摘要
目的:探讨糖化血红蛋白(HbA1c)、胰岛素释放水平和胰岛β细胞功能指标在妊娠糖尿病(GDM)诊断中的临床价值。方法:选取2016-01—2017-04在西安市第四医院产科门诊就诊的405例孕24~28周产前检查妇女为研究对象,将其分为GDM组289例,糖耐量正常(NGT组)116例,行75g口服葡萄糖耐量试验(OGTT)和胰岛素释放试验,分别测定HbA1c、血糖、胰岛素水平。根据血糖结果,将GDM组进一步分为GDM1组:空腹血糖≥5.1mmol/L;GDM2组:1h血糖≥10.0mmol/L;GDM3组:2h血糖≥8.5mmol/L;GDM4组:多点血糖异常(2点或2点以上血糖异常)。比较不同时间点血糖特点患者的稳态模型评估胰岛素抵抗指数(HOMAIR)、胰岛β细胞功能指数(HOMA-β)、葡萄糖曲线下面积(AUCG)、胰岛素曲线下面积(AUCI)和胰岛素敏感性(ISI)。结果:(1)与NGT组比较,GDM组的HbA1c、血糖、胰岛素均显著增高,差异有统计学意义(P<0.01);(2)GDM组的AUCG、AUCI、HOMA-IR与NGT组比较均明显升高,差异有统计学意义(P<0.01或P<0.05),HOMA-β、ISI与NGT组比较均明显降低,差异有统计学意义(P<0.01或P<0.05);(3)其中GDM1-4组的AUCG,GDM1、2、4组的AUCI,GDM1、3、4组的HOMA-IR均高于NGT组(P<0.01或P<0.05);GDM2、3、4组的HOMA-β,GDM1-4组的ISI均低于NGT组(P<0.01或P<0.05);(4)相关性分析结果显示,各时间点血糖均与HOMA-IR呈正相关,其中空腹血糖(FPG)与HOMA-IR的相关性最大(r=0.51),同时FPG与HOMA-β呈负相关(r=-0.28),餐后各时间点血糖与HOMA-β关系不大,各时间点血糖均与ISI呈负相关(P<0.01)。结论:HbA1c能更好地反映GDM患者的血糖水平且结果稳定,胰岛素释放试验能反映GDM患者的胰岛β细胞功能,GDM患者的胰岛素抵抗较NGT增高,胰岛分泌功能下降,不同时间点的血糖孕妇其基础状态及糖负荷后的胰岛素分泌功能均有不同程度受损。
Objective：To investigate the clinical value of glycosylated hemoglobin（HbA1 c）,insulin release and pancreaticβ-cell function in the diagnosis of gestational diabetes mellitus（GDM）.Method：A total of 405 pregnant women in the first 24—28 weeks who have treatment in the fourth hospital of Xi＇an from January 2016 to April2017 was selected,and divided into 289 cases of GDM group,116 cases of NGT group.The results of 75 g oral glucose tolerance test（OGTT）and insulin releasing test（IRT）were analyzed,and the HbA1 c,blood glucose,insulin levels were measured.,The GDM group were further divided into four groups according to the levels of blood glucose：fasting blood glucose abnormality only（GDM1,≥ 5.1 mmol/L）,1 hpostprandial blood glucose abnormality only（GDM2,≥ 10.0 mmol/L）,2 hpostprandial blood glucose abnormality only（GDM3,≥8.5 mmol/L）and two or more blood glucose abnormality（GDM4）.In homeostasis mode1 assessment,insulin resistance index（HOMAIR）,pancreaticβ-cell function index（HOMA-β）,area under curve of glucose（AUCG）,area under curve of insulin（AUCI）,and insulin sensitivity（ISI）were assessed and compared between NGT and GDM 1-4 groups.Result：（1）Compared with NGT group,HbA1 c,blood glucose and insulin were significantly increased in GDM group,the difference was statistically significant（P〈0.01）;（2）The level of AUCG,AUCI and HOMA-IR in GDM group were significantly higher than those of NGT group,while HOMA-βand ISI in the GDM group were significantly lower than those of NGT group,the difference had statistically significant（P〈0.01 or 0.05）;（3）Among them,AUCG of GDM 1,2,3 and 4 groups,AUCI of GDM 1,2 and 4 groups,and HOMA-IR of GDM 1,3 and 4 groups were higher than that of NGT group（P〈0.01 or 0.05）.HOMA-βof GDM 2,3 and 4 groups,and ISI of GDM1,2,3 and 4 groups was lower than that of NGT group（P〈0.01 or 0.05）;（4）According to the correlation analysis,the blood sugar at each time point was positively correlated wi
作者
张小平
张祥
刘瑞苗
赵家宁
ZHANG Xiaoping;ZHANG Xiang;LIU Ruimiao;ZHAO J ianing(Department of Clinical Laboratory, Fourth Hospital of Xi＇an, Xi＇an, 710004, China)
出处
《临床血液学杂志（输血与检验）》
CAS
2018年第3期411-414,共4页
Journal of Clinical Hematology(Blood Transfusion & Laboratory Medicine)
关键词
妊娠糖尿病
糖化血红蛋白
胰岛素释放
胰岛Β细胞功能
gestational diabetes mellitus
glycosylated hemoglobin
insulin release
pancreatic β cell function
