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目的比较妊娠糖尿病(GDM)及糖耐量减低(IGT)与糖耐量正常(NGT)孕妇的胰岛素敏感性(IS)及胰岛β细胞功能的差异,并寻找合理的评价指标,观察早期干预对妊娠结局的影响。方法比较313例NGT、128例IGT及270例GDM孕妇的临床特征,前瞻性研究糖负荷后的IS和β细胞功能,并对IGT及GDM组进行前瞻性干预。结果(1)IGT及GDM组的孕前BMI、WBC、ALT等指标较NGT组升高。(2)IGT、GDM组较NGT组的HOMA-IR、HOMA2-IR升高,△Ins60/△Glu60、IS-QUICKI及IS-OGTT则降低。(3)IGT及GDM组中除23例(5·8%)加用人胰岛素治疗外其余仅单纯饮食控制即可达标。分娩时其孕重增加较NGT组为少,且新生儿体重及巨大儿发生率与NGT组相当。结论胰岛素抵抗及β细胞功能代偿不足在GDM的发生中均起重要作用。评价孕期β细胞功能时,引入糖负荷后的指标可能更为准确。IGT及GDM孕妇经干预后巨大儿发生率可降低至正常孕妇水平。
Objective To compare the differences of insulin sensitivity (IS) and pancreatic β-cell function between pregnant women with gestational diabetes mellitus (GDM) and impaired glucose tolerance (IGT) and normal glucose tolerance (NGT), and to find a reasonable evaluation index to observe the effect of early intervention on pregnancy outcome Impact. Methods The clinical features of 313 NGT, 128 IGT and 270 GDM pregnant women were prospectively studied. The IS and β cell function after glucose load was prospectively studied, and prospective interventions were performed in IGT and GDM groups. Results (1) The indexes of BMI, WBC and ALT before IGT and GDM were higher than that of NGT in IGT and GDM groups. (2) The levels of HOMA-IR and HOMA2-IR in IGT and GDM groups were significantly higher than those in NGT group, while △ Ins60 / △ Glu60, IS-QUICKI and IS-OGTT decreased. (3) In IGT and GDM group, except for 23 cases (5.8%) plus human insulin treatment, only simple diet control could reach the standard. Pregnancy weight at delivery increased less than NGT group, and neonatal body weight and macrosomia were comparable with NGT group. Conclusion Insulin resistance and lack of β-cell function play an important role in the pathogenesis of GDM. When assessing β-cell function during pregnancy, the index of glucose load may be more accurate. The incidence of macrosomia in IGT and GDM pregnant women can be reduced to normal pregnant women after intervention.