【摘要】：研究背景：妊娠期高血糖包括糖尿病合并妊娠與妊娠期間首次發(fā)現(xiàn)的高血糖。2013年WHO對妊娠期新診斷的高血糖進行了重新分類,包括妊娠期間的糖尿病(diabetes mellitus in pregnancy,DIP)和妊娠期糖尿病(gestational diabetes mellitus,GDM),前者血糖診斷標準與1999年WHO的非妊娠人群糖尿病診斷標準一致。IDF的數(shù)據(jù)顯示,妊娠婦女孕期高血糖世界范圍內(nèi)發(fā)病率為6.9%,而我國發(fā)病率高達7.0%。妊娠期糖尿病(GDM)是妊娠期最常見的代謝性疾病,指妊娠期發(fā)生或初次發(fā)現(xiàn)的不同程度的糖耐量異常,它的發(fā)生率呈逐年上升趨勢。目前國際上對妊娠期糖尿病采用的診斷方法和標準尚未完全統(tǒng)一,因而報道的發(fā)生率相差較大,為1%～14%。謝幸等人指出,近年來隨著人們膳食結構的改變及GDM診斷標準的重新設定,GDM的診斷率呈上升趨勢,在我國GDM的發(fā)病率為1%～-5%。HAPO研究證實,妊娠期高血糖作為妊娠期間最常見的內(nèi)科并發(fā)癥,可導致母嬰的多種不良妊娠結局,如巨大兒、先兆子癇、妊娠期高血壓疾病、早產(chǎn)、肩難產(chǎn)、產(chǎn)傷、剖宮產(chǎn)、新生兒低血糖、新生兒高膽紅素血癥等,甚至可以導致孕婦及后代遠期發(fā)生代謝紊亂。血糖波動作為糖代謝紊亂的特征性表現(xiàn)之一,通過氧化應激使體內(nèi)氧自由基產(chǎn)生增多、血管內(nèi)皮功能紊亂參與糖尿病血管并發(fā)癥的發(fā)生發(fā)展。GDM患者的血糖波動與變異更為顯著,與其胰島p細胞功能缺陷及胰島素抵抗相關。隨著孕周的增加,妊娠中晚期垂體與胎盤分泌的多種激素增多導致生理性胰島素抵抗不斷加重,孕婦體內(nèi)胰島素分泌代償性增加至非孕期的2-3倍,以代償生理性的胰島素抵抗。GDM患者體內(nèi)還存在著慢性胰島素抵抗,使胰島素敏感性進一步下降；當胰島p細胞功能障礙使胰島素分泌不能滿足孕期對胰島素的需求,則導致孕期高血糖的出現(xiàn)。此外還有研究表明,產(chǎn)后恢復正常糖耐量的GDM患者在哺乳期間甚至產(chǎn)后1年,平均血糖水平及血糖波動仍較孕期血糖正常的婦女升高,提示GDM患者產(chǎn)后仍然存在著胰島β細胞功能缺陷與胰島素抵抗,增加了GDM患者遠期發(fā)生2型糖尿病的風險。血糖監(jiān)測是糖尿病治療的手段之一,而傳統(tǒng)的靜脈血及微量血糖儀檢測的血糖僅能反映瞬時的點血糖值,并不能反映線性血糖的特征及規(guī)律。隨著血糖監(jiān)測技術的發(fā)展,動態(tài)血糖監(jiān)測(continuous glucose monitoring,CGM)這種類似于"Holter"的微創(chuàng)監(jiān)測系統(tǒng)日益成熟,為目前最先進的血糖監(jiān)測技術,每10s從探頭獲取1次電信號,每5分鐘可以將信號平均值進行儲存,全天共可記錄288個血糖值,可以連續(xù)監(jiān)測72小時患者血糖水平,其優(yōu)勢在于能發(fā)現(xiàn)自我血糖監(jiān)測不易探測到的高血糖與低血糖,尤其是餐后高血糖和夜間無癥狀性低血糖,有助于全面分析血糖波動變化的趨勢、幅度、頻率、時間及其原因等。GDM與其他類型的糖尿病一樣,飲食控制對糖尿病的管理至關重要。鑒于妊娠這個階段的特殊性,除非病情非常嚴重,一般不采用藥物或胰島素干涉。然而GDM患者整體血糖水平升高及血糖波動增加與圍產(chǎn)期母嬰不良結局密切相關。美國糖尿病協(xié)會(American Diabetes Association,ADA)在糖尿病營養(yǎng)治療指南中建議,所有GDM患者確診時應盡可能咨詢營養(yǎng)學家的營養(yǎng)意見,根據(jù)其個人目前的飲食模式、偏好及血糖控制目標制訂具體營養(yǎng)素的分配比例,接受醫(yī)學營養(yǎng)治療。本研究采用CGM對GDM患者進行持續(xù)120小時以上的血糖監(jiān)測,分析和探討不同空腹血糖水平的GDM患者血糖波動特點,與妊娠結局的關系以及飲食治療對血糖波動的影響,為妊娠期間血糖管理提供部分臨床資料。一、研究目的：通過對OGTT試驗當天不同空腹血糖水平GDM患者的調查和使用動態(tài)血糖監(jiān)測系統(tǒng)(CGMS)進行血糖水平的監(jiān)測,探討不同空腹血糖水平的妊娠期糖尿病患者血糖波動特點,與妊娠結局的相關性,以及飲食治療對血糖波動的影響,以便臨床醫(yī)生對GDM圍生期血糖進行更好的管理,使其血糖水平在整個孕期維持在正常范圍,減少不良妊娠結局的發(fā)生。二、研究對象及方法：1.研究對象：回顧性收集并分析2010年10月至2015年7月于我院住院并使用動態(tài)血糖監(jiān)測系統(tǒng)的妊娠期高血糖患者共316名。需排除孕前診斷為1型或2型糖尿病及其他特殊類型糖尿病或糖耐量異常、合并高血壓疾病或其他內(nèi)分泌代謝性疾病者、其他肝腎功受損等急慢性疾病或長期服用特殊藥物、影響糖類代謝等藥物史者、有煙酒等不良嗜好者、雙胎妊娠者以及使用CGMS少于5天時間的患者。按照美國ADA指南中妊娠期糖尿病診斷標準,最后共納入173名GDM患者,患者平均年齡(31.6+4.8)歲,孕周(27.69+4.28)周。2.研究方法：依據(jù)OGTT試驗當天空腹血漿血糖水平(FPG)不同,分為A組(FPG5.1mmol/L),共72名；B組(5.1FPG6.1mmol/L),共67名；C組(FPG6.1mmol/L),共34名。三組患者均進行一般臨床資料的登記和基本實驗室檢查,同時采用CGMS進行動態(tài)血糖的監(jiān)測,分析各項臨床指標的意義及動態(tài)血糖數(shù)據(jù)。三、結果1、一般臨床資料：共納入GDM患者173名,其中A組(FPG5.1inmol/L)72名,B組(5.1≤FPG6.1mmol/L)67名,C組(FPG≥6.1mmol/L)34名。A、B、C三組間年齡、孕周、TG均無統(tǒng)計學差異(P0.05)；隨著OGTT試驗當天FPG水平的升高,OGTT試驗1h血糖、2小時血糖逐漸升高；B、C兩組的糖化血紅蛋白(HbA1C)、孕婦BMI、收縮壓(SBP)、舒張壓(DBP)水平及胰島素抵抗水平(HOMA-IR)均較A組升高明顯,差異有統(tǒng)計學意義(P0.05),而C組低密度脂蛋白水平(LDL-C)、總膽固醇水平(TC)、高密度脂蛋白水平(HDL-C)及基礎胰島素分泌水平(HOMA-β)較A組降低,差異有統(tǒng)計學意義(P0.05)。FPG與孕婦BM、SBP、DBP、TG、HbA1C及FINS呈正相關,與]HDDL-C呈負相關,差異均有統(tǒng)計學意義(P0.05)。2、CGMS參數(shù)：2.1三餐血糖特征：B、C兩組早餐前血糖、早餐后1小時血糖及早餐后2小時血糖均較A組升高,差異有統(tǒng)計學意義(P0.05)；同時C組午餐、晚餐前血糖以及餐后1小時、餐后2小時血糖亦較A、B兩組升高,差異有統(tǒng)計學意義(P0.05)；C組早餐后及午餐后血糖高峰均較A、B兩組升高,差異有統(tǒng)計學意義(P0.05)；而C組晚餐后血糖高峰亦較A組升高,差異有統(tǒng)計學意義(P0.05)。A、B、C三組早餐后的血糖上升較午餐及晚餐明顯,差異均有統(tǒng)計學意義(P0.05),而三組早、中、晚三餐餐后血糖達峰時間均沒有顯著性差異(P0.05),同時三組在低血糖發(fā)生率上亦沒有顯著性差異(P0.05)。2.2血糖波動參數(shù)：C組平均血糖波動幅度(MAGE)、平均血糖水平(MBG)、血糖的時間百分比(PT BG6.7mmol/L)、血糖曲線下面積(AUC BG6.7mmol/L)、白天平均血糖(6：30-23：30)及夜間平均血糖(23：30～6：30)均較A、B兩組升高,差異有統(tǒng)計學意義(P0.05)；而A、B、C三組間血糖水平標準差(SD)、空腹血糖波動系數(shù)(FPG-CV)及日間血糖平均絕對值(MODD)均無統(tǒng)計學意義(P0.05);FBG與MBG、MAGE、LAGE、PT、AUC、白天MBG及夜間MBG呈正相關,差異均有統(tǒng)計學意義(P0.05)。3、飲食治療3.1需胰島素治療率及飲食控制達標率：A組飲食治療達標率為90.3%,需胰島素治療率為9.7%；B組飲食治療達標率為83.1%,需胰島素治療率為26.9%；C組飲食治療達標率為58.8%,需胰島素治療率達70.6%。3.2需胰島素治療的預測因素及飲食控制達標的危險因素：Binary logistic回歸分析結果顯示,PT(BG6.7mmol/L)為分餐飲食治療達標的危險因素,而FPG為需胰島素治療的預測因素,差異均有統(tǒng)計學意義(P0.05)。3.3分餐飲食治療后CGMS參數(shù)：(1)A組經(jīng)飲食治療后,其早餐后2小時血糖、早餐后血糖高峰及血糖波動參數(shù)MAGE.SD均較前降低,夜間MBG較治療前升高,差異有統(tǒng)計學意義(P0.05)。(2)B組經(jīng)飲食治療后,其早餐后2小時血糖及血糖波動參數(shù)SD、PT. AUC、白天MBG均較治療前降低,差異均有統(tǒng)計學意義(P0.05)。(3)C組經(jīng)飲食治療后,其三餐餐時血糖水平及血糖波動參數(shù),差異均無統(tǒng)計學意義(P0.05)。4、妊娠結局(1)A、B、C三組在分娩時間、新生兒體重、新生兒血糖、新生兒膽紅素、剖宮產(chǎn)率、新生兒低血糖發(fā)生率及巨大兒發(fā)生率,差異均無統(tǒng)計學意義(P0.05)。(2)Pearson相關分析結果顯示,GDM患者空腹血糖與新生兒出生后血糖呈負相關,與剖宮產(chǎn)率呈正相關,差異均有統(tǒng)計學意義(P0.05)。(3)Binary logistic回歸分析顯示,OGTT試驗1小時血糖、MAGE及PT值均為巨大兒發(fā)生的危險因素,而空腹血糖為剖宮產(chǎn)的獨立危險因素,差異均有統(tǒng)計學意義(P0.05)。四、結論：1. CGMS可以提供完整的血糖譜信息,能發(fā)現(xiàn)自我血糖監(jiān)測不易探測到的高血糖與低血糖,尤其是餐后高血糖和夜間無癥狀性低血糖,有助于全面分析血糖波動變化的趨勢、幅度、頻率、時間及其原因等。2.與空腹血糖正常的GDM患者相比,空腹血糖異常者有更高的BMI、SBP、 DBP.HbAlc及FINS,隨著空腹血糖升高,其血糖波動指標如MBG、MAGE、 PT、AUC、白天MBG及夜間MBG均呈增加趨勢。3. OGTT試驗1h血糖、MAGE及PT水平均為巨大兒發(fā)生的危險因素,而空腹血糖為剖宮產(chǎn)的獨立危險因素。4.隨著空腹血糖升高,需胰島素治療率逐漸升高,而分餐飲食治療達標率逐漸降低,PT(BG6.7mmol/L)為分餐飲食治療達標的危險因素,而FPG為需胰島素治療的預測因素。5.對于FPG6.1mmol/L者,其血糖波動幅度大,高血糖持續(xù)時間長,胰島素抵抗明顯,且胰島B細胞功能受損嚴重,飲食治療對其效果差,建議盡早使用胰島素治療,盡量使其血糖水平在整個孕期內(nèi)維持在正常范圍,減少不良妊娠結局的發(fā)生。
[Abstract]:Background: Gestational hyperglycemia includes diabetes mellitus in pregnancy (DIP) and gestational diabetes mellitus (GDM), newly diagnosed hyperglycemia in pregnancy, which were reclassified by WHO in 2013. The IDF data show that the incidence of hyperglycemia during pregnancy in pregnant women is 6.9% worldwide, while the incidence in China is as high as 7.0%. Gestational diabetes mellitus (GDM) is the most common metabolic disorder during pregnancy, which refers to the occurrence of glucose during pregnancy or the first discovery of different levels of glucose. The incidence of gestational diabetes mellitus (GDM) is increasing year by year due to impaired tolerance. At present, the diagnostic methods and standards for gestational diabetes mellitus (GDM) have not been completely unified in the world, so the reported incidence varies greatly from 1% to 14%. Xie Xing et al. pointed out that in recent years, with the change of dietary structure and the re-setting of GDM diagnostic criteria, the diagnostic rate of GDM has assumed HAPO studies confirm that hyperglycemia during pregnancy, as the most common medical complication during pregnancy, can lead to a variety of adverse pregnancy outcomes, such as macrosomia, preeclampsia, pregnancy-induced hypertension, premature delivery, shoulder dystocia, birth trauma, cesarean section, neonatal hypoglycemia, neonatal hyperbilirubinemia. Blood glucose fluctuation is one of the characteristic manifestations of glucose metabolism disorder. Oxidative stress increases the production of oxygen free radicals in the body. Vascular endothelial dysfunction participates in the occurrence and development of diabetic vascular complications. With the increase of gestational age, the increase of hormones secreted by pituitary and placenta during the second and third trimesters of pregnancy leads to the aggravation of physiological insulin resistance, and the compensatory insulin secretion in pregnant women increases to 2-3 times of that in non-pregnant women to compensate for physiological insulin resistance. Chronic insulin resistance further reduces insulin sensitivity; when insulin secretion fails to meet insulin requirements during pregnancy due to islet P cell dysfunction, hyperglycemia occurs during pregnancy. The fluctuation of serum glucose in GDM patients was still higher than that in normal pregnant women, suggesting that there were still islet beta cell dysfunction and insulin resistance in postpartum GDM patients, which increased the risk of type 2 diabetes mellitus. With the development of blood glucose monitoring technology, continuous glucose monitoring (CGM), a kind of minimally invasive monitoring system similar to Holter, is becoming more and more mature. As the most advanced blood glucose monitoring technology at present, one electric signal is obtained from the probe every 10 seconds, every 5 seconds. The average signal can be stored in minutes, 288 blood glucose values can be recorded throughout the day, and blood glucose levels can be continuously monitored for 72 hours. Like other types of diabetes mellitus, dietary control is essential for the management of diabetes. Given the specificity of this stage of pregnancy, medication or insulin intervention is generally not used unless the condition is very serious. However, the overall blood glucose level and fluctuations in blood glucose in GDM patients increase and perimeter. Maternal and neonatal adverse outcomes are closely related. The American Diabetes Association (ADA) recommends that all patients with GDM should consult nutritionists as much as possible when they are diagnosed with diabetes and formulate specific nutrient allocations based on their current dietary patterns, preferences and glycemic control goals. In this study, CGM was used to monitor the blood glucose of GDM patients for more than 120 hours. The characteristics of blood glucose fluctuation in GDM patients with different fasting blood glucose levels, the relationship between blood glucose fluctuation and pregnancy outcome, and the effect of dietary therapy on blood glucose fluctuation were analyzed and discussed. Objective: To investigate the characteristics of blood glucose fluctuation and its correlation with pregnancy outcome in GDM patients with different fasting blood glucose levels on the day of OGTT test and to explore the effect of dietary therapy on blood glucose fluctuation by using dynamic glucose monitoring system (CGMS). So clinicians can better manage the perinatal blood glucose of GDM, keep the blood glucose level in the normal range during the whole pregnancy, and reduce the occurrence of adverse pregnancy outcomes. 2. Objects and methods: 1. Objectives: Retrospective collection and analysis of pregnancies hospitalized in our hospital from October 2010 to July 2015 using dynamic blood glucose monitoring system. A total of 316 patients with stage I hyperglycemia were excluded. Those diagnosed as type 1 or type 2 diabetes mellitus or other special types of diabetes mellitus or impaired glucose tolerance before pregnancy, complicated with hypertension or other endocrine and metabolic diseases, other acute or chronic diseases such as impaired liver and kidney function, or long-term use of special drugs, which affected the metabolism of carbohydrates and other drugs, such as cigarettes and alcoholic beverages, According to the diagnostic criteria of gestational diabetes mellitus in ADA guidelines, 173 GDM patients were enrolled with an average age of (31.6 + 4.8) years and gestational age of (27.69 + 4.28) weeks.2. Methods: According to the fasting plasma glucose level (FPG) on the day of OGTT test, they were divided into group A (FPG 5.1). Group B (5.1FPG 6.1mmol/L), 67; Group C (FPG 6.1mmol/L), 34. Three groups of patients were registered with general clinical data and basic laboratory tests, while CGMS was used to monitor the dynamic blood glucose and analyze the significance of various clinical indicators and dynamic blood glucose data. 3, Results 1, general clinical data: included in GDM There were 173 patients, 72 in group A (FPG 5.1 in mol/L), 67 in group B (5.1 < FPG 6.1 mmol/L), 34 in group C (FPG < 6.1 mmol/L). Age, gestational age, and TG were not significantly different among the three groups (P 0.05); with the increase of FPG level on the day of OGTT test, blood glucose at 1 hour and at 2 hours gradually increased in OGTT test; HbA1C in group B and C, BMI in pregnant women, BMI, and TG in group C. Systolic blood pressure (SBP), diastolic blood pressure (DBP) and insulin resistance (HOMA-IR) levels were significantly higher than those in group A (P 0.05), while low density lipoprotein (LDL-C), total cholesterol (TC), high density lipoprotein (HDL-C) and basal insulin secretion (HOMA-beta) levels in group C were significantly lower than those in group A (P 0.05). FPG was positively correlated with BM, SBP, DBP, TG, HbA1C and FINS of pregnant women, and negatively correlated with HDDL-C (P 0.05). Blood glucose and postprandial 1 hour, postprandial 2 hour blood glucose were also higher than A, B groups, the difference was statistically significant (P 0.05); group C after breakfast and after lunch blood glucose peak were higher than A, B groups, the difference was statistically significant (P 0.05); and group C after dinner blood glucose peak was also higher than A group, the difference was statistically significant (P 0.05). Glucose increased more significantly than lunch and dinner, the difference was statistically significant (P 0.05), and three groups of early, middle, and late meals after the peak time of blood glucose were not significantly different (P 0.05), while there was no significant difference in the incidence of hypoglycemia in three groups (P 0.05). 2.2 Glucose fluctuation parameters: C group average blood glucose fluctuation amplitude (MAGE), average blood glucose level (MB). G, time percentage of blood glucose (PT B G 6.7 mmol/L), area under blood glucose curve (AUC B G 6.7 mmol/L), daytime mean blood glucose (6:30-23:30) and nighttime mean blood glucose (23:30-6:30) were significantly higher in group A and group B than in group B (P 0.05), while the standard deviation of blood glucose (SD), fluctuation coefficient of fasting blood glucose (FPG-CV) and daytime blood glucose were significantly higher in group A, B and C (P 0.05). Mean absolute value of glucose (MODD) was not statistically significant (P 0.05); FBG was positively correlated with MBG, MAGE, LAGE, PT, AUC, daytime MBG and nighttime MBG, and the difference was statistically significant (P 0.05). 3.1 Dietary therapy required insulin treatment rate and dietary control compliance rate: A dietary treatment standard rate was 90.3%, the need for insulin treatment rate was 9.7%; B dietary treatment reached 9.7%. The standard rate was 83.1%, the insulin requirement rate was 26.9%; the standard rate of dietary therapy in group C was 58.8%, and the rate of insulin requirement was 70.6%. 3.2 Predictive factors of insulin requirement and risk factors of dietary control: Binary logistic regression analysis showed that PT (BG6.7 mmol/L) was the risk factor of dietary therapy and FPG was the risk factor of pancreas requirement. The predictive factors of insulin therapy were statistically significant (P 0.05). 3.3 points of CGMS parameters after dietary therapy: (1) After dietary therapy, the blood glucose 2 hours after breakfast, the blood glucose peak after breakfast and the blood glucose fluctuation parameter MAGE. SD were lower than before, and the MBG at night was higher than before, the difference was statistically significant (P 0.05). After breakfast, the blood glucose and blood glucose fluctuation parameters SD, PT. AUC, MBG during the day were significantly lower than those before treatment (P 0.05). (3) After dietary treatment, the blood glucose level and blood glucose fluctuation parameters at meals in group C had no significant difference (P 0.05). 4. Pregnancy outcomes (1) Delivery time, neonatal weight, and gestational outcomes (A, B, C). Neonatal blood glucose, neonatal bilirubin, cesarean section rate, incidence of neonatal hypoglycemia and macrosomia were not statistically significant (P 0.05). (2) Pearson correlation analysis showed that fasting blood glucose in GDM patients was negatively correlated with postnatal blood glucose, and positively correlated with cesarean section rate, the differences were statistically significant (P 0.05). (3) Binar. Y-logistic regression analysis showed that one-hour blood glucose, MAGE and PT values in OGTT test were risk factors for macrosomia, while fasting blood glucose was an independent risk factor for cesarean section. The difference was statistically significant (P Compared with hypoglycemia, especially postprandial hyperglycemia and nocturnal asymptomatic hypoglycemia, it is helpful to comprehensively analyze the trend, amplitude, frequency, time and causes of blood glucose fluctuation. 2. Compared with GDM patients with normal fasting blood glucose, fasting blood glucose abnormalities have higher BMI, SBP, DBP. HbAlc and FINS, and their blood glucose fluctuation index increases with the increase of fasting blood glucose. MBG, MAGE, PT, AUC, daytime MBG and nighttime MBG all showed an increasing trend. 3. OGTT test 1 hour blood glucose, MAGE and PT levels were risk factors for macrosomia, while fasting blood glucose was an independent risk factor for cesarean section. 4. With the increase of fasting blood glucose, the need for insulin treatment rate gradually increased, while the sub-catering treatment standard rate gradually decreased, PT (BG6.7m). Mol/L) is a risk factor for the attainment of the standard of dietary therapy, and FPG is a predictor of insulin therapy. 5. For FPG 6.1 mmol/L, the blood glucose fluctuation amplitude is large, the duration of hyperglycemia is long, insulin resistance is obvious, and the function of islet B cells is seriously damaged. Dietary therapy is not effective. It is recommended that insulin therapy be used as early as possible to make it as possible. Blood glucose levels remain normal throughout pregnancy and reduce adverse pregnancy outcomes.
【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】：2016
【分類號】：R714.256

【相似文獻】

相關期刊論文 前10條

1 史麗;蘇勝偶;趙占勝;王麗慧;;血糖波動與糖尿病并發(fā)癥的研究進展[J];中國老年學雜志;2010年17期

2 李丁;賈偉平;;血糖波動與血管并發(fā)癥[J];上海醫(yī)學;2011年05期

3 鄭煒;龍艷;蘇珂;;血糖波動與糖尿病微血管病變的研究進展[J];山東醫(yī)藥;2011年28期

4 鄭煒;龍艷;蘇珂;黃海;;血糖波動與糖尿病微血管病變的關系[J];廣東醫(yī)學;2011年23期

5 方福生;成曉玲;李志冰;李劍;田慧;李春霖;;老年2型糖尿病患者血糖波動性別差異的病例對照研究[J];中國藥物應用與監(jiān)測;2013年04期

6 徐芬娟;沈飛霞;;血糖波動的研究進展[J];中國糖尿病雜志;2014年09期

7 秦筠;王戰(zhàn)建;;血糖波動大 糖友度夏要注意[J];糖尿病新世界;2010年07期

8 高興;;血糖波動大 一天測幾次[J];家庭醫(yī)藥（快樂養(yǎng)生）;2011年01期

9 賈偉平;;血糖波動與靶器官損害[J];中華醫(yī)學雜志;2006年36期

10 王建華;;血糖波動的危害及控制策略[J];實用糖尿病雜志;2007年03期

相關會議論文 前10條

1 李娟;;血糖波動的危害及控制措施[A];中華醫(yī)學會第九次全國老年醫(yī)學學術會議暨第三屆全國老年動脈硬化與周圍血管疾病專題研討會論文匯編[C];2009年

2 詹俊鯤;劉幼碩;黃武;王艷姣;王翼;;血糖波動及其控制預測老年內(nèi)科危重癥短期死亡價值的研究[A];中華醫(yī)學會第九次全國老年醫(yī)學學術會議暨第三屆全國老年動脈硬化與周圍血管疾病專題研討會論文匯編[C];2009年

3 賈偉平;;血糖波動與靶器官損害[A];2008內(nèi)分泌代謝性疾病系列研討會暨中青年英文論壇論文匯編[C];2008年

4 童南偉;;血糖波動與血管病變的因果關系——缺乏強證據(jù)[A];2008內(nèi)分泌代謝性疾病系列研討會暨中青年英文論壇論文匯編[C];2008年

5 汪nr;吳漢妮;;不同血糖波動監(jiān)測指標在糖尿病血糖監(jiān)測中的實際應用[A];中華醫(yī)學會第十次全國內(nèi)分泌學學術會議論文匯編[C];2011年

6 唐健;;血糖波動與危重患者死亡率相關性的研究[A];中華醫(yī)學會第五次全國重癥醫(yī)學大會論文匯編[C];2011年

7 游為;鄒秀蘭;楊建明;;血糖波動對人外周血單核細胞的損傷及機制[A];中華醫(yī)學會第十二次全國內(nèi)分泌學學術會議論文匯編[C];2013年

8 王曉敏;孟作龍;周穎;楊惠珍;趙艷;韓月香;張立瑩;何柏林;;動態(tài)血糖波動與血清C反應蛋白、白介素-6、白介素-8、腫瘤壞死因子-α的相關性研究[A];中華醫(yī)學會第十二次全國內(nèi)分泌學學術會議論文匯編[C];2013年

9 魏翠英;何忠明;任麗玨;紀立農(nóng);韓芳;;阻塞性睡眠呼吸暫停綜合征對2型糖尿病患者動態(tài)血糖及血糖波動度的影響[A];中華醫(yī)學會第十一次全國內(nèi)分泌學學術會議論文匯編[C];2012年

10 章曉燕;鐘遠;苗雅;朱潔華;燕虹;金俊;王蓓云;胡廷軍;;血糖波動對老年2型糖尿病患者認知功能的影響[A];第三屆江浙滬三地老年醫(yī)學高峰論壇暨2012年浙江省老年醫(yī)學學術年會論文集[C];2012年

相關重要報紙文章 前10條

1 王霞;心理壓抑也會使血糖波動[N];醫(yī)藥養(yǎng)生保健報;2007年

2 健康時報記者　 鄭帆影;經(jīng)期血糖波動不用慌[N];健康時報;2006年

3 本報記者　 應洪舒;精確“把脈”血糖波動[N];中國醫(yī)藥報;2006年

4 二炮總醫(yī)院內(nèi)分泌科主任 李全民;病情加重有征兆[N];健康時報;2010年

5 健康時報記者 白軼南;血糖波動別服雌激素[N];健康時報;2007年

6 王建華;血糖波動比高血糖更可怕[N];農(nóng)村醫(yī)藥報（漢）;2007年

7 許曉華;血糖波動做做“饅頭餐”[N];健康時報;2007年

8 韓詠霞;血糖波動：激素藥物在搗亂[N];健康時報;2006年

9 王建華;糖尿�。喝绾螒獙ρ遣▌覽N];健康報;2005年

10 王建華;更年期血糖波動是“難關”[N];健康時報;2007年

相關博士學位論文 前6條

1 方福生;老年2型糖尿病血糖波動的臨床特征及控制目標的初步探討[D];中國人民解放軍軍醫(yī)進修學院;2011年

2 顧朋穎;骨鈣素在男性2型糖尿病中的水平變化及其與大血管病變關系的臨床研究[D];安徽醫(yī)科大學;2015年

3 宋建;血糖波動所致氧化應激對ARPE-19細胞自噬功能的影響及其機制研究[D];天津醫(yī)科大學;2016年

4 廖潔;血糖波動對糖尿病內(nèi)皮依賴性血管舒張功能的影響及機制研究[D];中南大學;2010年

5 康怡;不同糖調節(jié)受損人群血糖波動與氧化應激和胰島功能的相關性研究[D];中國人民解放軍軍醫(yī)進修學院;2009年

6 劉麗萍;血糖波動調控對大鼠全腦缺血后海馬神經(jīng)元損傷的影響[D];中國人民解放軍軍醫(yī)進修學院;2008年

相關碩士學位論文 前10條

1 丁林;2型糖尿病合并冠心病患者血糖波動與vWF、HMGB1及冠脈病變的相關性研究[D];安徽醫(yī)科大學;2015年

2 彭永;2型糖尿病下肢血管病變與血糖波動的相關性及硫辛酸的干預研究[D];安徽醫(yī)科大學;2015年

3 王亞雙;血糖波動對2型糖尿病患者下肢血管內(nèi)皮功能的影響及胰島素泵強化干預的研究[D];山西醫(yī)科大學;2015年

4 陳少敏;血糖波動對2型糖尿病患者頸動脈粥樣硬化程度的影響及胰島素泵短期強化干預的研究[D];山西醫(yī)科大學;2015年

5 馬艷霞;血糖波動對2型糖尿病合并急性腦梗死患者溶栓效果及預后的影響[D];山西醫(yī)科大學;2015年

6 馬香香;血糖波動對糖尿病大鼠周圍神經(jīng)病變的影響[D];鄭州大學;2016年

7 李素芬;不同空腹血糖水平的妊娠期糖尿病患者血糖波動特點及飲食治療對其影響[D];南方醫(yī)科大學;2016年

8 周淑晶;血糖波動對2型糖尿病冠脈病變嚴重程度的影響[D];山西醫(yī)科大學;2012年

9 鄭煒;血糖波動與糖尿病微血管病變相關性的研究[D];桂林醫(yī)學院;2012年

10 馬丁;血糖波動系數(shù)與頸動脈斑塊相關性研究[D];新疆醫(yī)科大學;2013年

，

本文編號：2220007