody negative group ~ 0.01). However, ΔI30 / ΔG30 and HBCI decreased significantly at 2 years postpartum. There was no significant change in islet function of GAD-Ab negative pregnant women during follow-up. Conclusions GAD-Ab positivity is a predictor of functional impairment of pancreatic β-cells; some subclinical type 1 diabetic patients are mixed with GDM pregnant women.