孕期口服葡萄糖耐量试验1小时血糖单独升高在预测产后代谢功能障碍方面类似于妊娠期糖尿病。
Isolated hyperglycemia at 1 hour on oral glucose tolerance test in pregnancy resembles gestational diabetes mellitus in predicting postpartum metabolic dysfunction.
作者信息
Retnakaran Ravi, Qi Ying, Sermer Mathew, Connelly Philip W, Zinman Bernard, Hanley Anthony J G
机构信息
Leadership Sinai Centre for Diabetes, Mount Sinai Hospital, Toronto, Canada.
出版信息
Diabetes Care. 2008 Jul;31(7):1275-81. doi: 10.2337/dc08-0126. Epub 2008 Mar 20.
OBJECTIVE
Gestational impaired glucose tolerance (GIGT), defined by a single abnormal value on antepartum 3-h oral glucose tolerance test (OGTT), is a metabolically heterogeneous disorder. Indeed, the antepartum metabolic phenotype of women with a single abnormal value at 1 h during the OGTT (1-h GIGT) resembles that of women with gestational diabetes mellitus (GDM), whereas GIGT at 2 or 3 h (2/3-h GIGT) is similar to normal glucose tolerance (NGT). Thus, we hypothesized that 1-h GIGT would be associated with the same adverse outcomes as GDM, i.e., increased infant birth weight and postpartum metabolic dysfunction.
RESEARCH DESIGN AND METHODS
A total of 361 women underwent an antepartum glucose challenge test (GCT) and a 3-h OGTT, assessment of obstetrical outcome at delivery, and metabolic characterization by OGTT at 3 months postpartum. The antepartum GCT/OGTT identified five study groups: GDM (n = 97), 1-h GIGT (n = 28), 2/3-h GIGT (n = 34), abnormal GCT NGT (abnormal GCT with NGT on OGTT) (n = 128), and normal GCT NGT (normal GCT with NGT on OGTT) (n = 74).
RESULTS
Caesarian section rate was higher in women with 1-h GIGT, but birth weight did not differ significantly between the non-GDM groups (P = 0.1978). At 3 months postpartum, glycemia (area under the glucose curve) progressively increased across the groups from normal GCT NGT to abnormal GCT NGT to 2/3-h GIGT to 1-h GIGT to GDM (P < 0.0001), while both insulin sensitivity (IS(OGTT)) and beta-cell function (insulinogenic index/homeostasis model assessment of insulin resistance [HOMA-IR]) progressively decreased (P = 0.002 and P < 0.0001, respectively). The strongest independent negative predictors of insulinogenic index/HOMA-IR were GDM (t = -4.1, P < 0.0001) and 1-h GIGT (t = -3.8, P = 0.0002).
CONCLUSIONS
Like GDM, 1-h GIGT is associated with postpartum glycemia, insulin resistance, and beta-cell dysfunction.
目的
妊娠期糖耐量受损（GIGT）由产前3小时口服葡萄糖耐量试验（OGTT）中的单个异常值定义，是一种代谢异质性疾病。实际上，在OGTT期间1小时出现单个异常值的女性（1小时GIGT）的产前代谢表型类似于妊娠期糖尿病（GDM）女性，而2或3小时的GIGT（2/3小时GIGT）与正常糖耐量（NGT）相似。因此，我们假设1小时GIGT与GDM具有相同的不良结局，即婴儿出生体重增加和产后代谢功能障碍。
研究设计与方法
共有361名女性接受了产前葡萄糖筛查试验（GCT）和3小时OGTT，评估分娩时的产科结局，并在产后3个月通过OGTT进行代谢特征分析。产前GCT/OGTT确定了五个研究组：GDM（n = 97）、1小时GIGT（n = 28）、2/3小时GIGT（n = 34）、异常GCT NGT（OGTT为NGT但GCT异常）（n = 128）和正常GCT NGT（OGTT为NGT且GCT正常）（n = 74）。
结果
1小时GIGT女性的剖宫产率较高，但非GDM组之间的出生体重无显著差异（P = 0.1978）。产后3个月时，血糖（葡萄糖曲线下面积）从正常GCT NGT组到异常GCT NGT组、到2/3小时GIGT组、到1小时GIGT组、再到GDM组逐渐升高（P < 0.0001），而胰岛素敏感性（IS(OGTT)）和β细胞功能（胰岛素生成指数/胰岛素抵抗稳态模型评估[HOMA-IR]）均逐渐降低（分别为P = 0.002和P < 0.0001）。胰岛素生成指数/HOMA-IR最强的独立负性预测因素是GDM（t = -4.1，P < 0.0001）和1小时GIGT（t = -3.8，P = 0.0002）。
结论
与GDM一样，1小时GIGT与产后血糖、胰岛素抵抗和β细胞功能障碍有关。
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