目的探讨血糖控制满意的妊娠期糖尿病(GDM)孕妇血清视黄醇结合蛋白4(RBP4)水平、胰岛素抵抗与妊娠结局的关系。方法选取2011年2月-2012年11月在上海市浦东医院产科门诊确诊的孕24~28周GDM孕妇98例,其中血糖控制满意的72例为血糖控制满意组(A组),血糖控制不满意的26例为血糖控制不满意组(B组)。选取同期孕24~28周健康孕妇95例为健康对照组(C组)。分别于孕24~28周和孕37~40周测定各组孕妇空腹血清RBP4、血糖(FPG)和血清胰岛素(FINS)。计算稳态模型胰岛素抵抗指数(HOMA-IR)。记录并观察各组孕妇的妊娠结局。结果妊娠期高血压疾病、巨大儿的发生率B组最高,A组次之,均高于C组(P<0.05)。早产、羊水过多、新生儿窒息、新生儿低血糖、剖宫产的发生率,A组和C组比较差异无统计学意义(P>0.05),均低于B组(P<0.05)。产褥感染、产后出血的发生率各组比较,差异无统计学意义(P>0.05)。孕24~28周时,RBP4、FINS、FPG、HOMA-IR B组最高,A组次之,均高于C组(P<0.05)。孕37~40周时,RBP4、FPG A组和C组比较差异无统计学意义(P>0.05),均低于B组(P<0.05);FINS、HOMA-IR B组最高,A组次之,均高于C组(P<0.05)。结论随着血糖水平控制,GDM孕妇RBP4水平下降,但高胰岛素抵抗仍持续存在;血糖控制满意并不能完全改善GDM孕妇的妊娠结局。 Objective To investigate the relationship between serum retinol binding protein 4 (RBP4) levels, insulin resistance and pregnancy outcomes in patients with gestational diabetes mellitus (GDM) with satisfactory glycemic control. Methods From February 2011 to November 2012, 98 pregnant women with GDM at 24-24 weeks of gestation who were diagnosed at Shanghai Pudong Hospital obstetric department were selected. Among them 72 were satisfied with glycemic control (group A), and those with glycemic control Satisfactory 26 cases were not satisfied with the control of blood glucose (group B). Ninety-five healthy pregnant women aged 24-28 weeks pregnant were selected as healthy control group (C group). The fasting serum RBP4, FPG and FINS in pregnant women were measured at 24 to 28 weeks pregnant and 37 to 40 weeks pregnant respectively. The homeostasis model insulin resistance index (HOMA-IR) was calculated. Record and observe the pregnancy outcome of pregnant women in each group. Results The incidence of hypertensive disorders in pregnancy and macrosomia was the highest in group B, followed by that in group A, which was significantly higher than that in group C (P <0.05). The incidence of preterm birth, polyhydramnios, neonatal asphyxia, neonatal hypoglycemia and cesarean section had no significant difference between groups A and C (P> 0.05), which were all lower than those in group B (P <0.05). The incidence of puerperal infection and postpartum hemorrhage in each group was no significant difference (P> 0.05). The levels of RBP4, FINS, FPG and HOMA-IR group B were the highest at 24-28 weeks of gestation, followed by that of group A at the 24th to 28th week (P <0.05). There was no significant difference between RBP4, FPG A group and C group at 37 to 40 weeks of gestation (P> 0.05), all of which were lower than those in group B (P <0.05); FINS and HOMA-IR group B were the highest, Which were higher than those in group C (P <0.05). Conclusions With the control of blood glucose level, the level of RBP4 in pregnant women with GDM is decreased, but the persistent high insulin resistance persists. Satisfactory glycemic control does not completely improve the pregnancy outcome in GDM pregnant women.