妊娠期间的β细胞功能和胰岛素抵抗及其与胎儿发育的关系。

Beta-cell function and insulin resistance in pregnancy and their relation to fetal development.

机构信息

Department of Medicine, S.C.B. Medical College and Hospital, Cuttack, Orissa 753001, India.

出版信息

Metab Syndr Relat Disord. 2010 Feb;8(1):25-32. doi: 10.1089/met.2009.0017.

DOI:10.1089/met.2009.0017

PMID:19929599

Abstract

BACKGROUND

Insulin resistance in pregnancy is consequent to the physiological adaptation necessary to provide glucose to the growing fetus. Disturbance in the maternal metabolism can induce structural and functional adaptations during fetal development.

METHODS

Pregnant women with duration of conception between 24 and 28 weeks were assessed for insulin resistance (IR) and beta-cell function by using homeostatic model assessment IR (HOMA-IR) and homeostatic model assessment of beta-cell function (HOMA-B) models, respectively. One hundred pregnant women and 42 age-matched controls were taken for the study. Fourteen pregnant women were diagnosed as gestational diabetes mellitus (GDM) as per World Health Organization (WHO) criteria.

RESULTS

Pregnant women with normal glucose tolerance (NGT) did not reveal significant IR as compared to controls but the HOMA-B was higher (268.91 +/- 197.16 vs 188.6 +/- 88.83, P < 0.01), suggesting excessive beta-cell function to maintain glucose homeostasis. The subset of pregnant women who presented with GDM had significantly higher HOMA-IR values (6.59 +/- 2.93 vs. 1.77 +/- 1.49, P < 0.001) and similar HOMA-B values as compared to pregnant women with NGT. Pregnant women with severe IR manifested as GDM, even without any previous history of dysglycemia.

CONCLUSIONS

With regard to fetal outcome, HOMA-IR is an independent predictor in pregnant women with NGT (biparietal diameter r(2) = 0.204, P < 0.01; weight r(2) = 0.097, P < 0.01), whereas beta-cell function (HOMA-B) is a strong independent predictor of fetal outcome in pregnant GDM (biparietal diameter r(2) = 0.58, P < 0.05; FL r(2) = 0.71, P < 0.01 AC r(2) = 0.79, P < 0.001; weight r(2) = 0.57, P < 0.01).

摘要

背景

妊娠期间的胰岛素抵抗是为了向生长中的胎儿提供葡萄糖而产生的生理适应性的结果。母体代谢的紊乱会在胎儿发育过程中引起结构和功能的适应性改变。

方法

对妊娠 24 至 28 周的孕妇进行胰岛素抵抗（IR）和β细胞功能的评估，分别采用稳态模型评估的胰岛素抵抗（HOMA-IR）和β细胞功能的稳态模型评估（HOMA-B）模型。研究纳入了 100 名孕妇和 42 名年龄匹配的对照组。根据世界卫生组织（WHO）标准，有 14 名孕妇被诊断为妊娠期糖尿病（GDM）。

结果

糖耐量正常（NGT）的孕妇与对照组相比没有明显的 IR，但 HOMA-B 更高（268.91 +/- 197.16 与 188.6 +/- 88.83，P < 0.01），提示为维持葡萄糖稳态而过度的β细胞功能。表现为 GDM 的孕妇亚组的 HOMA-IR 值显著升高（6.59 +/- 2.93 与 1.77 +/- 1.49，P < 0.001），与 NGT 孕妇的 HOMA-B 值相似。表现为严重 IR 的孕妇即使没有任何先前的糖代谢异常史，也会发展为 GDM。

结论

就胎儿结局而言，HOMA-IR 是 NGT 孕妇的独立预测因子（双顶径 r(2) = 0.204，P < 0.01；体重 r(2) = 0.097，P < 0.01），而β细胞功能（HOMA-B）是 GDM 孕妇胎儿结局的强有力的独立预测因子（双顶径 r(2) = 0.58，P < 0.05；股骨长 r(2) = 0.71，P < 0.01；腹围 r(2) = 0.79，P < 0.001；体重 r(2) = 0.57，P < 0.01）。