本文選題：妊娠糖尿病 + 血脂代謝　； 參考：《寧夏醫(yī)科大學(xué)》2014年碩士論文

【摘要】：目的通過(guò)對(duì)不同孕周、不同血糖狀態(tài)的妊娠婦女血脂譜的變化狀況分析，了解妊娠期孕婦的血脂譜波動(dòng)的狀態(tài)，同時(shí)觀察妊娠完成后母體血脂譜的變化狀況。 方法連續(xù)收集2013年1月至2013年12月在寧夏醫(yī)科大學(xué)總醫(yī)院就診患者433例，按照美國(guó)ADA標(biāo)準(zhǔn)分為正常孕婦(NGRG)組315例，妊娠糖尿病孕婦（GDM）組118例，需排除孕前患有糖耐量異常、糖尿病、高血壓和其他內(nèi)分泌代謝性疾病者，排除有煙酒嗜好者。依據(jù)篩查及診斷標(biāo)準(zhǔn)進(jìn)行排除后即可入組。兩組孕婦均進(jìn)行問(wèn)卷調(diào)查和基本實(shí)驗(yàn)室檢查，監(jiān)測(cè)血脂譜、空腹血糖、餐后血糖1小時(shí)、餐后2小時(shí)、餐后3小時(shí)、血壓、血肌酐、尿素氮、白蛋白并做統(tǒng)計(jì)學(xué)分析。 結(jié)果1.正常妊娠組（NGRG組）與妊娠糖尿病組（GDM組）兩組一般臨床資料相比較：妊娠糖尿病組中孕婦的年齡、孕前BMI、妊娠過(guò)程中孕婦的體重增加情況均明顯高于正常妊娠組，兩組比較有顯著差異，兩組間一般臨床資料比較具有統(tǒng)計(jì)學(xué)意義（P0.05）。2.兩組間研究對(duì)象的一般臨床特征：GDM組收縮壓值明顯高于NGRG組，具有統(tǒng)計(jì)學(xué)意義（P0.05）；GDM組白蛋白水平明顯低于NGRG組，具有統(tǒng)計(jì)學(xué)意義。而兩組間舒張壓、血肌酐、尿素氮水平比較無(wú)明顯差異，，不具有統(tǒng)計(jì)學(xué)差異（P0.05）。3.兩組間血糖值對(duì)比得出：可得出GDM組空腹血糖、餐后1小時(shí)、餐后2小時(shí)血糖值水平均明顯高于NGRG組，有明顯差異，具有統(tǒng)計(jì)學(xué)差異（P0.05）。餐后3小時(shí)血糖值GDM組明顯低于NGRG組，具有統(tǒng)計(jì)學(xué)差異（P0.05）。4.兩組間血脂譜分析：在妊娠28周及產(chǎn)后42天后分別監(jiān)測(cè)血脂代謝指標(biāo)，得出表一下結(jié)果：妊娠糖尿病組中的甘油三酯、膽固醇、低密度脂蛋白、載脂蛋白-A水平均明顯高于正常妊娠組，有明顯差異，具有明顯統(tǒng)計(jì)學(xué)意義（P0.05），而妊娠糖尿病組的高密度脂蛋白水平明顯低于正常妊娠組，具有統(tǒng)計(jì)學(xué)差異（P0.05）。5.血脂代謝相關(guān)因素分析：妊娠過(guò)程中孕婦體重增加狀況、基礎(chǔ)體重指數(shù)、餐后1小時(shí)血糖可升高血漿膽固醇及甘油三酯水平，而餐后2小時(shí)血糖還可升高血漿膽固醇。 結(jié)論1.GDM孕婦空腹血糖、餐后1小時(shí)及2小時(shí)血糖升高，餐后3小時(shí)血糖降低，應(yīng)監(jiān)測(cè)餐后3小時(shí)血糖，以防孕期低血糖的發(fā)生。2.GDM孕婦存在甘油三酯、膽固醇、低密度脂蛋白、載脂蛋白-A的升高，且存在高密度脂蛋白水平降低，即使在生產(chǎn)后仍難以恢復(fù)，其血脂水平的升高與孕婦基礎(chǔ)指數(shù)、孕期體重增加狀況有關(guān)。3.孕期監(jiān)測(cè)血糖、血脂、血壓等指標(biāo)尤其重要，孕期調(diào)整飲食結(jié)構(gòu)、改善生活習(xí)慣、適當(dāng)運(yùn)動(dòng)等可有效減少妊娠不良結(jié)局的發(fā)生。
[Abstract]:Objective to analyze the changes of serum lipids in pregnant women with different gestational weeks and different blood glucose status, and to understand the fluctuating state of blood lipids in pregnant women. Methods from January 2013 to December 2013, 433 patients in the General Hospital of Ningxia Medical University were collected and divided into normal pregnant women group (315 cases) and normal pregnant women group (NGRG) according to American ADA standard. In the GDM group 118 patients with gestational diabetes should be excluded from impaired glucose tolerance diabetes hypertension and other endocrine and metabolic diseases. According to the screening and diagnostic criteria for exclusion can be added to the group. The blood lipid profile, fasting blood glucose, postprandial blood glucose 1 hour, postprandial 2 hours, postprandial 3 hours, blood pressure, serum creatinine, urea nitrogen, albumin and statistical analysis were performed in both groups. Normal pregnancy group (NGRG group) and gestational diabetes group (GDM group) the general clinical data of the two groups were as follows: the age of pregnant women in gestational diabetes group, pre-pregnancy BMIs and weight gain during pregnancy were significantly higher than those in normal pregnancy group. There is a significant difference between the two groups, the general clinical data between the two groups have statistical significance (P 0.05). 2. The general clinical features of the two groups were as follows: the systolic blood pressure of the two groups was significantly higher than that of the NGRG group, and the albumin level in the GDM group was significantly lower than that in the NGRG group. However, there was no significant difference in diastolic blood pressure, serum creatinine and urea nitrogen levels between the two groups. The results showed that fasting blood glucose, 1 hour after meal and 2 hours after meal in GDM group were significantly higher than those in NGRG group (P 0.05). 3 hours postprandial blood glucose level in GDM group was significantly lower than that in NGRG group (P 0.05. 4). Blood lipid spectrum analysis between the two groups: blood lipid metabolism indexes were monitored at 28 weeks of pregnancy and 42 days after delivery, and the following results were obtained: triglyceride, cholesterol, low density lipoprotein in gestational diabetes mellitus group, The level of apolipoprotein A was significantly higher than that of normal pregnancy group (P 0.05), while the level of high density lipoprotein in gestational diabetes group was significantly lower than that in normal pregnancy group (P 0.05. 5). Factors related to blood lipid metabolism: maternal weight gain, basal body mass index and 1 hour postprandial blood glucose increased plasma cholesterol and triglyceride levels during pregnancy. Conclusion 1. The fasting blood glucose of GDM pregnant women increased at 1 hour and 2 hours postprandial, but decreased at 3 hours postprandial, so the blood glucose of 3 hours after meal should be monitored. To prevent hypoglycemia during pregnancy. 2. GDM pregnant women have elevated triglycerides, cholesterol, low density lipoprotein, apolipoprotein A, and reduced high density lipoprotein levels, which are difficult to recover even after childbirth. The increase of serum lipids was related to the basic index of pregnant women and the weight gain during pregnancy. It is very important to monitor blood sugar, blood lipid and blood pressure during pregnancy. Adjusting diet structure, improving living habits and proper exercise during pregnancy can effectively reduce the occurrence of adverse outcome of pregnancy.
【學(xué)位授予單位】：寧夏醫(yī)科大學(xué)
【學(xué)位級(jí)別】：碩士
【學(xué)位授予年份】：2014
【分類號(hào)】：R714.256

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