本文關(guān)鍵詞：糖尿病家屬史對GDM血糖和血脂影響及圍產(chǎn)結(jié)局分析　出處：《浙江大學(xué)》2017年碩士論文　論文類型：學(xué)位論文

  更多相關(guān)文章： 妊娠期糖尿病 糖尿病家族史 圍產(chǎn)結(jié)局

【摘要】：研究背景:妊娠期糖尿病(GDM)是指妊娠期首次發(fā)生或發(fā)現(xiàn)的糖尿病,是常見的產(chǎn)科并發(fā)癥之一,與一系列不良圍產(chǎn)結(jié)局有關(guān)。目前,GDM在全球范圍內(nèi)的發(fā)病率為1.8～24.5%,中國GDM的發(fā)病率為17.5%,隨著GDM發(fā)病率的上升,GDM已經(jīng)成為全球性健康難題。已有大量研究表明,糖尿病家族史(FHD)是妊娠期糖尿病的危險因子,危險因素模式包括遺傳易感基因與生活習(xí)慣兩方面。糖尿病人數(shù)的激增,將進(jìn)一步提高GDM的發(fā)病率,危害母嬰健康。但是FHD對GDM孕婦血糖、血脂水平的影響及與不良圍產(chǎn)結(jié)局研究文獻(xiàn)較少,而且結(jié)論不一。本文旨在探究FHD對GDM孕婦血糖、血脂的影響及可能干預(yù)方式,為臨床改善糖尿病家族史GDM孕婦的圍產(chǎn)結(jié)局提供幫助。方法:本研究納入2014年1月1日～12月31日于浙江大學(xué)醫(yī)學(xué)院附屬婦產(chǎn)科醫(yī)院產(chǎn)科門診進(jìn)行孕中期首次產(chǎn)檢并于本院分娩的所有單胎妊娠GDM孕婦;根據(jù)FHD,分為FHD組和無FHD組。根據(jù)OGTT血糖異常值分類,僅空腹血糖異常為OGTT-A,僅服糖后血糖異常為OGTT-B,空腹血糖與服糖后血糖均異常為OGTT-C。觀察指標(biāo)包括年齡、孕次、孕前體質(zhì)量指數(shù)(BMI)、孕期增加體重(GWG)、75g-OGTT血糖值以及異常指標(biāo)項數(shù)、孕中晚期血脂水平(包括甘油三酯(TG)、總膽固醇(TC)、高密度脂蛋白(HDL)、低密度脂蛋白(LDL))以及妊娠結(jié)局(包括大于胎齡兒(LGA)、小于胎齡兒(SGA)、剖宮產(chǎn)、子癇前期、早產(chǎn)、胎兒窘迫、產(chǎn)后出血)。經(jīng)統(tǒng)計分析所有計量資料非正態(tài)分布,結(jié)果用中位數(shù)M(四分位數(shù)間距Q)表示,組間比較用秩和檢驗;計數(shù)資料結(jié)果用頻數(shù)和率表示,組間比較采用卡方檢驗,不符合卡方檢驗條件的用Fisher檢驗;獨立相關(guān)性研究采用二元logistic回歸分析,以P0.05為差異有統(tǒng)計學(xué)意義。結(jié)果:1.FHD組孕婦LGA[24.8%,63/254]、子癇前期[3.5%,9/254]以及剖宮產(chǎn)[50.8%,129/254]的發(fā)生率均顯著高于無FHD組[分別為(19.5%,312/1603),(1.6%,25/1603),(43.8%,702/1603),P值均0.05]。2.孕晚期FHD組TG水平明顯高于無FHD組[3.53(1.74)比3.27(1.77)nmol/L,P0.05]。3.FHD組空腹血糖、服糖1h血糖、服糖2h血糖及糖化血紅蛋白水平均明顯高于無FHD組[分別為4.81(0.80)比4.66(0.76),10.39(2.01)比 10.1(1.5),8.86(1.55)比8.52(1.75),5.1(0.40)比5.0(0.40)mmol/L,P值均0.05]。且FHD孕婦OGTT血糖三項、兩項異常率均明顯高于無FHD組,一項異常率則明顯低于無FHD組[分別為(15.3%,39/254)比(4.3%,70/1603),(39.8%,101/254)比(26.1%,418/1603),(44.9%,114/254)比(69.6%,1115/1603),P值均0.001]。FHD組孕婦中OGTT-B類比例明顯低于無FHD組,而OGTT-C類比例則明顯高于無FHD組[分別為(64.2%,163/254)比(73.6%,1180/1603),(24%,61/254)比(10.1%,162/1603),P值均0.05]。4.所有研究對象孕中期OGTT三項指標(biāo)均異常的孕婦,較一項、兩項異常組,LGA[(36.7%,40/108)比(19.4%,239/1231)比(18.5%,96/518)]、子癇前期[(7.3%,8/108)比(1.5%,19/1231)比(1.3%,7/518)]、剖宮產(chǎn)[(62.4%,68/108)比(43.1%,530/1231)比(44.9%,233/518)]發(fā)生率均呈上升趨勢,且有顯著性差異(P0.01)。OGTT-C組孕婦與A組和B組相比,子癇前期[(4.9%,11/224)比(1.0%,3/299)比(1.5%,20/1334)]、剖宮產(chǎn)[(59.2%,132/224)比(46.7%,136/299)比(41.9%,563/1334)]的發(fā)生率明顯升高,同時與B組相比,LGA[(34.5%,77/224)比(16.3%,219/1334)]、產(chǎn)后出血[(2.7%,6/224)比(0.7%,10/1334)]的發(fā)生率均明顯升高,且有統(tǒng)計學(xué)差異(P0.01)。OGTT-A組孕婦與B組相比,LGA[(27.1%,79/299)比(16.3,219/1334)]、胎兒窘迫[(8.9%,26/299)比(4.9%,67/1334)]的發(fā)生率均顯著升高(P0.01)5.通過二元logistic回歸分析發(fā)現(xiàn),對LGA而言,孕前BMI、孕期增加體重、FBG及TG是其獨立正相關(guān)因素,OR值分別為1.15(95%CI 1.10～1.20)、1.13(95%CI 1.10～1.17)、1.37(95%CI 1.12～1.67)、1.21(95%CI 1.14-1.28);對剖宮產(chǎn)而言,孕前BMI、孕期增加體重及FBG是其正相關(guān)因素,OR值分別為1.14(95%CI1.11～1.19)、1.04(95%CI 1.02～1.07)、1.30(95%CI 1.13～1.59);對子癇前期而言,孕前BMI、孕期增加體重、2h-OGTT及TG均是其獨立影響因素,OR值分別為1.33(95%CI 1.23～1.48)、1.16(95%CI 1.08～1.26)、1.38(95%CI 1.09～1.79)、1.15(95%CI 1.00～1.30)。結(jié)論:1.對于FHD組GDM孕婦,在孕早期即應(yīng)接受醫(yī)學(xué)營養(yǎng)和運動治療,必要時胰島素提前干預(yù),嚴(yán)格控制血糖水平;2.FHD組GDM孕婦孕晚期TG水平與不良妊娠結(jié)局有關(guān),需要密切監(jiān)測與干預(yù)。3.為改善FHD組孕婦妊娠結(jié)局,建議孕前適當(dāng)控制體重。
[Abstract]:Background: gestational diabetes mellitus (GDM) during pregnancy for the first time refers to the occurrence or discovery of diabetes, is one of the common complications of pregnancy, and a series of adverse perinatal outcome. At present, the incidence of GDM in the global scope of the rate is 1.8 ~ 24.5%, China incidence rate of GDM was 17.5%, with the rising incidence of GDM the GDM has become a global health problem. There are a large number of studies show that family history of diabetes (FHD) is a risk factor for gestational diabetes mellitus, patterns of risk factors including genetic susceptibility gene and two habits. In diabetes, will further increase the incidence of GDM, but the harm to the maternal and child health for pregnant women with GDM FHD. The blood glucose, and few studies and adverse perinatal outcome affects blood lipid levels, and not a conclusion. This paper aims to explore the FHD of pregnant women with GDM blood glucose, blood lipid and effect of intervention, clinical improvement of diabetes Help GDM family history of pregnant women and perinatal outcome. Methods: This study included in the January 1, 2014 to December 31st in the affiliated obstetrics and Gynecology Hospital of Zhejiang University Medical College of Obstetrics outpatient examination and first trimester in our hospital during all singleton pregnancy GDM pregnant women; according to FHD, divided into FHD group and non FHD group according to the classification of abnormal values. OGTT blood glucose, only impaired fasting glucose OGTT-A, postprandial blood glucose abnormalities only OGTT-B, fasting blood glucose and postprandial blood glucose were abnormal for OGTT-C. observation indexes including age, pregnancy, pre pregnancy body mass index (BMI), pregnancy weight gain (GWG), 75g-OGTT blood glucose levels and abnormal blood lipid level index number, late pregnancy (including triglycerides (TG), total cholesterol (TC), high density lipoprotein (HDL), low density lipoprotein (LDL)) and pregnancy outcomes (including large for gestational age (LGA), gestational age (SGA), cesarean section, preeclampsia, preterm birth, fetal Fetal distress, postpartum hemorrhage). Through the statistical analysis of all the non normal distribution of measurement data, the median (four percentile interval M Q) said, compared with the rank sum test results; count data by frequency and rate of said groups were compared by chi square test, chi square test does not meet the conditions Fisher test; independent association studies using two logistic regression analysis, with P0.05 as the difference was statistically significant. Results: 1.FHD group LGA[24.8%, 63/254], 9/254] and [3.5% in preeclampsia and cesarean section [50.8%, the incidence rate of 129/254] was significantly higher than that of non FHD Group [respectively (19.5%, 312/1603), (1.6%. 25/1603), (43.8%, 702/1603), P value was 0.05].2. in late pregnancy group FHD TG was significantly higher than that of non FHD group ([3.53 1.74) 3.27 (1.77) nmol/L, P0.05].3.FHD group, fasting blood glucose, oral glucose 1H blood glucose, blood glucose and glycosylated hemoglobin levels take sugar 2h were significantly higher than those without FHD group. 涓，

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