本文選題：糖尿病前期 + 隨訪�。� 參考：《上海體育學(xué)院》2017年碩士論文

【摘要】：研究目的:糖調(diào)節(jié)受損是普通人向糖尿病轉(zhuǎn)變的過渡階段和必經(jīng)階段,具有可逆性,在該階段采取生活方式干預(yù),能很大程度上減緩甚至逆轉(zhuǎn)糖尿病前期向2型糖尿病轉(zhuǎn)換的過程。但生活方式干預(yù)停止后,干預(yù)產(chǎn)生的對血糖、血脂的控制作用和生活方式如何變化,目前較不明確。本研究在對受試者前期進(jìn)行生活方式干預(yù)后,停止對受試者的生活方式干預(yù),一年后隨訪,觀察其血糖、血脂、身體形態(tài)、生活方式等方面的變化,以期為2型糖尿病前期患者的健康促進(jìn)方案和預(yù)防措施提供科學(xué)的理論依據(jù),保證整體實(shí)驗(yàn)的完整性。研究方法:本研究前期招募糖尿病前期的22名50-65歲絕經(jīng)后中老年婦女進(jìn)行為期6個(gè)月生活方式干預(yù),隨機(jī)分為對照組、運(yùn)動干預(yù)組和飲食干預(yù)組。運(yùn)動干預(yù)的方式為北歐式行走(Nordic Walking),運(yùn)動頻率為每周2~3次,每次50~60分鐘,運(yùn)動強(qiáng)度為65%~85%的最大心率。飲食干預(yù)主要采取以低碳水化合物為主的午餐飲食干預(yù)。6個(gè)月的生活方式干預(yù)后,對受試者進(jìn)行為期一年的隨訪,隨訪期間不對受試者的生活方式采取任何干預(yù)措施,為保證實(shí)驗(yàn)完整性,減少受試者的流失,采取不定期與受試者通話、上門溝通、定期組織活動、微信建群等方式維護(hù)與受試者的良好關(guān)系。隨訪測試中集合受試者,于晚上8點(diǎn)后禁食,第二天早上7點(diǎn)進(jìn)行OGTT測試,獲取血液指標(biāo),血液檢驗(yàn)由上海市市東醫(yī)院完成。身體成分和骨密度數(shù)據(jù)受試者在上海體育學(xué)院運(yùn)動健身科學(xué)館Dax身體成分骨密度儀進(jìn)行測定。分別將對照組、運(yùn)動組和飲食組0M、6M和18M的測試數(shù)據(jù)進(jìn)行對比,同一組不同時(shí)間段的數(shù)據(jù)分析采用配對T檢驗(yàn)的分析方法,同一時(shí)間點(diǎn)不同組別的數(shù)據(jù)采取方差檢驗(yàn),p0.05表示在統(tǒng)計(jì)學(xué)上具有顯著性差異。研究結(jié)果:(1)一年后隨訪中對照組和飲食組膽固醇較6M干預(yù)后下降,運(yùn)動組略有上升;三組的甘油三酯較干預(yù)后都有下降,三組相比運(yùn)動組和飲食組均低于對照組且均p0.05;高密度脂蛋白對照組隨訪較0M明顯下降,p0.05,干預(yù)組均高于對照組;低密度脂蛋白隨訪干預(yù)組均低于對照組。(2)一年后隨訪時(shí)干預(yù)組的FBG水平均低于對照組,運(yùn)動組在3組中最低;餐后2h血糖較0M和6M都有所增加,但對照組最高;糖化血紅蛋白飲食組0M與18M相比明顯下降,p0.05,三組隨訪時(shí)相比對照組最高,飲食組最低。(3)一年后隨訪上肢脂肪占比都呈下降趨勢,運(yùn)動組和飲食組0M和18M相比明顯下降且均,P0.05;下肢脂肪比三組隨訪時(shí)出現(xiàn)下降,飲食組0M和18M相比明顯下降,p0.05;軀干脂肪占比3組同樣呈下降趨勢,運(yùn)動組和飲食組0M和18M相比均出現(xiàn)明顯下降且均p0.05;腰區(qū)(腰區(qū))脂肪比3組在干預(yù)后和隨訪時(shí)的差異不大;臀區(qū)(臀區(qū))脂肪比運(yùn)動組和飲食組0M和18M相比均出現(xiàn)明顯下降且均p0.05;全身脂肪占比3組均呈下降趨勢,運(yùn)動組0M和6M、0M和18M相比均明顯下降且p0.05,飲食組0M和18M出現(xiàn)下降且p0.05。(4)一年后隨訪對照組的上肢、下肢、軀干、腰區(qū)、臀區(qū)及全身肌肉質(zhì)量與0M和6M相比均出現(xiàn)明顯下降。運(yùn)動組和飲食組上肢和下肢的肌肉質(zhì)量較0M和6M出現(xiàn)下降,降幅明顯小于對照組。干預(yù)組18M軀干、腰區(qū)、臀區(qū)及全身肌肉質(zhì)量均出現(xiàn)增加。(5)一年后隨訪骨密度3組均出現(xiàn)下降,對照組最低;運(yùn)動組6M與18M相比出現(xiàn)下降且p0.05;飲食組0M與18M相比,P0.05,6M與18M相比,P0.05。(6)一年后隨訪運(yùn)動組18M與6M相比運(yùn)動頻率和運(yùn)動時(shí)間略有下降但高于對照組。運(yùn)動組有一部分受試者仍會采取北歐式行走的運(yùn)動方式。飲食組18M與6M相比蛋白質(zhì)的攝入減少,脂肪和碳水化合物攝入有所增加。飲食組在飲食過程中仍注重粗糧和膳食纖維的攝入。研究結(jié)論:(1)運(yùn)動或飲食干預(yù)后,干預(yù)對血糖、血脂的控制作用仍存在但出現(xiàn)下降趨勢,要繼續(xù)保持健康的生活方式;(2)運(yùn)動或飲食干預(yù)停止后,干預(yù)對減少肌肉流失的有利影響仍在存在,脂肪含量有所增加,要持續(xù)保持干預(yù)時(shí)的運(yùn)動或飲食方式才能有持續(xù)的有利影響;(3)運(yùn)動和飲食干預(yù)對骨密度維持具有持續(xù)性積極作用,但其作用隨時(shí)間的增加而減少;(4)運(yùn)動、飲食干預(yù)對受試者的日常生活方式產(chǎn)生影響,受試者有改善日常生活習(xí)慣,注意增加運(yùn)動和控制飲食。
[Abstract]:Objective: the impaired glucose regulation is the transition stage and the required stage of the ordinary people to diabetes. It is reversible. The intervention of life style at this stage can greatly reduce and even reverse the process of the transition from pre diabetes to type 2 diabetes. However, after the intervention of lifestyle intervention, the control of blood glucose and blood lipids is produced by intervention. It is not clear at present how to change the way of life and life. In this study, the lifestyle intervention of the subjects was stopped, the lifestyle intervention of the subjects was stopped. After one year, the changes of blood sugar, blood lipid, body shape and life style were observed, in order to promote the health promotion plan and prevention measures of patients with pre type 2 diabetes. Scientific theoretical basis was provided to ensure the integrity of the whole experiment. Methods: 22 50-65 year old postmenopausal women with Premenopause were recruited in this study for 6 months of life style intervention, which were randomly divided into control group, exercise intervention group and diet intervention group. The way of exercise intervention was Nordic Walking (North European walk). The exercise frequency is 2~3 times a week, 50~60 minutes each time, and the maximum heart rate of the exercise intensity is 65%~85%. The diet intervention mainly adopts a low carbohydrate based lunch diet intervention for.6 months of life style, and the subjects are followed up for one year, and no intervention measures are taken during the follow-up period. In order to ensure the integrity of the experiment, reduce the loss of the subjects, take the aperiodic conversation with the subjects, communicate with the subjects, organize the activities regularly, and maintain a good relationship with the subjects, such as WeChat construction group. During the follow-up test, the subjects were fasted after 8 p.m., and the OGTT test was carried out at 7 a.m. on the second day. The blood indexes were obtained and the blood test was on the upper part. The body composition and bone mineral density data were measured by the Dax body composition bone densitometer at the sports fitness Science Museum of Shanghai Institute of Physical Education. The test data of the control group, the exercise group and the diet group 0M, 6M and 18M were compared, and the data analysis of the same group of different time periods was analyzed by the paired T test. The data of different groups at the same time were tested by variance, and P0.05 showed significant difference in statistics. (1) the results of the study were as follows: (1) the cholesterol in the control group and the diet group decreased after one year and the exercise group increased slightly, and the triglyceride in the three groups decreased compared with the dry prognosis, and the three groups were lower than the exercise group and the diet group. The control group was all P0.05, the high density lipoprotein control group was significantly lower than the 0M, P0.05, the intervention group were all higher than the control group, and the low density lipoprotein follow-up group was lower than the control group. (2) the level of FBG in the intervention group was lower than the control group one year later, and the exercise group was the lowest in the 3 groups; the 2H blood glucose in the postprandial group was higher than that of the 0M and 6M, but the control group was more than the control group. The glycated hemoglobin diet group 0M was significantly lower than the 18M, P0.05, the three groups were the highest in the control group, and the diet group was the lowest. (3) a year later, the fat occupation of the upper limbs decreased, the exercise group and the diet group were significantly lower than the 0M and 18M and all, P0.05; the lower limb fat was decreased in the three groups, and the diet group 0M and 18M phase Compared to the 3 groups, the body fat accounted for a decrease in the 3 groups. The 0M and 18M in the exercise group and the diet group were both significantly decreased and P0.05, and the fat in the lumbar region (lumbar region) was not significant in the 3 groups. The fat of the hip region (hip region) was significantly lower than that of the exercise group and the diet group 0M and 18M and all P0.05; the whole body was all P0.05; 0M and 6M, 0M and 18M decreased significantly in the exercise group and P0.05, P0.05, 0M and 18M in the diet group and p0.05. (4) in the upper limbs of the control group. The lower limbs, the trunk, the waist area, the hip area and the whole body muscle mass were obviously decreased compared with 0M and 6M. The muscles of the upper limbs and the lower limbs of the exercise group and the diet group were significantly decreased. The volume of 0M and 6M decreased significantly less than the control group. The quality of 18M trunk, lumbar region, hip area and whole body muscle increased in the intervention group. (5) after one year, the follow-up bone density 3 groups decreased, the control group was the lowest; the exercise group 6M and 18M decreased and P0.05; P0.05,6M compared with 18M in the diet group, P0.05,6M and 18M, P0.05. (6) followed up a year later. The exercise group 18M has a slight decrease in movement frequency and time compared with that of the control group but higher than the control group. Some subjects in the exercise group still take the way of the Nordic walking. The dietary group 18M and 6M have less protein intake and more fat and carbohydrate intake. In the diet group, the diet group still pays attention to coarse grain and dietary fiber during the diet process. Conclusions: (1) the control effect of intervention on blood sugar and blood lipids still exists but has a declining tendency to continue to maintain a healthy lifestyle; (2) after the stop of exercise or diet intervention, the beneficial effects of intervention on reducing muscle loss are still existing, the fat content is increased, and the intervention should be maintained. Exercise or diet can have a sustained beneficial effect; (3) exercise and dietary intervention have a sustained and positive effect on bone density maintenance, but their effects decrease with time; (4) exercise, diet intervention has an effect on the routine lifestyle of the subjects, and the subjects can improve their daily habits, pay more attention to exercise and control. Diet.

【學(xué)位授予單位】：上海體育學(xué)院
【學(xué)位級別】：碩士
【學(xué)位授予年份】：2017
【分類號】：R587.1

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