Bitó T, Földesi I, Nyári T, Pál A
Department of Obstetrics and Gynaecology, Albert Szent-Györgyi Medical and Pharmacological Centre, University of Szeged, Hungary.
Diabet Med. 2005 Oct;22(10):1434-9. doi: 10.1111/j.1464-5491.2005.01634.x.
We hypothesized that an increased serum insulin level in early pregancy reflects an increased demand on the compensatory capacity of the pregnant woman, and can serve as a predictor of gestational diabetes mellitus (GDM).
A 2-h, 75-g oral glucose tolerance test (OGTT), with fasting and 2-h postprandial serum insulin determination, was performed in 71 pregnant women with one or more risk factors for GDM before gestation week 16. In 64 patients, subsequent OGTTs were performed at gestation weeks 24-28, and in the event of a negative result, at gestation weeks 32-34.
Insulin determination at fasting and at 120 min had sensitivities of 69.2% and 92.3%, and specificities of 96.4% and 85.7%, respectively, for the prediction of GDM at gestation weeks 24-28. The sensitivities decreased to 33.3% and 75.0%, respectively, for the prediction of GDM at gestation weeks 32-34. Insulin determination at fasting and at 120 min had positive predictive values of 0.90 and 0.75, respectively, for the prediction of GDM at gestation weeks 32-34. The negative predictive values of fasting and 120-min serum insulin determination at gestation week < or = 16 were 0.87 and 0.96, respectively, for the prediction of GDM at gestation weeks 24-28. Increased serum insulin levels both at fasting and 120 min before gestation week 16 were very strong predictive factors for GDM by gestation weeks 32-34 with an odds ratio of 16.6 and 13.3, respectively.
Serum insulin determination at gestation week < or = 16 is an easy and reliable method with which to predict GDM in a high-risk group. Despite a negative OGTT, patients with an elevated fasting and/or 120-min serum insulin level at gestation week < or = 16 should be managed in the same way as those with GDM. Considering the very high negative predictive value of the method, patients with a normal fasting and/or 120-min serum insulin level at gestation week < or = 16 should undergo an OGTT only at gestation weeks 32-34.
我们推测，妊娠早期血清胰岛素水平升高反映了孕妇代偿能力需求的增加，并且可作为妊娠期糖尿病（GDM）的一个预测指标。
对71例在妊娠16周前具有一项或多项GDM危险因素的孕妇进行了2小时75克口服葡萄糖耐量试验（OGTT），并测定空腹及餐后2小时血清胰岛素水平。64例患者在妊娠24 - 28周时进行了后续OGTT，若结果为阴性，则在妊娠32 - 34周时进行。
空腹及120分钟时胰岛素测定对于预测妊娠24 - 28周时的GDM，敏感性分别为69.2%和92.3%，特异性分别为96.4%和85.7%。对于预测妊娠32 - 34周时的GDM，敏感性分别降至33.3%和75.0%。空腹及120分钟时胰岛素测定对于预测妊娠32 - 34周时的GDM，阳性预测值分别为0.90和0.75。妊娠≤16周时空腹及120分钟血清胰岛素测定对于预测妊娠24 - 28周时的GDM，阴性预测值分别为0.87和0.96。妊娠16周前空腹及120分钟时血清胰岛素水平升高是妊娠32 - 34周时发生GDM的非常强的预测因素，优势比分别为16.6和13.3。
妊娠≤16周时测定血清胰岛素是一种在高危人群中预测GDM的简便可靠方法。尽管OGTT结果为阴性，但妊娠≤16周时空腹和/或120分钟血清胰岛素水平升高的患者应与GDM患者接受相同的管理。鉴于该方法具有非常高的阴性预测值，妊娠≤16周时空腹和/或120分钟血清胰岛素水平正常的患者仅应在妊娠32 - 34周时进行OGTT。
