摘要
目的探讨谷氨酸脱羧酶抗体（GAD—Ab）和蛋白酪氨酸磷酸酶抗体（IA-2A）对妊娠期糖尿病（COM）患者随访的意义。方法选取GDM患者84例（GOM组）和口服葡萄糖耐量试验正常孕妇82例（对照组），GDM组又分为抗体阳性（CAD-Ab、IA．2A任何一项阳性）组18例和抗体阴性（GAD-Ab、IA-2A均阴性）组66例，分别于孕24—28周、产后6～12周和产后2年进行随访，测定GAD-Ab、IA-2A、胰岛素水平及糖代谢指标。结果GDM组稳态模型胰岛素抵抗指数（HONA-IR）高于对照组（3．87±2．17比2．31±0．52，P〈0．05），稳态模型胰岛β细胞功能指数（HBCI）和30min净增胰岛素／30min净增血糖（△I30/△G30）低于对照组{z06．38±138．06比422．43±228．93和（20．16±11．38）mU／mmol比（26．54±24．30）mU／mmol，P〈0．05]。抗体阳性组糖尿病家族史、在孕期需胰岛素治疗率均高于抗体阴性组[83．3％（15／18）比28．8％（19／66）和77．8％（14／18）比30．3％（20／66），P〈0．05]，HOMA．IR、△I30/△G30和HBCI均低于抗体阴性组[3．20±0．84比4．02±0．36，（16．81±2．91）mU／mmol比（21．55±11．11）mU／mmol和124．95．4-5．03比217．43±115．64，P〈0．01）；抗体阳性组产后6—12周和2年空腹血糖（FPG）、餐后2h血糖（2hPG）、糖化血红蛋白（HbA1c）均高于抗体阴性组[产后6～12周：（8．20±3．11）mmol／L比（5．39±0．76）mmol／L，（15．22±7．29）mmol／L比（8．15±1．93）mmo]JL，（7．26±1．04）％比（5．88±0．41）％；产后2年：（8．91±2．80）mmo]]L比（4．93±0．66）mmo]]L，（15．75±7．87）mmo]／L比（7．85±1．79）mm01]L，（7．18±1．22）％比（5．64±0．32）％，P〈0．01]，而产后2年抗体阳性组△I30/△G30蚧HBCI明显下降，抗体阴性组无显著变化。抗体阳性组产后6～12周和2年分别有16．7％（3118）、33．3％（6／18）的患者发展为1型糖尿病（T1DM），而抗体阴性组无转为T1DM病例。结论GDM患者中混有一些亚临床状态的T1DM患者；孕期需要胰岛素治疗，GAD-Ab和IA-2A阳性者，产后发展为T1DM的几率增加；GAD—Ab和IA-2A阳性是GDM患者产后发展为T1DM的一个重要预测因素。
Objective To investigate the role ofglutamic acid decarboxylase autoantibody（GAD-Ab） and protein tyrosine phosphatase autoantibody （IA-2A） in postpartum follow-up of gestational diabetes mellitus （GDM）. Methods GAD-Ab, IA-2A,insulin and glucose metabolism index were measured in 82 subjects with normal glucose tolerance （control group） and 84 patients with GDM （GDM group） during 24 to 28 weeks in pregnancy, postpartum 6 to 12 weeks and 2 years. GDM group was divided into antibodies positive group （GAD-Ab or IA-2A were positive） with 18 cases and antibodies negative group （GAD-Ab and IA-2A was negative） with 66 cases. Results Homeostasis model insulin resistance index （HOMA-IR） in GDM group was higher than that in control group （3.87 ± 2.17 vs. 2.31± 0.52, P 〈 0.05 ）. Homeostasis β -cell function index （HBCI） and 30 min net increment of insulin/30 min net increment of glucose （ △I30/△G30） in GDM group were lower than those in control group [206.38 ± 138.06 vs. 422.43 ±228.93 and （20.16 ± 11.38） mU/mmol vs. （26.54 ±24.30） mU/mmol,P 〈0.05]. The numbers who had the family history of diabetes mellitus and the used of insulin for treatment in antibodies positive group were higher than those in antibodies negative group [83.3% （15/18） vs. 28.8% （19/66） and 77.8% （14/18） vs. 30.3% （20/66） ], HOMA-IR,△I30/△G30 and HBCI in antibodies positive group were lower than those in antibodies negative group [ 3.20 ± 0.84 vs. 4.02 ± 0.36, （ 16.81 ± 2.91 ） mU/mmol vs. （21.55± 11.11 ） mU/mmol and 124.95 ±5.03 vs. 217.43 ± 115.64, P 〈 0.01 ]. Fasting plasma glucose （FPG）, 2 hours postprandial glucose （2hPG） and glycosylated hemoglobin （HbAlc） in antibodies positive group were higher than those in antibodies negative group during postpartum 6 to 12 weeks and 2 years [postpartum 6 to 12 weeks： （8.20± 3.11） mmol/L vs. （5.39 v0.76） mmol/L, （15.22 ±7.29） mmol/L vs.（8.15 ± 1.93） mmol/L, （7.26 ± 1.04）% vs. （5.88 ± 0.41）% ;postpartum 2 years： （8.91 ± 2.80） mmol/L vs. （4.93 ± 0.66） mmol/L, （15.75 ±7.87） mmol/L vs.（7.85 ± 1.79） mmol/L, （7.18 ± 1.22）% vs.（5.64 ± 0.32）%,P〈 0.01 ]. △I30/△G30 and HBCI were significantly decreased in antibodies positive group postpartum 2 years. No change of the above parameters in antibodies negative group was found. The occurrence rate of type 1 diabetes mellitus （T1DM） was 16.7% （3/18） and 33.3%（6/18） postpartum 6 to 12 weeks and 2 years in antibodies positive group,there was no T1DM in antibodies negative group. Conehmiorm Women with GDM are partly associated with T1DM. Requiring insulin therapy during pregnancy and GAD-Ab or IA-2A positive have considerable risk for developing T1DM. It is also an important predictor to GDM after parturition.
出处
《中国医师进修杂志》
2012年第1期9-12,共4页
Chinese Journal of Postgraduates of Medicine
基金
广东省医学科研基金（A2010552）
深圳市科技和信息局资助项目（200602037）
深圳市福了田区卫生系统公益性科研项目（FTWS039）
关键词
谷氨酸脱羧酶
蛋白酪氨酸激酶类
糖尿病
妊娠
随访研究
Glutamate decarboxylase
Protein-tyrosine kinases
Diabetes,gestational
Followup studies
