孕期糖耐量不同变化与妊娠结局及胰岛素分泌水平的相关性研究

发布时间：2018-08-27 15:48

【摘要】：研究背景妊娠改变机体糖代谢,严重时可发生妊娠期糖尿病。血糖管理是孕期重要的管理项目之一,持续高血糖状态会增加不良妊娠结局的发生风险,甚至影响孕母及子代的近远期健康。75g OGTT检查是目前诊断孕期糖代谢异常的主要检查,随着HAPO研究结果的出现,现国内外多采用IADPSG诊断标准确诊妊娠期糖尿病,我国也制定了相关指南,统一使用该标准。OGTT中早时相胰岛素分泌不足、延迟或消失是T2DMβ-细胞功能缺陷的表现之一。正常人在给予糖负荷后,约30分钟时肘静脉血中血糖可达峰值,服糖后1～2小时血糖可回降至接近空腹水平。但糖代谢异常者并不遵循此规律,该类人群可出现血糖值逆向增高或回降延迟,即其代谢曲线表现为逐渐上升趋势。同时,胰岛素作为调控机体糖代谢的重要激素,主要由胰岛β-细胞合成分泌,当胰岛素出现分泌不足、分泌延迟或胰岛素受体抵抗、敏感性下降等情况会影响机体糖代谢途径的进行。研究者们常使用与胰岛素分泌浓度相关的指标来评价机体胰岛细胞分泌功能及胰岛素受体抵抗性。目前认为,糖尿病的致病原因与胰岛素分泌不足及抵抗增加有关。第一章糖耐量变化趋势与妊娠结局的关系研究研究目的采用回顾性分析的研究方法,探讨孕期糖耐量变化趋势与妊娠结局的关系,为临床上早期发现和早期干预孕期糖代谢异常孕产妇提供理论依据,减少不良妊娠结局的发生。对象与方法1研究对象选择2014年在本单位规律产检及分娩的孕产妇作为研究对象,根据其孕期75g OGTT结果,纳入正常组235例,血糖逆向增高组226例及妊娠期糖尿病组255例。2方法采用回顾性分析的研究方法,结合孕期病历资料,将三组血糖相关指标及不良妊娠结局发生情况分别进行比较。采用SPSS19.0对数据进行统计分析。结果1 一般资料比较GDM组年龄、孕次及产次均大于另两组,差异有统计学意义。三组终止妊娠孕周差异均有统计学意义,分别是逆向增高组正常组GDM组。2血糖相关指标比较三组中,GDM组空腹血糖最高,与另两组差异有统计学意义。三组间服糖后1小时血糖及2小时血糖差异均有统计学意义。其中,逆向增高组在服糖后1小时血糖低于正常组,却在服糖后2小时血糖高于正常组,差异有统计学意义。而对比孕期糖化血红蛋白时,GDM组最高,与另两组比较差异有统计学意义。3妊娠结局比较GDM组早产发生率最高,差异有统计学意义。逆向增高组羊水过多、羊水过少、FGR、早产等发生率均高于正常组,但差异无统计学意义。逆向增高组及GDM组新生儿转科率均高于正常组,差异有统计学意义。结论血糖的合理管理对妊娠结局的影响具有重要的意义。孕期血糖逆向增高者存在糖代谢途径异常,可能从多因素微改变综合影响到母儿的妊娠结局。临床上除了监测妊娠期糖尿病孕产妇外,仍需警惕对孕期血糖逆向增高者的孕期管理。第二章探索胰岛素分泌水平与孕期血糖的关系研究目的采用前瞻性观察的研究方法,比较三组血糖浓度及胰岛素分泌水平的关系,尝试从胰岛素水平解释三组糖代谢趋势差异发生的可能原因,为临床上对糖代谢异常者早期干预提供理论依据。对象与方法1研究对象收集2016年本单位定期产检孕产妇病历资料,根据其75g OGTT结果同上分为三组,纳入正常组38例,血糖逆向增高组24例及妊娠期糖尿病组28例。2方法采用前瞻性观察的研究方法,比较三组间孕期75g OGTT检查及其胰岛素检测结果,引入胰岛素相关评价指标一并进行分析研究。统计方法同上。结果1血糖及胰岛素值三组血糖结果与第一章相似。比较各组见空腹情况下胰岛素分泌水平差异无统计学意义。逆向增高组服糖后1小时胰岛素最低,与另两组相比差异有统计学意义。GDM组中服糖后2小时胰岛素最高,与另两组相比差异有统计学意义。2血糖及胰岛素相关性正常组血糖值与胰岛素分泌水平呈中强度正相关。逆向增高组与GDM组胰岛素分泌趋势相似。逆向增高组空腹胰岛素与血糖值不相关,而GDM组服糖后1小时胰岛素与血糖不相关,差异均有统计学意义。3胰岛素评价指标静息状态下,GDM组HOMA-βF最低,而正常组HOMA-βF最高;在给予葡萄糖负荷后,逆向增高组MBCI明显高于另两组,差异有统计学意义(P0.05)。GDM组ISI △I60/ΔG60在三组中最低,而HOMA-IR最高,差异均有统计学意义(P0.05)。结论胰岛素是调控机体血糖的重要激素,其分泌水平及血糖浓度具有中强度相关性。孕期血糖逆向增高者存在基础胰岛素分泌不足且动态胰岛素分泌相对不足的情况,其胰岛素分泌趋势与妊娠期糖尿病者相类似,提示孕期血糖逆向增高可能是妊娠期糖尿病前期过度状态。妊娠期糖尿病者存在胰岛素分泌不足及胰岛素抵抗增强,并且主要表现在给予葡萄糖负荷的1小时内。
[Abstract]:Background Gestational diabetes mellitus (GDM) occurs when pregnancy changes glucose metabolism. Glucose management is one of the most important management items during pregnancy. Persistent hyperglycemia increases the risk of adverse pregnancy outcomes, and even affects the near and long term health of pregnant women and their offspring. With the emergence of HAPO research results, IADPSG diagnostic criteria have been widely used to diagnose gestational diabetes mellitus at home and abroad, and related guidelines have been formulated in China to unify the use of the criteria. The blood glucose in venous blood can reach the peak value and return to near fasting level 1-2 hours after taking glucose. However, the abnormal glucose metabolism does not follow this rule. The reverse increase or delay of blood glucose may occur in this group, that is, the metabolic curve shows a gradual upward trend. When insulin is secreted inadequately, delayed or resistant to insulin receptors, or decreased sensitivity, the pathway of glucose metabolism is affected by the synthesis and secretion of beta-cells from pancreatic islets. Chapter 1 The relationship between the change trend of glucose tolerance and pregnancy outcomes Objective To explore the relationship between the change trend of glucose tolerance during pregnancy and pregnancy outcomes by retrospective analysis, so as to find out and interfere with glucose metabolism in early pregnancy. Objectives and Methods 1 The study subjects selected the pregnant and lying-in women who underwent regular obstetric examination and delivery in our unit in 2014 as the research objects. According to the results of 75 g OGTT during pregnancy, 235 cases were included in the normal group, 226 cases in the reverse hyperglycemia group and 255 cases in the gestational diabetes mellitus group. The data were analyzed by SPSS 19.0. Results 1 The age, gestation and delivery times of GDM group were higher than those of the other two groups, and the difference was statistically significant. The difference was statistically significant, respectively, in the reverse-elevation group normal group GDM group. 2 Blood glucose-related indicators compared with the other two groups, GDM group fasting blood glucose was the highest, and the difference was statistically significant. Compared with the other two groups, the GDM group had the highest incidence of preterm labor, the difference was statistically significant. 3 Pregnancy outcomes were the highest in GDM group, the difference was statistically significant. Conclusion The reasonable management of blood glucose is of great significance to the pregnancy outcome. The second chapter explores the relationship between insulin secretion and blood glucose during pregnancy. Objective To compare the blood glucose concentration and insulin secretion in three groups by prospective observation. Objectives and Methods 1 The subjects collected the medical records of pregnant and lying-in women at regular maternity check-ups in 2016, and were divided into three groups according to the results of 75g OGTT, and 38 cases were included in the normal group. Methods A prospective study was conducted in 24 patients with hyperglycemia and 28 patients with gestational diabetes mellitus. The results of 75 g OGTT and insulin test were compared among the three groups, and the insulin-related evaluation indexes were introduced. The statistical methods were the same. Results 1 Blood glucose and insulin levels in the three groups were compared with those in the first chapter. There was no significant difference in insulin secretion between the two groups. The lowest insulin level was found in the reverse-elevation group 1 hour after taking glucose, which was significantly different from the other two groups. There was no correlation between fasting insulin and blood glucose in the reverse elevation group, but no correlation between insulin and blood glucose in the GDM group at 1 hour after taking glucose. 3 The HOMA-beta F of GDM group was the lowest in the resting state of insulin evaluation index, while the HOMA-beta F was the lowest in the reverse elevation group. HOMA-beta F was the highest in the normal group, and MBCI was significantly higher in the reverse-elevation group than in the other two groups after glucose loading (P 0.05). ISI Delta I60/G60 in the GDM group was the lowest in the three groups, while HOMA-IR was the highest, the difference was statistically significant (P 0.05). Conclusion Insulin is an important hormone regulating blood glucose, and its secretion level and blood glucose concentration were significantly higher in the GDM group. There is a moderate intensity correlation between the degree of hyperglycemia during pregnancy and the degree of hyperglycemia during pregnancy. Insulin secretion and insulin secretion were increased and mainly manifested in 1 hours of glucose loading.
【学位授予单位】：南方医科大学
【学位级别】：硕士
【学位授予年份】：2017
【分类号】：R714.256

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