【摘要】：第一部分年齡對(duì)妊娠期糖尿病發(fā)病風(fēng)險(xiǎn)影響的調(diào)查研究目的:調(diào)查分析孕婦年齡對(duì)妊娠期糖尿病(gestational diabetes mellitus,GDM)發(fā)病的影響。方法:對(duì)21371例2007年-2015年在解放軍第306醫(yī)院婦產(chǎn)科分娩,且在妊娠24~32周行一步法75 g葡萄糖耐量試驗(yàn)(OGTT)的初產(chǎn)單活胎孕婦的年齡及糖代謝情況進(jìn)行回顧性調(diào)查分析。根據(jù)OGTT結(jié)果將孕婦分為非妊娠期糖尿病組(NGDM組)和妊娠期糖尿病組(GDM組),評(píng)估懷孕年齡與OGTT血糖水平的關(guān)系及對(duì)GDM患病的影響。采用SPSS17.0進(jìn)行統(tǒng)計(jì)學(xué)分析。結(jié)果:GDM患者2577例,其發(fā)病率為12.1%。GDM在~20歲、~25歲、~30歲、~35歲、~40歲及~45歲的發(fā)病率分別為0、5.1%、7.5%、13.5%、30.4%及68.5%。GDM組孕婦年齡(33.28±5.36)歲顯著高于NGDM組孕婦的(29.67±3.58)歲(P0.05)。2007-2015年,GDM孕婦平均年齡由(32.57±5.52)歲增加至(34.57±4.95)歲。所有孕婦及NGDM組峰值年齡均在29歲,而GDM組峰值年齡在31歲。隨妊娠年齡的增加,NGDM組和GDM組孕婦OGTT的0 min、60 min和120 min血糖均呈上升趨勢(shì)。結(jié)論:近年來GDM患病率較高,孕婦年齡逐年增高是重要原因,同時(shí),GDM在30歲以下孕婦中有較高患病比例值得密切關(guān)注。第二部分妊娠期糖尿病患者孕中晚期血清胰高血糖素樣肽-1變化及其臨床意義目的:探討妊娠期糖尿病(GDM)患者孕中晚期血清胰高血糖素樣肽-1(GLP-1)水平變化。方法:選擇妊娠期糖尿病40例(年齡32.69±5.46歲,孕周24.18±1.83周)及正常糖耐量(NGT)孕婦42例(年齡30.45±2.72歲,孕周24.38±0.88周),測(cè)定孕24-28周行一步法75 g葡萄糖耐量試驗(yàn)(OGTT)過程中血清GLP-1水平,比較其變化,分析其與GDM患者病情的關(guān)系。采用SPSS 21.0進(jìn)行統(tǒng)計(jì)學(xué)分析。結(jié)果:與NGT比較,GDM患者OGTT過程中各時(shí)間點(diǎn)(0min、30min、60min、120min)GLP-1水平較無顯著變化,但GDM患者血清GLP-1水平峰值在120分鐘,較NGT組60分鐘峰值延后,30分鐘胰島素(INS)/GLP-1顯著降低(38.37±32.77 vs 69.55±69.43,P0.05)。空腹GLP-1、GLP-1曲線下面積(AUCGLP-1)均與胰島素曲線下面積(AUCINS)呈顯著正相關(guān)(r=0.24,r=0.27,p0.05)。結(jié)論:GDM孕婦OGTT過程中GLP-1早期分泌可能存在相對(duì)不足。
[Abstract]:Part one: the influence of age on the risk of gestational diabetes mellitus objective: to investigate and analyze the influence of gestational age on gestational diabetes mellitus (gestational diabetes mellitus,GDM). Methods: the age and glucose metabolism of 21371 pregnant women who gave birth in the department of gynecology and obstetrics in the 306 Hospital of PLA from 2007 to 2015 were analyzed retrospectively. One step 75 g glucose tolerance test (OGTT) was performed in 2432 weeks of pregnancy. According to the results of OGTT, pregnant women were divided into non-gestational diabetes mellitus (NGDM) group and gestational diabetes mellitus (GDM) group. SPSS17.0 was used for statistical analysis. Results: the incidence of 12.1%.GDM in 2577 patients with GDM was 2577 years old. The incidence rates of 12.1%.GDM in the range of ~ 20 years, ~ 25 years, ~ 30 years, ~ 35 years, ~ 40 years and ~ 45 years old were 0.5.1and 7.5cm, respectively. The age of pregnant women in 30.4% and 68.5%.GDM group (33.28 鹵5.36) was significantly higher than that in NGDM group (29.67 鹵3.58) years (P0.05). The average age of GDM pregnant women increased from (32.57 鹵5.52) years to (34.57 鹵4.95) years old. The peak age of all pregnant women and NGDM group was 29 years old, while the peak age of GDM group was 31 years old. With the increase of gestational age, the blood glucose of 0 min,60 min and 120 min of OGTT in NGDM group and GDM group showed an increasing trend. Conclusion: the prevalence of GDM is relatively high in recent years, and the age of pregnant women is increasing year by year. At the same time, the higher prevalence rate of GDM in pregnant women under 30 years old deserves close attention. Part two changes of serum glucagon like peptidyl (Glucagon-like peptide 1) in patients with gestational diabetes mellitus (GDM) and its clinical significance objective: to investigate the changes of serum glucagon like peptide-1 (GLP-1) levels in (GDM) patients with gestational diabetes mellitus (GDM) in the middle and late trimester of gestational diabetes mellitus (GDM). Methods: forty pregnant women with gestational diabetes mellitus (age 32.69 鹵5.46, gestational age 24.18 鹵1.83 weeks) and 42 pregnant women with normal glucose tolerance (NGT) (30.45 鹵2.72 years old, 24.38 鹵0.88 weeks of gestational age) were selected. Serum GLP-1 levels were measured during 75 g glucose tolerance test (OGTT) at 24-28 weeks of gestation. The changes of serum GLP-1 levels were compared, and the relationship between serum GLP-1 levels and the condition of GDM patients was analyzed. SPSS 21.0 was used for statistical analysis. Results: compared with NGT, there was no significant change in GLP-1 level at different time points (0 min, 30 min, 60 min or 120 min) during OGTT in GDM patients, but the peak of serum GLP-1 level in GDM patients was 120min, which was delayed than that in NGT group. Insulin (INS) / GLP-1 decreased significantly (38.37 鹵32.77 vs, 69.55 鹵69.43 vs, P0.05). There was a significant positive correlation between the area under fasting GLP-1,GLP-1 curve (AUCGLP-1) and (AUCINS) under insulin curve (r = 0.24). Conclusion: the early secretion of GLP-1 may be deficient in OGTT of GDM pregnant women.
【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】：2017
【分類號(hào)】：R714.256

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