本文選題：妊娠期糖尿病　切入點：產(chǎn)后　出處：《安徽醫(yī)科大學(xué)》2017年碩士論文　論文類型：學(xué)位論文

【摘要】：目的:本研究旨在了解妊娠期糖尿病(GDM)婦女產(chǎn)后1年糖代謝轉(zhuǎn)歸情況,分析糖代謝轉(zhuǎn)歸異常的可能影響因素,探尋GDM婦女產(chǎn)后轉(zhuǎn)變?yōu)?型糖尿病(T2DM)及糖代謝異常的危險因素,為預(yù)防GDM婦女產(chǎn)后轉(zhuǎn)變?yōu)?型糖尿病提供理論依據(jù)。資料與方法:選取2014年5月至2015年5月在銅陵市某婦幼保健院婦產(chǎn)科門診進行產(chǎn)檢并且在孕24-28周之間進行75g葡萄糖耐量試驗(OGTT)被診斷為GDM的婦女作為研究對象,于2015年7月至2016年5月進行產(chǎn)后1年隨訪。收集研究對象產(chǎn)后1年時的體重、血壓、體成分、母乳喂養(yǎng)情況、體力活動情況等信息。同時復(fù)查OGTT,并檢測空腹血糖、餐后2h血糖、甘油三酯、總膽固醇、高密度脂蛋白、低密度脂蛋白、瘦素、C-反應(yīng)蛋白、脂聯(lián)素、白介素-6水平。了解GDM婦女產(chǎn)后1年T2DM及糖代謝異常發(fā)病率,采用Logistic回歸分析探尋影響糖代謝轉(zhuǎn)歸的危險因素。結(jié)果:(1)經(jīng)過納入排除標準,確定孕中期OGTT試驗診斷出的204名GDM婦女作為研究對象,最終于產(chǎn)后1年隨訪到166名GDM婦女,失訪率為18.6%。經(jīng)過產(chǎn)后1年OGTT試驗,診斷出3例2型糖尿病患者,24例空腹血糖受損患者(IFT),9例餐后2h血糖受損者(IGT),4例空腹血糖受損合并餐后兩小時血糖受損者(IFT合并IGT),產(chǎn)后1年GDM婦女T2DM發(fā)病率為1.81%,糖代謝異常發(fā)病率為24.1%。(2)產(chǎn)后1年糖代謝轉(zhuǎn)歸異常的GDM婦女與糖代謝轉(zhuǎn)歸正常的婦女相比,孕前及產(chǎn)后1年BMI較高,孕早、中、晚期及產(chǎn)后一年空腹血糖水平較高,孕中期餐后1h血糖水平較高,產(chǎn)后1年餐后2h血糖水平較高,產(chǎn)后1年空腹胰島素及胰島素抵抗水平較高,孕早期、孕中期及產(chǎn)后1年甘油三酯水平較高,孕晚期高密低脂蛋白水平較低(P0.05)。此外糖代謝轉(zhuǎn)歸異常的GDM婦女產(chǎn)后1年有著更高的腰圍、肱三頭肌皮褶厚度、肩胛下皮褶厚度、腹部皮褶厚度、體脂肪含量、體脂百分比及收縮壓(P0.05)。(3)C-反應(yīng)蛋白水平與產(chǎn)后1年空腹血糖、空腹胰島素及HOMA-IR水平呈現(xiàn)正相關(guān)趨勢(P0.05),瘦素水平與產(chǎn)后1年空腹胰島素及HOMA-IR水平呈現(xiàn)正相關(guān)趨勢(P0.05)。(4)Logistic回歸分析結(jié)果顯示產(chǎn)后1年BMI、孕中期-產(chǎn)后1年空腹血糖值差異、孕中期-產(chǎn)后1年餐后2h血糖值差異、產(chǎn)后1年體脂百分比及產(chǎn)后一年內(nèi)臟脂肪含量等級是GDM婦女產(chǎn)后糖代謝異常發(fā)生的危險因素(OR=1.679,95%CI[1.085~2.596];OR=5.857,95%CI[1.957~17.529];OR=1.568,95%CI[1.130~2.176];OR=1.481,95%CI[1.042~2.105];OR=0.366,95%CI[0.182~0.732])。結(jié)論:(1)孕前及產(chǎn)后1年BMI,孕期及產(chǎn)后血脂水平,產(chǎn)后1年腰圍、體脂百分比及內(nèi)臟脂肪含量都與GDM婦女產(chǎn)后糖代謝轉(zhuǎn)歸密切相關(guān),其中產(chǎn)后1年BMI、孕中期-產(chǎn)后1年空腹血糖值差異、孕中期-產(chǎn)后1年餐后2h血糖值差異、產(chǎn)后1年體脂百分比及產(chǎn)后一年內(nèi)臟脂肪含量等級均為GDM婦女產(chǎn)后發(fā)生糖代謝異常的危險因素。(2)患有妊娠期糖尿病的婦女產(chǎn)后易發(fā)生T2DM和糖代謝異常,因此對妊娠期糖尿病婦女進行產(chǎn)后隨訪十分必要,對預(yù)防和延遲將來發(fā)生T2DM有重要意義。
[Abstract]:Objective: This study aimed to understand the gestational diabetes mellitus (GDM) women 1 years postpartum glucose metabolism conditions, factors that may affect the outcome of abnormal glucose metabolism, to explore the transformation of GDM postpartum women for type 2 diabetes (T2DM) and the risk factors of abnormal glucose metabolism, for the prevention of postpartum GDM transformation provides a theoretical basis for type 2 diabetes materials and methods: from May 2014 to May 2015 in the Department of Obstetrics and gynecology clinic in Tongling city a hospital for production inspection and glucose tolerance test 75g in 24-28 weeks of pregnancy (OGTT) women diagnosed with GDM as the research object, followed up for 1 years from July 2015 to May 2016. After collected 1 years postpartum the body weight, blood pressure, body composition, breastfeeding, physical activity and other information. At the same time to review the OGTT and fasting blood glucose, 2h postprandial blood glucose, triglyceride, total cholesterol, high density lipoprotein , low density lipoprotein, leptin, adiponectin, C- reactive protein, interleukin -6 level. 1 year incidence of abnormal T2DM and GDM postpartum glucose metabolism rate, Logistic regression analysis was used to explore the risk factors of glucose metabolism outcome. Results: (1) through the inclusion and exclusion criteria, determine the second trimester OGTT diagnosis test the 204 women with GDM as the research object, in the final 1 years postpartum follow-up to 166 women with GDM, the dropout rate was 18.6%. after 1 years postpartum OGTT test, diagnosed 3 cases of patients with type 2 diabetes, 24 cases of patients with impaired fasting glucose (IFT), 9 cases of impaired 2h postprandial blood sugar (IGT) two hours, 4 cases of impaired impaired fasting glucose and postprandial glucose (IFT and IGT), 1 years postpartum women GDM incidence rate of T2DM was 1.81%, the incidence rate of abnormal glucose metabolism in 24.1%. (2) 1 years postpartum glucose metabolism outcome GDM women with abnormal glucose metabolism outcome of normal pregnant and postpartum women compared to 1 BMI High, early, late pregnancy, and postpartum a fasting glucose level is higher, the second trimester 1H postprandial blood glucose level is high, high 2H blood glucose levels 1 years postpartum postpartum 1 years after the meal, fasting insulin and insulin resistance in high level, early pregnancy, pregnancy and postpartum 1 years higher triglyceride levels in late pregnancy, low fat and high density the protein level was low (P0.05). In addition the outcome of glucose metabolism abnormal GDM postpartum women 1 years have a higher waist circumference, triceps skinfold thickness, subscapular skinfold, abdominal skinfold thickness, body fat, body fat percentage and systolic blood pressure (P0.05). (3) the levels of C-reactive protein and C- after 1 years of fasting blood glucose, fasting insulin and HOMA-IR levels showed positive correlation (P0.05), leptin and 1 year postpartum fasting insulin and HOMA-IR levels showed positive correlation (P0.05). (4) Logistic regression analysis results showed that 1 years postpartum BMI, mid pregnancy - 1 years postpartum The fasting blood glucose level difference, the second trimester - 1 years postpartum 2h postprandial blood glucose values, 1 year postpartum body fat percentage and a year postpartum visceral fat content rating is a risk factor for abnormal postpartum glucose metabolism in women with GDM (OR=1.679,95%CI[1.085~2.596] OR=5.857,95%CI[1.957~17.529]; OR=; 1.568,95%CI[1.130~2.176]; OR=1.481,95%CI[1.042~2.105]; OR=0.366,95%CI[0.182~0.732]). Conclusion: (1) before pregnancy and postpartum 1 years BMI, blood lipid levels during pregnancy and postpartum, 1 years postpartum waist circumference, percentage of body fat and visceral fat content and outcome of postpartum glucose metabolism of women is closely related to GDM, including 1 years postpartum BMI, mid pregnancy - 1 years postpartum fasting blood glucose values, second trimester - 1 years postpartum 2h postprandial blood glucose value differences. After 1 years the percentage of body fat and visceral fat level a year postpartum were risk factors of abnormal glucose metabolism in GDM. (2) postpartum women with gestational diabetes mellitus Postpartum women are prone to have abnormal T2DM and glucose metabolism. Therefore, postpartum follow-up is very necessary for women with gestational diabetes mellitus, which is significant for preventing and delaying the occurrence of T2DM in the future.

【學(xué)位授予單位】：安徽醫(yī)科大學(xué)
【學(xué)位級別】：碩士
【學(xué)位授予年份】：2017
【分類號】：R714.256

【參考文獻】

相關(guān)期刊論文 前10條

1 張明;潘麗娟;譚詩亮;安力彬;;妊娠期糖尿病婦女產(chǎn)后血糖管理的研究進展[J];護理學(xué)雜志;2016年06期

2 華春梅;;妊娠期糖尿病孕婦產(chǎn)后糖代謝異常的影響分析[J];糖尿病新世界;2015年11期

3 徐艷梅;雷波;馬愛蘭;;妊娠期糖代謝異�；颊弋a(chǎn)后3年糖代謝轉(zhuǎn)歸的隨訪性研究[J];中國實用醫(yī)藥;2015年15期

4 邱先桃;丘媛媛;高飛;龍燕;陳小娟;蔡敏敏;;妊娠期糖尿病患者孕晚期血清TC、TG、HDL-C、LDL-C與產(chǎn)后糖耐量異常的相關(guān)性分析[J];熱帶醫(yī)學(xué)雜志;2015年04期

5 羅大江;;妊娠期糖尿病相關(guān)危險因素對產(chǎn)后發(fā)生糖尿病的預(yù)測作用[J];實用醫(yī)學(xué)雜志;2014年04期

6 王霖霞;蘇娜;付東霞;王光亞;許金秀;郭寧寧;張云娜;;妊娠期糖尿病患者產(chǎn)后脂代謝轉(zhuǎn)歸隨訪研究[J];現(xiàn)代中西醫(yī)結(jié)合雜志;2014年05期

7 唐林鳳;高燕燕;林慧;姚培培;;純母乳喂養(yǎng)對妊娠期糖尿病患者產(chǎn)后糖脂代謝和體成分的影響[J];山東大學(xué)學(xué)報(醫(yī)學(xué)版);2013年05期

8 蘭玉;;妊娠期糖尿病產(chǎn)后發(fā)生糖尿病的危險因素分析[J];中國醫(yī)藥指南;2012年17期

9 衛(wèi)夢南;吳艷麗;饒明禮;王一清;劉建;;妊娠期糖尿病產(chǎn)后血糖轉(zhuǎn)歸與瘦素水平相關(guān)性研究[J];昆明醫(yī)科大學(xué)學(xué)報;2012年06期

10 戚本華;張燕軍;肖本熙;李遠紅;余薇;李琳;馬文君;;妊娠期糖代謝異常孕婦的產(chǎn)后隨訪研究[J];廣東醫(yī)學(xué);2011年18期

相關(guān)會議論文 前1條

1 趙曼林;馮玉昆;祁文瑾;;HLA-Ⅱ類基因與妊娠期糖尿病和2型糖尿病的比較性研究[A];中國遺傳學(xué)會七屆一次青年研討會暨上海高校模式生物E——研究院第一屆模式生物學(xué)術(shù)研討會論文匯編[C];2005年

相關(guān)碩士學(xué)位論文 前4條

1 馬士俠;妊娠期糖尿病遠期發(fā)展為2型糖尿病危險因素的回顧性前瞻性隊列研究[D];安徽醫(yī)科大學(xué);2011年

2 楊麗穎;妊娠期糖尿病產(chǎn)后2型糖尿病的發(fā)生狀況及行為干預(yù)的探討[D];大連醫(yī)科大學(xué);2011年

3 劉薇;妊娠期糖尿病產(chǎn)后行為干預(yù)對2型糖尿病發(fā)病影響的探討[D];大連醫(yī)科大學(xué);2009年

4 陳映照;妊娠期糖尿病婦女產(chǎn)后糖代謝變化[D];中南大學(xué);2007年

，

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