孕期糖耐量不同變化與妊娠結局及胰島素分泌水平的相關性研究
發(fā)布時間：2018-08-27 15:48
【摘要】：研究背景妊娠改變機體糖代謝,嚴重時可發(fā)生妊娠期糖尿病。血糖管理是孕期重要的管理項目之一,持續(xù)高血糖狀態(tài)會增加不良妊娠結局的發(fā)生風險,甚至影響孕母及子代的近遠期健康。75g OGTT檢查是目前診斷孕期糖代謝異常的主要檢查,隨著HAPO研究結果的出現(xiàn),現(xiàn)國內(nèi)外多采用IADPSG診斷標準確診妊娠期糖尿病,我國也制定了相關指南,統(tǒng)一使用該標準。OGTT中早時相胰島素分泌不足、延遲或消失是T2DMβ-細胞功能缺陷的表現(xiàn)之一。正常人在給予糖負荷后,約30分鐘時肘靜脈血中血糖可達峰值,服糖后1～2小時血糖可回降至接近空腹水平。但糖代謝異常者并不遵循此規(guī)律,該類人群可出現(xiàn)血糖值逆向增高或回降延遲,即其代謝曲線表現(xiàn)為逐漸上升趨勢。同時,胰島素作為調(diào)控機體糖代謝的重要激素,主要由胰島β-細胞合成分泌,當胰島素出現(xiàn)分泌不足、分泌延遲或胰島素受體抵抗、敏感性下降等情況會影響機體糖代謝途徑的進行。研究者們常使用與胰島素分泌濃度相關的指標來評價機體胰島細胞分泌功能及胰島素受體抵抗性。目前認為,糖尿病的致病原因與胰島素分泌不足及抵抗增加有關。第一章糖耐量變化趨勢與妊娠結局的關系研究研究目的采用回顧性分析的研究方法,探討孕期糖耐量變化趨勢與妊娠結局的關系,為臨床上早期發(fā)現(xiàn)和早期干預孕期糖代謝異常孕產(chǎn)婦提供理論依據(jù),減少不良妊娠結局的發(fā)生。對象與方法1研究對象選擇2014年在本單位規(guī)律產(chǎn)檢及分娩的孕產(chǎn)婦作為研究對象,根據(jù)其孕期75g OGTT結果,納入正常組235例,血糖逆向增高組226例及妊娠期糖尿病組255例。2方法采用回顧性分析的研究方法,結合孕期病歷資料,將三組血糖相關指標及不良妊娠結局發(fā)生情況分別進行比較。采用SPSS19.0對數(shù)據(jù)進行統(tǒng)計分析。結果1 一般資料比較GDM組年齡、孕次及產(chǎn)次均大于另兩組,差異有統(tǒng)計學意義。三組終止妊娠孕周差異均有統(tǒng)計學意義,分別是逆向增高組正常組GDM組。2血糖相關指標比較三組中,GDM組空腹血糖最高,與另兩組差異有統(tǒng)計學意義。三組間服糖后1小時血糖及2小時血糖差異均有統(tǒng)計學意義。其中,逆向增高組在服糖后1小時血糖低于正常組,卻在服糖后2小時血糖高于正常組,差異有統(tǒng)計學意義。而對比孕期糖化血紅蛋白時,GDM組最高,與另兩組比較差異有統(tǒng)計學意義。3妊娠結局比較GDM組早產(chǎn)發(fā)生率最高,差異有統(tǒng)計學意義。逆向增高組羊水過多、羊水過少、FGR、早產(chǎn)等發(fā)生率均高于正常組,但差異無統(tǒng)計學意義。逆向增高組及GDM組新生兒轉(zhuǎn)科率均高于正常組,差異有統(tǒng)計學意義。結論血糖的合理管理對妊娠結局的影響具有重要的意義。孕期血糖逆向增高者存在糖代謝途徑異常,可能從多因素微改變綜合影響到母兒的妊娠結局。臨床上除了監(jiān)測妊娠期糖尿病孕產(chǎn)婦外,仍需警惕對孕期血糖逆向增高者的孕期管理。第二章探索胰島素分泌水平與孕期血糖的關系研究目的采用前瞻性觀察的研究方法,比較三組血糖濃度及胰島素分泌水平的關系,嘗試從胰島素水平解釋三組糖代謝趨勢差異發(fā)生的可能原因,為臨床上對糖代謝異常者早期干預提供理論依據(jù)。對象與方法1研究對象收集2016年本單位定期產(chǎn)檢孕產(chǎn)婦病歷資料,根據(jù)其75g OGTT結果同上分為三組,納入正常組38例,血糖逆向增高組24例及妊娠期糖尿病組28例。2方法采用前瞻性觀察的研究方法,比較三組間孕期75g OGTT檢查及其胰島素檢測結果,引入胰島素相關評價指標一并進行分析研究。統(tǒng)計方法同上。結果1血糖及胰島素值三組血糖結果與第一章相似。比較各組見空腹情況下胰島素分泌水平差異無統(tǒng)計學意義。逆向增高組服糖后1小時胰島素最低,與另兩組相比差異有統(tǒng)計學意義。GDM組中服糖后2小時胰島素最高,與另兩組相比差異有統(tǒng)計學意義。2血糖及胰島素相關性正常組血糖值與胰島素分泌水平呈中強度正相關。逆向增高組與GDM組胰島素分泌趨勢相似。逆向增高組空腹胰島素與血糖值不相關,而GDM組服糖后1小時胰島素與血糖不相關,差異均有統(tǒng)計學意義。3胰島素評價指標靜息狀態(tài)下,GDM組HOMA-βF最低,而正常組HOMA-βF最高;在給予葡萄糖負荷后,逆向增高組MBCI明顯高于另兩組,差異有統(tǒng)計學意義(P0.05)。GDM組ISI △I60/ΔG60在三組中最低,而HOMA-IR最高,差異均有統(tǒng)計學意義(P0.05)。結論胰島素是調(diào)控機體血糖的重要激素,其分泌水平及血糖濃度具有中強度相關性。孕期血糖逆向增高者存在基礎胰島素分泌不足且動態(tài)胰島素分泌相對不足的情況,其胰島素分泌趨勢與妊娠期糖尿病者相類似,提示孕期血糖逆向增高可能是妊娠期糖尿病前期過度狀態(tài)。妊娠期糖尿病者存在胰島素分泌不足及胰島素抵抗增強,并且主要表現(xiàn)在給予葡萄糖負荷的1小時內(nèi)。
[Abstract]:Background Gestational diabetes mellitus (GDM) occurs when pregnancy changes glucose metabolism. Glucose management is one of the most important management items during pregnancy. Persistent hyperglycemia increases the risk of adverse pregnancy outcomes, and even affects the near and long term health of pregnant women and their offspring. With the emergence of HAPO research results, IADPSG diagnostic criteria have been widely used to diagnose gestational diabetes mellitus at home and abroad, and related guidelines have been formulated in China to unify the use of the criteria. The blood glucose in venous blood can reach the peak value and return to near fasting level 1-2 hours after taking glucose. However, the abnormal glucose metabolism does not follow this rule. The reverse increase or delay of blood glucose may occur in this group, that is, the metabolic curve shows a gradual upward trend. When insulin is secreted inadequately, delayed or resistant to insulin receptors, or decreased sensitivity, the pathway of glucose metabolism is affected by the synthesis and secretion of beta-cells from pancreatic islets. Chapter 1 The relationship between the change trend of glucose tolerance and pregnancy outcomes Objective To explore the relationship between the change trend of glucose tolerance during pregnancy and pregnancy outcomes by retrospective analysis, so as to find out and interfere with glucose metabolism in early pregnancy. Objectives and Methods 1 The study subjects selected the pregnant and lying-in women who underwent regular obstetric examination and delivery in our unit in 2014 as the research objects. According to the results of 75 g OGTT during pregnancy, 235 cases were included in the normal group, 226 cases in the reverse hyperglycemia group and 255 cases in the gestational diabetes mellitus group. The data were analyzed by SPSS 19.0. Results 1 The age, gestation and delivery times of GDM group were higher than those of the other two groups, and the difference was statistically significant. The difference was statistically significant, respectively, in the reverse-elevation group normal group GDM group. 2 Blood glucose-related indicators compared with the other two groups, GDM group fasting blood glucose was the highest, and the difference was statistically significant. Compared with the other two groups, the GDM group had the highest incidence of preterm labor, the difference was statistically significant. 3 Pregnancy outcomes were the highest in GDM group, the difference was statistically significant. Conclusion The reasonable management of blood glucose is of great significance to the pregnancy outcome. The second chapter explores the relationship between insulin secretion and blood glucose during pregnancy. Objective To compare the blood glucose concentration and insulin secretion in three groups by prospective observation. Objectives and Methods 1 The subjects collected the medical records of pregnant and lying-in women at regular maternity check-ups in 2016, and were divided into three groups according to the results of 75g OGTT, and 38 cases were included in the normal group. Methods A prospective study was conducted in 24 patients with hyperglycemia and 28 patients with gestational diabetes mellitus. The results of 75 g OGTT and insulin test were compared among the three groups, and the insulin-related evaluation indexes were introduced. The statistical methods were the same. Results 1 Blood glucose and insulin levels in the three groups were compared with those in the first chapter. There was no significant difference in insulin secretion between the two groups. The lowest insulin level was found in the reverse-elevation group 1 hour after taking glucose, which was significantly different from the other two groups. There was no correlation between fasting insulin and blood glucose in the reverse elevation group, but no correlation between insulin and blood glucose in the GDM group at 1 hour after taking glucose. 3 The HOMA-beta F of GDM group was the lowest in the resting state of insulin evaluation index, while the HOMA-beta F was the lowest in the reverse elevation group. HOMA-beta F was the highest in the normal group, and MBCI was significantly higher in the reverse-elevation group than in the other two groups after glucose loading (P 0.05). ISI Delta I60/G60 in the GDM group was the lowest in the three groups, while HOMA-IR was the highest, the difference was statistically significant (P 0.05). Conclusion Insulin is an important hormone regulating blood glucose, and its secretion level and blood glucose concentration were significantly higher in the GDM group. There is a moderate intensity correlation between the degree of hyperglycemia during pregnancy and the degree of hyperglycemia during pregnancy. Insulin secretion and insulin secretion were increased and mainly manifested in 1 hours of glucose loading.
【學位授予單位】：南方醫(yī)科大學
【學位級別】：碩士
【學位授予年份】：2017
【分類號】：R714.256
本文編號：2207732
[Abstract]:Background Gestational diabetes mellitus (GDM) occurs when pregnancy changes glucose metabolism. Glucose management is one of the most important management items during pregnancy. Persistent hyperglycemia increases the risk of adverse pregnancy outcomes, and even affects the near and long term health of pregnant women and their offspring. With the emergence of HAPO research results, IADPSG diagnostic criteria have been widely used to diagnose gestational diabetes mellitus at home and abroad, and related guidelines have been formulated in China to unify the use of the criteria. The blood glucose in venous blood can reach the peak value and return to near fasting level 1-2 hours after taking glucose. However, the abnormal glucose metabolism does not follow this rule. The reverse increase or delay of blood glucose may occur in this group, that is, the metabolic curve shows a gradual upward trend. When insulin is secreted inadequately, delayed or resistant to insulin receptors, or decreased sensitivity, the pathway of glucose metabolism is affected by the synthesis and secretion of beta-cells from pancreatic islets. Chapter 1 The relationship between the change trend of glucose tolerance and pregnancy outcomes Objective To explore the relationship between the change trend of glucose tolerance during pregnancy and pregnancy outcomes by retrospective analysis, so as to find out and interfere with glucose metabolism in early pregnancy. Objectives and Methods 1 The study subjects selected the pregnant and lying-in women who underwent regular obstetric examination and delivery in our unit in 2014 as the research objects. According to the results of 75 g OGTT during pregnancy, 235 cases were included in the normal group, 226 cases in the reverse hyperglycemia group and 255 cases in the gestational diabetes mellitus group. The data were analyzed by SPSS 19.0. Results 1 The age, gestation and delivery times of GDM group were higher than those of the other two groups, and the difference was statistically significant. The difference was statistically significant, respectively, in the reverse-elevation group normal group GDM group. 2 Blood glucose-related indicators compared with the other two groups, GDM group fasting blood glucose was the highest, and the difference was statistically significant. Compared with the other two groups, the GDM group had the highest incidence of preterm labor, the difference was statistically significant. 3 Pregnancy outcomes were the highest in GDM group, the difference was statistically significant. Conclusion The reasonable management of blood glucose is of great significance to the pregnancy outcome. The second chapter explores the relationship between insulin secretion and blood glucose during pregnancy. Objective To compare the blood glucose concentration and insulin secretion in three groups by prospective observation. Objectives and Methods 1 The subjects collected the medical records of pregnant and lying-in women at regular maternity check-ups in 2016, and were divided into three groups according to the results of 75g OGTT, and 38 cases were included in the normal group. Methods A prospective study was conducted in 24 patients with hyperglycemia and 28 patients with gestational diabetes mellitus. The results of 75 g OGTT and insulin test were compared among the three groups, and the insulin-related evaluation indexes were introduced. The statistical methods were the same. Results 1 Blood glucose and insulin levels in the three groups were compared with those in the first chapter. There was no significant difference in insulin secretion between the two groups. The lowest insulin level was found in the reverse-elevation group 1 hour after taking glucose, which was significantly different from the other two groups. There was no correlation between fasting insulin and blood glucose in the reverse elevation group, but no correlation between insulin and blood glucose in the GDM group at 1 hour after taking glucose. 3 The HOMA-beta F of GDM group was the lowest in the resting state of insulin evaluation index, while the HOMA-beta F was the lowest in the reverse elevation group. HOMA-beta F was the highest in the normal group, and MBCI was significantly higher in the reverse-elevation group than in the other two groups after glucose loading (P 0.05). ISI Delta I60/G60 in the GDM group was the lowest in the three groups, while HOMA-IR was the highest, the difference was statistically significant (P 0.05). Conclusion Insulin is an important hormone regulating blood glucose, and its secretion level and blood glucose concentration were significantly higher in the GDM group. There is a moderate intensity correlation between the degree of hyperglycemia during pregnancy and the degree of hyperglycemia during pregnancy. Insulin secretion and insulin secretion were increased and mainly manifested in 1 hours of glucose loading.
【學位授予單位】：南方醫(yī)科大學
【學位級別】：碩士
【學位授予年份】：2017
【分類號】：R714.256
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