本文選題：妊娠期糖尿病 + 脂肪酸水平��； 參考：《安徽醫(yī)科大學(xué)》2016年碩士論文

【摘要】：目的:探討妊娠期糖尿病及其糖脂代謝對(duì)新生兒體脂含量的影響,為GDM母體及新生兒的管理提供參考依據(jù)。方法:選取2014年5月至2015年5月,在銅陵市婦幼保健院產(chǎn)前門(mén)診做常規(guī)產(chǎn)檢并在此院分娩的孕早期孕婦。按照納入排除標(biāo)準(zhǔn),取得知情同意后,建立前瞻性觀察隊(duì)列,收集孕婦及新生兒人口統(tǒng)計(jì)學(xué)資料及身體測(cè)量指標(biāo)基本信息。于孕24-28周,進(jìn)行75g口服葡萄糖耐量試驗(yàn)(OGTT試驗(yàn)),并根據(jù)國(guó)際妊娠與糖尿病研究組織(IADPSG)診斷標(biāo)準(zhǔn):空腹血糖≥5.1mm/L,負(fù)荷后1h血糖≥10.0mm/L,負(fù)荷后2h血糖≥8.5mm/L,任意一點(diǎn)血糖值達(dá)到或超過(guò)上述界值,即可診斷為GDM。采集孕婦孕晚期的肘靜脈血及新生兒臍帶血,并將血清放在-81℃冰箱保存?zhèn)溆谩２捎脷庀嗌V-質(zhì)譜(GC-MS)聯(lián)用技術(shù),檢測(cè)孕婦孕晚期血清及臍帶血清中脂肪酸的種類及其水平。用Dauncey法計(jì)算新生兒體脂含量。結(jié)果:(1)GDM組與對(duì)照組一般人口學(xué)特征:本研究共632例孕婦,其中GDM組189例,對(duì)照組443例,平均年齡27.1±4.0歲,其中最大年齡43歲,最小年齡17歲;GDM組平均年齡27.8±4.0歲,對(duì)照組平均年齡26.8±4.0歲。GDM組平均身高160.8±4.4cm,對(duì)照組平均身高161.0±4.5cm。GDM組與對(duì)照組相比,孕前BMI(21.0±3.0kg/m2 vs.20.1±2.4 kg/m2,P=0.001)、胎盤(pán)重量(577.0±100.4g vs.554.0±91.3g,P=0.039),差異有統(tǒng)計(jì)學(xué)意義。GDM組孕期增重為15.5±5.3kg,低于對(duì)照組16.8±5.0kg,差異有統(tǒng)計(jì)學(xué)意義(P0.05)。(2)GDM組和對(duì)照組新生兒體格測(cè)量資料的比較:GDM組新生兒出生體重3397.1±500.8g、身長(zhǎng)50.1±2.0cm、頂臀長(zhǎng)32.1±1.9cm、頭圍34.7±1.7cm、胸圍34.0±1.8cm、上臂圍11.9±1.0cm、大腿圍15.9±1.3cm、小腿圍11.7±1.1cm,與對(duì)照組相比,差異均無(wú)統(tǒng)計(jì)學(xué)意義;而全臂長(zhǎng)15.3±1.3cm、肱三頭肌皮褶厚度6.4±1.5mm、肩胛下皮褶厚度6.0±1.4 mm,均高于對(duì)照組,差異均有統(tǒng)計(jì)學(xué)意義(P0.05)。GDM組新生兒總脂肪質(zhì)量平均為0.65±0.29kg、體脂百分比含量為18.37±5.92%,對(duì)照組分別為0.53±0.22kg、15.45±4.89%,GDM組新生兒總脂肪質(zhì)量及體脂百分比含量均高于對(duì)照組,兩組之間的差異有統(tǒng)計(jì)學(xué)意義(P0.05)。(3)GDM組和對(duì)照組孕婦孕期血糖、血脂及脂肪酸水平的比較:(1)GDM組孕婦孕早期血糖、血脂水平的比較,GDM孕早期空腹血糖(FPG)為5.16±0.48mmol/L、TG為1.57±0.68mmol/L、HDL為1.61±0.39mmol/L、LDL為2.20±0.46mmol/L均高于對(duì)照組孕婦,差異均有統(tǒng)計(jì)學(xué)意義(P0.05)。(2)孕中期孕婦孕24-28周口服75g葡糖糖耐量試驗(yàn),GDM組空腹血糖、餐后1h血糖及餐后2小時(shí)血糖分別為5.19±0.46 mmol/L、9.84±1.74 mmol/L、7.51±1.43 mmol/L,對(duì)照組三個(gè)時(shí)間點(diǎn)血糖值分別為4.57±0.28 mmol/L、7.74±1.50 mmol/L、6.28±4.06mmol/L。結(jié)果顯示GDM組每個(gè)時(shí)間點(diǎn)的血糖值均高于對(duì)照組,兩組之間每個(gè)時(shí)間點(diǎn)血糖值差異均有統(tǒng)計(jì)學(xué)意義(P0.001)。(3)GDM組孕婦孕晚期FPG為5.03±0.54 mmol/L,TG為3.94±1.52 mmol/L、均高于對(duì)照組孕婦,差異具有統(tǒng)計(jì)學(xué)意義(P0.05)。(4)GDM組和對(duì)照組孕婦孕晚期血清SOD、MDA、GSH-Px、8-異前列腺素差異均無(wú)統(tǒng)計(jì)學(xué)意義。(4)(1)GDM組與對(duì)照組孕晚期母血血清及臍血血清脂肪酸組成譜的比較。GDM組n-6PUFA中C20:2,n-6低于對(duì)照組(0.37±0.06%vs.0.39±0.07%,P=0.049),差異有統(tǒng)計(jì)學(xué)意義;而GDM組單不飽和脂肪酸(MUFA)總量、C18:1,n-9均高于對(duì)照組(21.97±2.50%vs.21.04±2.45%,P=0.010;18.09±2.40%vs.17.10±2.19%,P=0.003),差異有統(tǒng)計(jì)學(xué)意義。然而,GDM組與對(duì)照組臍血中的脂肪酸含量差異均無(wú)統(tǒng)計(jì)學(xué)意義(P0.05)。(2)GDM組血清脂肪酸含量在孕晚期母血和臍血中的差異分析,GDM組母血中LC-PUFA總量、n-3PUFA中α-亞麻酸(C18:3,n-3)、C20:5,n-3(EPA)、n-6 PUFA總量、亞油酸(C18:2,n-6)、C20:2,n-6、MUFA總量、C18:1,n-9、C24:1,n-9、SFA中C14:0脂肪酸水平及omega-6:omega-3均高于臍血,差異有統(tǒng)計(jì)學(xué)意義。而臍血中n-3 PUFA總量、C22:6,n-3(DHA)、n-6 PUFA中γ-亞麻酸(C18:3,n-6)、C20:3,n-6、C20:4,n-6(AA)、C22:4,n-6、單不飽和脂肪酸(MUFA)中C16:1,n-7;飽和脂肪酸(SFA)中SFA總量、C18:0、C20:0、C22:0、C24:0脂肪酸水平、omega-3指數(shù)及AA:EPA均顯著高于母血,差異具有統(tǒng)計(jì)學(xué)意義(P0.001)。而n-3PUFA中C22:5,n-3、MUFA中C20:1,n-9、SFA中C16:0,母血和臍血中的脂肪酸水平差異均無(wú)統(tǒng)計(jì)學(xué)意義(P0.05)。(5)新生兒體脂含量影響因素的多元線性回歸分析:患有妊娠期糖尿病(β=3.509,P0.001))、分娩孕周(β=1.505,P0.001)、C18:1,n-9(β=1.259,P=0.001)、孕前BMI(β=0.259,P=0.019)、DHA(β=0.980,P=0.031)與新生兒體脂百分比含量呈正相關(guān),而MUFA總量(β=-0.713,P=0.039)與新生兒體脂百分比含量呈負(fù)相關(guān)。結(jié)論:妊娠期糖尿病孕婦所分娩的新生兒體脂含量增多。妊娠期糖尿病患者體內(nèi)糖脂代謝紊亂,引起宮內(nèi)環(huán)境異常,進(jìn)而引起新生兒體脂集聚。
[Abstract]:Objective: To investigate the effect of gestational diabetes and its glycolipid metabolism on the body fat content of the newborn, and to provide reference for the management of GDM mother and newborn. Methods: to select the pregnant women in the early pregnancy in the outpatient clinic of Tongling maternal and child health care hospital from May 2014 to May 2015. After 24-28 weeks of pregnancy, the 75g oral glucose tolerance test (OGTT test) was carried out, and the diagnostic criteria of international pregnancy and diabetes research organization (IADPSG): fasting blood glucose was more than 5.1mm/L, and 1H blood sugar was more than 10.0mm after load. /L, after the load, the blood sugar of 2H is more than 8.5mm/L, and any point of blood sugar reaches or exceeds the above boundary value, it can be diagnosed as GDM. to collect the elbow vein blood and newborn umbilical cord blood in the late pregnancy of pregnant women, and put the serum in the -81 refrigerator to keep the reserve. The gas chromatography mass spectrometry (GC-MS) technique is used to detect the fatty acids in the serum and umbilical cord serum of pregnant women in the late pregnancy. Dauncey method was used to calculate the body fat content of the newborn. Results: (1) the general demographic characteristics of group GDM and control group: there were 632 cases of pregnant women in this study, including 189 cases in group GDM and 443 cases in control group, the average age was 27.1 + 4 years old, the maximum age was 43 years and the minimum age was 17 years old; the average age of the group GDM was 27.8 + 4 years, the average age of the control group was 26.8 + 4. The average height of.0 year old.GDM group was 160.8 + 4.4cm, and the average height of the control group was 161 + 4.5cm.GDM. Compared with the control group, the pre pregnancy BMI (21 + 3.0kg/m2 vs.20.1 + 2.4 kg/m2, P=0.001) and the placental weight (577 + 100.4g vs.554.0 91.3g) were 15.5 +. Study significance (P0.05). (2) comparison of the physical measurement data between the GDM group and the control group: the birth weight of the GDM group was 3397.1 + 500.8g, the length of the body was 50.1 + 2.0cm, the length of the top hip was 32.1 + 1.9cm, the head circumference was 34.7 + 1.7cm, the chest circumference was 34 + 1.8cm, the upper arm circumference was 11.9 + 1.0cm, the thigh circumference was 15.9 + 1.3cm, and the leg circumference was 11.7 + 1.1cm. The difference was not statistically significant compared with the control group. The total arm length was 15.3 + 1.3cm, the skin fold thickness of the triceps brachii was 6.4 + 1.5mm, and the thickness of the subscapular skin pleats was 6 + 1.4 mm, which were all higher than the control group. The difference was statistically significant (P0.05) in the.GDM group, the total fat of the newborn was 0.65 + 0.29kg, the percentage of body fat was 18.37 + 5.92%, and the control group was 0.53 + 0.22kg, 15.45 + 4.89%, GDM new birth. The total fat mass and body fat percentage were higher than those of the control group, the difference between the two groups was statistically significant (P0.05). (3) the blood glucose, blood lipid and fatty acid levels of pregnant women in group GDM and control group were compared: (1) in group GDM, blood glucose and blood lipid levels were compared in group GDM, 5.16 + 0.48mmol/L in early stage of pregnancy (FPG) and 1.57 + 0.68 in TG. Mmol/L, HDL was 1.61 + 0.39mmol/L, and LDL was 2.20 + 0.46mmol/L higher than the control group, the difference was statistically significant (P0.05). (2) 24-28 weeks pregnant women were given oral 75g glucose tolerance test, GDM group fasting blood glucose, postprandial 1H blood sugar and 2 hours postprandial blood sugar 5.19 + 0.46 mmol/L, 9.84 + 1.74 mmol/L, 7.51 + 1.43 mmol/L, control group The blood glucose values at three time points were 4.57 + 0.28 mmol/L, 7.74 + 1.50 mmol/L and 6.28 + 4.06mmol/L. respectively. The blood glucose values at each time point in group GDM were higher than those in the control group. The blood sugar values at each time point between the two groups were statistically significant (P0.001). (3) the FPG in the late pregnant women of group GDM was 5.03 + 0.54 mmol/L, TG was 3.94 + 1.52 mmol/L, both high In the control group, the difference was statistically significant (P0.05). (4) there was no significant difference in serum SOD, MDA, GSH-Px, 8- isoprostaglandins in the late pregnancy of the GDM group and the control group. (1) the composition of the serum and umbilical blood fatty acids in the GDM group and the control group was compared to the.GDM group n-6PUFA C20:2, n-6 lower than the control group (0.37 + 0.06%vs.). 0.39 + 0.07%, P=0.049), the difference was statistically significant, but the total amount of MUFA, C18:1, N-9 in group GDM were higher than those in the control group (21.97 + 2.50%vs.21.04 + 2.45%, P=0.010, 18.09 + 2.40%vs.17.10 + 2.19%, P=0.003), and the difference was statistically significant (P0.0) (P0.0) (2) the difference between the serum fatty acid content in the GDM group and the difference in the maternal and umbilical blood in the late pregnancy, the total amount of LC-PUFA in the mother blood of the group GDM, the C18:3, n-3, C20:5, n-3 (EPA) and n-6 PUFA in n-3PUFA. The total amount of n-3 PUFA in umbilical cord blood, C22:6, n-3 (DHA), C18:3, n-6 in n-6 PUFA, C20:3, n-6, C20:4. There were statistical significance (P0.001). But there was no significant difference in the levels of fatty acids in C22:5, n-3, MUFA, C20:1, N-9, SFA in MUFA, N-9, SFA, and maternal and umbilical blood (P0.05). (5) multivariate linear regression analysis of factors affecting body fat content in newborns: gestational diabetes mellitus (beta =3.509, P0.001)) =1.259, P=0.001), pre pregnancy BMI (beta =0.259, P=0.019), DHA (beta =0.980, P=0.031) and newborn body fat percentage content positive correlation, but the total amount of MUFA (beta =-0.713, P=0.039) is negatively correlated with the percentage of body fat in newborn babies. Conclusion: gestational diabetes pregnant women born with increased body fat content. Gestational diabetes patients with Glycolipid Xie's disorder causes abnormal intrauterine environment, which leads to body fat accumulation in newborns.
【學(xué)位授予單位】：安徽醫(yī)科大學(xué)
【學(xué)位級(jí)別】：碩士
【學(xué)位授予年份】：2016
【分類號(hào)】：R714.256

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