本文選題：糖尿病 + 有氧運動　； 參考：《河北醫(yī)科大學》2017年碩士論文

【摘要】：目的:探討有氧運動聯(lián)合抗阻訓練對青少年2型糖尿病患者血糖、血脂、血壓、體質(zhì)量指數(shù)、腰臀比等方面的影響。糖尿病由多種病因引起,遺傳、社會、環(huán)境及生活方式等因素共同影響著疾病的發(fā)生及發(fā)展。研究報道,青少年隨著體力活動減少,超重、肥胖現(xiàn)象日益增多,在世界范圍內(nèi),青少年2型糖尿病發(fā)病率以12.0/10萬和24.3/10萬的速度平穩(wěn)增長,對健康產(chǎn)生嚴重影響,逐漸成為全球公共衛(wèi)生問題,迫切要求建立完善的糖尿病檢測系統(tǒng),尋找有效的早期預防及干預手段,減少疾病對患者造成的痛苦和經(jīng)濟負擔,延緩或防止并發(fā)癥的發(fā)生與發(fā)展,提高健康水平。最新研究發(fā)現(xiàn):運動可增強骨骼肌中的過氧化物酶體增殖物激活受體γ輔助激活因子的活性,從而促進骨骼肌纖連蛋白組件FNDC5mRNA的表達,加速肌肉因子分泌,誘導白色脂肪棕色化,最終改善胰島素抵抗、調(diào)節(jié)糖脂代謝、增加能量消耗。有氧運動以增強吸入、運送和利用氧氣為目的,機體耗氧量與吸氧量大致相等,具有持續(xù)時間長、有韻律性、運動強度低等特點。抗阻運動是指在運動過程中針對某一肌肉群施加一定阻力的無氧運動,又稱力量運動或阻力運動,主要包括克服彈性物體運動、利用力量訓練器械、負重抗阻運動、對抗性運動等�？棺柽\動可有效防止肌肉力量和體積的減小,從而增加胰島素受體數(shù)量及敏感性,提高血糖控制能力。本研究旨在探討有氧運動聯(lián)合抗組訓練干預方式是否能夠改善青少年2型糖尿病患者的血糖和血脂,防止糖尿病并發(fā)癥的進展,改善患者的預后及轉(zhuǎn)歸。方法:1研究對象選取2015年08月~2016年08月在河北醫(yī)科大學第二醫(yī)院內(nèi)分泌科住院的青少年2型糖尿病患者為研究對象,共45例,年齡13~20歲,其中男性24例,女性21例。2研究方法采用便利抽樣的方法,按照住院患者的病案號將45例研究對象分為對照組23例,干預組22例。兩組患者均接受糖尿病綜合教育管理方案,指導其正確的飲食、用藥、血糖監(jiān)測和復診時間,并發(fā)放《青少年2型糖尿病患者健康指導手冊》,出院后兩組患者分別建立微信群,并接受5次電話隨訪。研究團隊成員每周在微信群中上傳糖尿病相關(guān)知識及一些生活小貼士,隨時針對患者的具體問題給予個體化指導。按電話隨訪內(nèi)容表(見附錄)進行定期電話隨訪,鼓勵患者科學飲食、合理運動,督促患者按時服藥、定期監(jiān)測血糖等。如電話隨訪中患者提出疾病治療問題,則需與專科醫(yī)師協(xié)商后再對患者進行指導。在此基礎(chǔ)上應用運動干預方式,對照組采用有氧運動方案,干預組采用有氧運動聯(lián)合抗阻訓練方案,干預12周后,觀察兩組患者血糖、血脂水平以及血壓、體質(zhì)量指數(shù)、腰臀比有無統(tǒng)計學差異。3統(tǒng)計學處理錄入數(shù)據(jù)采用epidata3.1軟件,spss21.0軟件進行統(tǒng)計分析,計量資料做正態(tài)性檢驗,滿足正態(tài)分布的結(jié)果用均數(shù)±標準差(x±s)表示,采用兩樣本均數(shù)比較的t檢驗;不滿足正態(tài)分布的結(jié)果用中位數(shù)±四分位間距(m±qr)表示,采用秩和檢驗中兩獨立樣本非參數(shù)檢驗的mann-whitneyz檢驗方法;對等級資料采用秩和檢驗;計數(shù)資料采用四格表或r×c表的卡方檢驗;檢驗方法采用雙側(cè)檢驗,檢驗水準a=0.05。結(jié)果:1兩組研究對象性別、年齡、文化程度、病程等一般資料比較(t=-0.411,x2=0.033,z=0.794,z=-0.372),差異無統(tǒng)計學意義(p0.05)。兩組患者一般資料均衡、可比。2干預前,兩組患者在空腹血糖(fpg)、餐后2小時血糖(2hpg)、糖化血紅蛋白(hba1c)、總膽固醇(tc)、甘油三脂(tg)、低密度脂蛋白膽固醇(ldl-c)及高密度脂蛋白膽固醇(hdl-c)比較,差異無統(tǒng)計學意義(p0.05)。干預后,fpg、2hpg和hba1c的改善,干預組優(yōu)于對照組(t=-3.147,t=-3.460,t=-2.718),差異有統(tǒng)計學意義(p0.01);血脂中的tc、tg降低和hdl-c升高,干預組優(yōu)于對照組(z=-3.157,z=-3.339,Z=-3.524),差異有統(tǒng)計學意義(P0.01),血脂中的LDL-C降低(Z=-1.775),兩組比較差異無統(tǒng)計學意義(P0.05)。3干預前后兩組患者在體質(zhì)量指數(shù)(BMI)、腰臀比(WHR)、收縮壓和舒張壓方面比較(干預前:Z=-0.104,Z=-0.717,Z=-0.914,Z=-0.574;干預后Z=-0.026,Z=-0.733,Z=-1.301,Z=-0.832),差異均無統(tǒng)計學意義(P0.05)。結(jié)論:1有氧運動聯(lián)合抗阻訓練能更好地控制青少年2型糖尿病患者血糖和糖化血紅蛋白水平。2有氧運動聯(lián)合抗阻訓練能更好地控制青少年2型糖尿病患者總膽固醇、甘油三酯和高密度脂蛋白水平,但是低密度脂蛋白無顯著影響。3對青少年2型糖尿病患者進行有氧運動聯(lián)合抗阻訓練干預是有效的。
[Abstract]:Objective: To investigate the effects of aerobic exercise combined with resistance training on blood glucose, blood lipid, blood pressure, body mass index, waist hip ratio and other factors in adolescents with type 2 diabetes. Diabetes is affected by many factors, heredity, society, environment and lifestyle. Less, overweight, and obesity are increasing. In the world, the incidence of type 2 diabetes is steadily increasing with the speed of 12.0/10 Vanward 24.3/10 million. It has a serious impact on health, and has gradually become a global public health problem. It is urgent to establish a perfect diabetes detection system to find effective early prevention and intervention measures to reduce the incidence of diabetes. The latest research has found that exercise can enhance the activity of peroxisome proliferator activated receptor gamma assistant activator in skeletal muscle and promote the expression of FNDC5mRNA in skeletal muscle fibronectin component and accelerate muscle cause. Subsecreting, inducing white fat browning, eventually improving insulin resistance, regulating glycolipid metabolism, and increasing energy consumption. Aerobic exercise is aimed at enhancing inhalation, transporting and utilizing oxygen. The body's oxygen consumption is roughly equal to oxygen absorption, long lasting, rhythmic, and low exercise intensity. Resistance movement refers to the movement process. The anaerobic exercise, which applies certain resistance to a certain muscle group, is also called force movement or resistance movement, mainly including overcoming the movement of elastic objects, using strength training instruments, bearing resistance and resistance movement, antagonistic movement, etc.. Resistance movement can effectively prevent muscle strength and volume reduction, thus increasing the number and sensitivity of insulin receptor, and increasing the sensitivity of insulin receptor. The purpose of this study is to explore whether aerobic exercise combined with anti group training intervention can improve blood glucose and blood lipids in type 2 diabetics, prevent the progression of diabetic complications, and improve the prognosis and prognosis of patients. 1 subjects were selected in the second hospital of Hebei Medical University, 08 months, 2015, and 08 months of ~2016. A total of 45 patients with type 2 diabetes in the secretory department were studied, with a total of 45 cases of age 13~20 years, of which 24 were male and 21 in women, with a convenient sampling method. 45 subjects were divided into 23 cases in the control group and 22 in the intervention group according to the case number of the hospitalized patients. The comprehensive education management scheme for diabetes was accepted in all the two groups. Guide the correct diet, medication, blood glucose monitoring and visit time, and release the health guidance manual for patients with type 2 diabetes. After discharge, the two groups of patients set up WeChat group and received 5 telephone follow-up. The team members uploaded the knowledge of diabetes and some life tips in the WeChat group every week, at any time to the patients. Specific questions are given individualized guidance. Follow up the telephone follow up table (see Appendix) for regular telephone follow-up, encourage patients to eat scientifically, exercise rationally, urge the patients to take medicine on time, and regularly monitor blood sugar. Using exercise intervention, the control group adopted aerobic exercise program, the intervention group adopted aerobic exercise combined with resistance training program. After 12 weeks, the blood glucose, blood lipid level, blood pressure, body mass index and waist hip ratio were observed in the two groups..3 statistics were used to deal with data using epidata3.1 software and spss21.0 software. In the analysis, the measurement data are tested in normality, and the results of normal distribution are expressed with mean number + standard deviation (x + s), and the t test is used to compare the average number of two samples; the result of the normal distribution is expressed by the median of four division spacing (M + QR), and the non parametric test of two independent samples in the rank sum test is used. The rank sum test was used. The counting data were checked with four grid or R x C table. The test method adopted bilateral test and test level a=0.05. results: 1 two groups of subjects' sex, age, education level, course of disease, and other general data (t=-0.411, x2=0.033, z= 0.794, z=-0.372), the difference was not statistically significant (P0.05). Two groups of patients were general. Data balance, before.2 intervention, two groups of patients in the fasting blood glucose (FPG), 2 hours postprandial blood glucose (2hPG), glycated hemoglobin (HbA1c), total cholesterol (TC), glycerin three fat (TG), low density lipoprotein cholesterol (LDL-C) and high-density lipoprotein cholesterol (HDL-C), the difference was not statistically significant (P0.05). The prognosis, FPG, 2hPG and HbA1c improved, dry. The pre group was better than the control group (t=-3.147, t=-3.460, t=-2.718), the difference was statistically significant (P0.01), the TC, TG and HDL-C in the blood lipid were lower and HDL-C increased. The intervention group was better than the control group (z=-3.157, z=-3.339, Z=-3.524), the difference was statistically significant (P0.01), the two groups had no statistical significance (two) before and after intervention. Group patients were compared with body mass index (BMI), waist to hip ratio (WHR), systolic pressure and diastolic pressure (before intervention: Z=-0.104, Z=-0.717, Z=-0.914, Z=-0.574; Z=-0.026, Z=-0.733, Z=-1.301, Z=-0.832) after intervention (P0.05). Conclusion: 1 aerobic exercise combined with resistance training can better control the blood sugar of type 2 diabetes patients. Combined with glycosylated hemoglobin level.2 aerobic exercise combined with resistance training can better control total cholesterol, triglycerides, and high density lipoprotein levels in adolescents with type 2 diabetes, but low density lipoprotein has no significant effect on.3 for aerobic exercise in adolescents with type 2 diabetes.
【學位授予單位】：河北醫(yī)科大學
【學位級別】：碩士
【學位授予年份】：2017
【分類號】：R587.1

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