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目的探讨妊娠期合并糖代谢异常对子代新生儿期胰岛素敏感性的影响。方法选择2009年12月至2010年11月本院产科出生的新生儿,根据母亲妊娠期是否合并糖代谢异常分为糖代谢异常母亲的新生儿和糖代谢正常母亲的新生儿。所有研究对象均进行出生体格测量,并于生后 3 天内测定空腹血糖( FPG) 和空腹血清胰岛素( FINS) ,计算胰岛素敏感指数( ISI) ,采用胰岛素稳态模型( HOMA) 计算胰岛素抵抗指数( IR) ,即 HOMA-IR,其中 FINS、ISI 和 HOMA-IR 值为胰岛素敏感性的评价指标。以性别、胎龄、出生体重为协变量,分别在早产儿和足月儿中进行胰岛素敏感性的协方差分析。结果 89 例早产新生儿和 96 例足月新生儿纳入分析。糖代谢异常母亲新生儿的出生体重、出生身长和重量指数( PI) 与糖代谢正常母亲的新生儿相比,差异无统计学意义( P >0. 05) 。与糖代谢正常母亲的早产儿相比,糖代谢异常母亲的早产儿 FPG 降低、FINS 升高,差异有统计学意义[FPG( mmol/L) : ( 4. 00 ±0. 25) 比( 4. 82 ±0. 18) ,FINS( 经对数 Lg 转换) : ( 0. 69± 0. 06) 比( 0. 54 ± 0. 04) ,P < 0. 05],ISI 值降低、HOMA-IR 值升高,但差异无统计学意义[ISI( 经对数 Ln 转换) : ( -2. 89 ±0. 15) 比( -2. 78 ±0. 11) ,HOMA-IR 值( 经对数 Lg 转换) : ( -0. 10 ±0. 06)比( -0. 15 ±0. 05) ,P >0. 05]; 足月儿中糖代谢异常母亲的新生儿 FPG、FINS 和 HOMA-IR 值低,ISI 值高,但差异均无统计学意义[FPG( mmol / L) : ( 4. 68 ± 0. 23) 比( 5. 17 ± 0. 13) ,FINS( 经对数 Lg转换) : ( 0. 56 ±0. 06) 比( 0. 61 ±0. 03) ,HOMA-IR 值( 经对数 Lg 转换) : ( -0. 14 ±0. 06) 比( -0. 03± 0. 03) ,ISI( 经对数 Ln 转换) : ( - 2. 79 ± 0. 14) 比( - 3. 04 ± 0. 08) ,P > 0. 05]。结论母亲妊娠期合并糖代谢异常虽然对新生儿的出生体重没有影响,但血糖仍然呈现低水平趋势,且对早产儿胰岛素敏感性可能有一定的影响。
Objective To investigate the influence of abnormal glucose metabolism during pregnancy on neonatal insulin sensitivity in offspring. Methods The neonates born in obstetrics of our hospital from December 2009 to November 2010 were divided into newborns with abnormal glucose metabolism and newborns with normal glucose metabolism according to whether their mother combined with abnormal glucose metabolism during pregnancy. All subjects were measured at birth, and fasting blood glucose (FPG) and fasting serum insulin (FINS) were measured within 3 days after birth. Insulin sensitivity index (ISI) was calculated and insulin resistance index (HOMA) IR), that is, HOMA-IR, FINS, ISI and HOMA-IR values for the assessment of insulin sensitivity. Covariate analysis of insulin sensitivity was performed in preterm and term infants, respectively, using sex, gestational age, and birth weight as covariates. Results 89 preterm newborns and 96 full-term newborns were included in the analysis. There was no significant difference in birth weight, birth length and weight index (PI) between newborns with normal glucose metabolism and newborns with normal glucose metabolism (P> 0.05). Compared with preterm infants with normal glucose metabolism, preterm infants with abnormal glucose metabolism had lower FPG and higher FINS, the difference was statistically significant [FPG (mmol / L): (4.00 ± 0.25) vs .82 ± 0.18), FINS (logarithmic Lg conversion): (0.69 ± 0. 06) (0. 54 ± 0. 04, P <0.05) IR value increased, but the difference was not statistically significant [ISI (logarithmic Ln conversion): (-2.89 ± 0.15) vs (-2.78 ± 0.11), HOMA-IR value Lg conversion): (-0.10 ± 0.06) vs (-0.15 ± 0.05), P> 0.05]. FPG, FINS and HOMA in neonatal mothers with term abnormal glucose metabolism -IR value was low and ISI value was high but the differences were not statistically significant [FPG (mmol / L) :( 4.68 ± 0.23) vs (5.17 ± 0.13), FINS (-0.56 ± 0.06) vs. (0.61 ± 0.03), HOMA-IR (log Lg conversion): (-0.14 ± 0.06) 03 ± 0. 03), ISI (logarithmic Ln conversion): (-2.79 ± 0.14) vs (-3.04 ± 0.08), P> 0.05]. Conclusion The abnormal glucose metabolism during pregnancy in maternal mothers has no effect on the birth weight of newborns. However, the blood glucose level still shows a low level and may affect the insulin sensitivity of premature babies.