妊娠期妇女糖耐量胰岛素 胰岛素抵抗变化规律的观察

目的：观察不同孕期孕妇的糖耐量、胰岛素释放、胰岛素抵抗，以了解妊娠期糖代谢变化的规律。方法：对早、中、晚孕期三组共１２４例正常孕妇及２３例健康非孕妇女作为对照组进行７５ｇ口服糖耐量试验（ＯＧＴＴ）。其中１３例自早孕期开始纵向跟踪。以胰岛素曲线下面积与血糖曲线下面积的比值反映胰岛素抵抗（ＩＳＲ）。结果：各个孕期的空腹血糖无明显差异，但均显著低于非孕期（Ｐ＜００５），服糖后血糖、胰岛素释放、胰岛素抵抗均随孕期延长逐渐上升。于中孕期开始出现显著性改变，至晚孕期进一步加重均显著高于孕早期（Ｐ＜００５）。结论：中孕期是妊娠期糖代谢开始出现根本性变化的时期，于此期对孕妇进行血糖监测，有助于妊娠期糖尿病（ＧＤＭ）的早期诊断。晚孕期是ＧＤＭ最容易发生的时期

An observation of the changes of glucose tolerance, insulin release and insulin resistance in normal pregnant women.

Objective: To explore the changes in glucose metabolism during pregnancy. Method: 124 cases of normal pregnant women and 23 cases of non-pregnant healthy women were given 75g oral glucose tolerance test(OGTT). Thirteen women were followed up longtudinally from early pregnancy and tested in early, mid and late gestation respectively. The ratio between the total area below insulin concentration curve and that below glucose concentration curve was caculated to evaluate insulin resistance. Result: No significant difference was observed between the FBG levels in different stages of pregnancy,but FBG levels were significantly lower in all pregnant women than in non-pregnant women. After given glucose, a gradual increase of glucose concentration, insulin level and insulin resistance was demonstrated along with the progress of pregnancy. Significant elevation can be seen at mid gestation and at late gestation. Conclusion: All these indicated that a significant carbohydrate metabolism change occurs in the mid gestational stage. This is the optimal period for the pregnant women to have a blood glucose examation so that an early diagnosis of gestational diabetes mellitus(GDM) could be made. GDM usually occurs in late gestational stage. \ \