2019 年第 2 期 第 14 卷

补充维生素D对妊娠期糖尿病患者胰岛素抵抗程度的影响

Influence of vitamin D on insulin resistance in patients with gestational diabetes mellitus

作者：张艳梅宋晓平黄莺

英文作者：

单位：830000乌鲁木齐，新疆维吾尔自治区人民医院产科

英文单位：

关键词：妊娠期糖尿病；维生素D；胰岛素抵抗；β细胞功能

英文关键词：

• 摘要：

• 【摘要】目的    探讨补充维生素D对妊娠期糖尿病（GDM）孕妇胰岛素抵抗的临床影响。方法    选择2016年9月至2017年11月于新疆维吾尔自治区人民医院诊断为GDM孕妇84例,应用随机数字表法分为观察组和对照组，各42例,另选择同期在本院建档并定期产检42名健康孕妇为非GDM组。观察组接受饮食控制和口服维生素D治疗,对照组在观察组饮食控制方案的基础上每日口服安慰剂，非GDM组孕妇每日接受常规饮食,观察时间为12周。分别于治疗前后检测2组GDM孕妇的空腹血糖、空腹胰岛素（FINS）、25-羟维生素D［25-(OH)D］，并计算胰岛素抵抗指数（HOMA-IR）、胰岛β细胞功能指数（HOMA-β），治疗12周后检测2组GDM孕妇的血脂指标及体重指数，统计每日能量摄入量，并计算25-(OH)D与HOMA-IR、HOMA-β、空腹血糖及FINS的相关性。非GDM组孕妇于入组12周后进行上述指标的检测。结果    治疗前，2组GDM孕妇空腹血糖、FINS、HOMA-IR均高于非GDM组，25-(OH)D、HOMA-β均低于非GDM组，差异均有统计学意义（均P＜0.05）。对照组治疗12周后各指标与治疗前比较差异均无统计学意义（均P＜0.05），空腹血糖、FINS、HOMA-IR仍高于非GDM组，25-(OH)D、HOMA-β仍低于非GDM组，差异均有统计学意义（均P＜0.05）；观察组治疗12周后空腹血糖、FINS、HOMA-IR均低于治疗前，25-(OH)D、HOMA-β均高于治疗前，但HOMA-IR仍高于非GDM组［（2.10±0.29）比（1.87±0.21）］，25-(OH)D、HOMA-β仍低于非GDM组［（38±5）nmol/L比（45±8）nmol/L，（191±15）比（219±19）］，差异均有统计学意义（均P＜0.05）。相关性分析结果显示，血清25-(OH)D水平与HOMA-IR、空腹血糖、FINS呈负相关（r＝-0.683、-0.565、-0.463，均P＜0.05），与HOMA-β呈正相关（r＝0.576，P＜0.05）。结论    补充维生素D能有效改善妊娠期糖尿病患者胰岛素抵抗，降低空腹血糖及FINS，同时不会影响体内脂类代谢。

• 【Abstract】Objective    To investigate the clinical effect of vitamin D supplementation on insulin resistance in pregnant women with gestational diabetes mellitus(GDM). Methods    From September 2016 to November 2017, 84 women with GDM in People′s Hospital of Xinjiang Uygur Autonomous Region were randomly divided into observation group and control group, with 42 cases in each group; 42 healthy pregnant women were enrolled as non-GDM group. The observation group was treated with diet control and oral vitamin D; the control group was treated with diet control and placebo; the non-GDM group had regular diet. Observation time was 12 weeks. Fasting blood glucose, fasting insulin, 25-hydroxyvitamin D［25-(OH)D］, insulin resistance index(HOMA-IR), islet β-cell function index(HOMA-β), blood lipids, body mass index and daily energy intake were measured before and 12 weeks after intervention in GDM patients. The indicators were measured in the non-GDM group 12 weeks after enrollment. Results    Before treatment, fasting blood glucose, fasting insulin and HOMA-IR in the two GDM groups were higher, 25-(OH)D and HOMA-β were lower than those in the non-GDM group（P＜0.05）. These indicators showed no significant changes after treatment in the control group（P＞0.05）. In the observation group, fasting blood glucose, fasting insulin and HOMA-IR after treatment were lower, 25-(OH)D and HOMA-β were higher than those before treatment（P＜0.05）; but HOMA-IR was still higher than that in the non-GDM group［(2.10±0.29) vs (1.87±0.21)］; 25-(OH)D and HOMA-β were still lower than those in the non-GDM group ［(38±5) vs (45±8), (191±15) vs (219±19)］(P<0.05). Correlation analysis showed that serum 25-(OH)D level was negatively correlated with HOMA-IR, fasting blood glucose and fasting insulin(r=-0.683, -0.565, -0.463; P<0.05) and it was positively correlated with HOMA-β(r=0.576, P<0.05). Conclusion    Vitamin D supplementation can improve insulin resistance, lower fasting glucose and fasting insulin in GDM patients without affecting lipid metabolism.